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Objective: With an increase in the new generation of antipsychotic drugs and resulting antipsychotic polypharmacy, treatment of schizophrenic patients has again come into the daily agenda. In spite of the annual increase of these new drugs in recent years, no expected benefit in the treatment of patients has been observed. A lack of alternative treatments of schizophrenia and the increase in polypharmaceutical approaches to treatment have led clinicians feel helpless; especially as schizophrenia is known to be treatment resistant over time and is often subject to poor prognosis. According to the treatment algorhythm, the application of antipsychotic polypharmacy can be the choice of treatment for treatment-resistant patients but only by following a program of sufficient monotherapy. For a short period, antipsychotic polypharmacy can ease the transition from the use of one antipsychotic to that of another. However it is thought that this approach is often over used in clinical experiments and observations. In this study, it is aimed to determine the prevalence of polypharmacy, rates of treatment adherence and disease severity in schizophrenic patients admitted to the psychiatry policlinic at Ankara Numune Training and Research Hospital.
Method: The patients admitted to psychiatry policlinic of Ankara Numune Training and Research Hospital in June 2010 - September 2010 period with the diagnosis of schizophrenia were reviewed and 122 patients were included in the study. Participants were evaluated for their treatment compliance, use of polypharmacy, drug doses, and severity of the disorder.
Results: The rate of polypharmacy was 49,2%. The polypharmacy and monotherapy groups were not statistically different in terms of comorbidity, disorder and treatment duration, number of previous hospitalizations, type of admission and general medical condition. However, the monotherapy and polypharmacy groups were statistically different in terms of the use of antipsychotic type. Distribution of “first to prescribe” antipsychotics was 25.4% (n=31) for olanzapine, 18% (n=22) for risperidone, 18% (n=22) for clozapine, 10.7% (n=13) for quetiapine, 8.2% of typical antipsychotics, and 4.9% (n=6) for amisulpiride-sulpiride. Distribution of “add on” antipsychotic was 26.7% (n=16) for amisulpiride-sulpiride, 25% (n=15) for risperidone consta, 15% (n=9) for depot antipsychotics, 10% (n=6) for typical antipsychotics, 8%, 3 (n=5) for quetiapine, 5% (n=3) for risperidone, 3.3% (n=2) for olanzapine and 3.3% (n=2) for clozapine.
Conclusion: Use of polypharmacy is limited in good clinical practice guidelines but surveys on clinical practices show that the use of polypharmacy is more frequent than the suggested levels in the guidelines.