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Objective: Combined antipsychotic treatment is used frequently in clinical practice either to improve the symptom control or to reduce the side effects. There is no consistent data about the real prevalence rates of the antipsychotic polypharmacy, and reported data lay in a wide range (4-70%). The expected benefits from combination of different antipsychotics include active cross-titration and the co-utilization of different administration routes of the therapeutic agents. In addition to that, different symptom domains such as cognitive and negative symptoms can individually be controlled better by using combined therapy, by alleviating the unwanted effects of any drug by adjusting its daily dose at the same time. However, except the add-on therapies to clozapine, there is no objective evidence about the superiority of combined therapy over monotherapy. Furthermore, there are a number of published case reports of significant side effects accompanying combined antipsychotic usage such as extrapyramidal and metabolic symptoms, seizures, and electrocardiographic abnormalities. Therefore the choice of appropriate antipsychotic treatment depends strictly on the factors related both to the patients and the nature of illness. It is also argued that switching to a new therapeutic agent might be more beneficial than augmenting the ongoing medication by polypharmacy. We studied on a group of hospitalized schizophrenia patients in a training and education hospital whether combined therapy has any effects on the Positive and Negative Symptom Scale (PANSS) scores, which might differ from the patients on monotherapy.
Methods: Archival data of schizophrenia patients, who were hospitalized between the years of 2003-2013 were retrieved. Schizophrenia diagnoses were re-evaluated in accordance with the DSM-IV-TR. All patients who met the diagnostic criteria and having PANSS subscale scores (n: 158) were included in the study. PANSS scores at the time of hospitalization are defined by adding - before suffixes, while the ones at the time of discharge by adding - after.
Results: Our series composed of 158 schizophrenia patients (54 females and 104 males). Although we noticed slightly statistically important differences in PANSS negative scores at the time of hospitalization, we found no differences in terms of PANSS scales, in general.
Conclusion: The exact rates and the general patterns of combined antipsychotic therapy differ greatly from center to center. In this study, we have documented a map and a frequency of our combined therapy in our daily routine work. In a recent meta-analysis, Correll et al. argued that antipsychotic polypharmacy might have a clinical advantage over standard, non-clozapine monotherapy in non-responsive patients. We could only refer to the severity of symptoms in our study, and observed no differences between mono and polypharmacy groups in terms of the PANSS evaluation. Obviously, more clinical studies with clinical, metabolic, and laboratory data are needed to uncover if combined therapy has really anything beneficial over monotherapy.