Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009.

Introduction: Antipsychotic polypharmacy (APP), the concomitant use of ≥ 2 antipsychotics, is common in clinical practice. Prior reviews have focused on the efficacy of APP, but no systematic review exists regarding the safety and tolerability of this practice. Areas covered: A systematic review of adverse effects associated with APP was conducted to prepare this review; case series with ≥ 2 patients, chart reviews, naturalistic, database, cohort and randomized studies that reported on the association between APP in general or specific APP combinations and global or specific adverse effect were included. Methodological limitations of available studies are discussed and recommendations for clinicians and future research are provided. Expert opinion: Across mostly small and uncontrolled studies, APP has been associated with increased global side effect burden, rates of Parkinsonian side effects, anticholinergic use, hyperprolactinemia, sexual dysfunction, hypersalivation, sedation/somnolence, cognitive impa...

/pdf/safety-and-tolerability-of-antipsychotic-polypharmacy-48v7gpbwex.pdf

Safety and tolerability of antipsychotic polypharmacy

Users' Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice / The Unfavorable Result in Plastic Surgery: Avoidance and Treatment, 3rd ed

:A substantial number of patients with mania have significant concomitant depressive features, and they may respond differently to mood stabilizers than patients with pure mania. This post-hoc analysis explored the response characteristics of olanzapine versus placebo in bipolar I manic pati

Acute dysphoric mania: treatment response to olanzapine versus placebo.

Background 

There is concern over the methods used to evaluate antipsychotic drugs.

Aims 

To assess the clinical relevance of findings in the literature.

Method 

A systematic review identified studies of antipsychotics that used the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS). A published method of translating these into Clinical Global Impression – Change scale (CGI–C) scores was used to measure clinical relevance.

Results 

In total 98 data-sets were included in the BPRS analysis and 202 data-sets in the PANSS analysis. When aggregated scores were translated into notional CGI–C scores, most drugs reached ‘minimal improvement’ on the BPRS, but few reached that level for PANSS. This was true of both first- and second-generation drugs, including clozapine. Amisulpride and olanzapine had better than average CGI–C scores.

Conclusions 

Our findings show improvements of limited clinical relevance. The CGI–C scores were better for the BPRS than for the PANSS.

/pdf/clinical-relevance-of-findings-in-trials-of-antipsychotics-24i5fprbtb.pdf

Clinical relevance of findings in trials of antipsychotics: systematic review

Background.There is a paucity of empirical support for polypharmacy with second generation (atypical) antipsychotics (SGAs), especially in understudied populations.Objective.To investigate the frequency, effectiveness, and safety of this practice in patients with severe and persistent mental illness

A study of polypharmacy with second generation antipsychotics in patients with severe and persistent mental illness.

OBJECTIVE:To study the effects of adjunctive gabapentin on agitation in severely and persistently mentally ill (SPMI) inpatients.METHOD:Eleven chronic SPMI inpatients on stable psychotropic medication regimens were evaluated before and after the initiation of adjunctive gabapentin for six months. The following psychometric tests were used: Brief Psychiatric Rating Scale (BPRS), Corrigan Agitated Behavior Scale (CABS), and Clinical Global Impression (CGI)–Severity. Data collection was accomplished via retrospective chart review. An internal reliability check indicated that a chart review BPRS is significantly predictive of one performed face-to-face.RESULTS:Statistically significant reductions were found at six months for each assessment instrument (p > 0.05, two-tailed). BPRS scores were reduced from 40.6 to 33.2, CABS from 34.4 to 25.0, and CGI—Severity from 5.9 to 5.3. The bulk of the BPRS reduction was accounted for by several subscores exclusive of those assessing affective/anxious symptomatology. Adv...

Gabapentin's Effect on Agitation in Severely and Persistently Mentally III Patients

OBJECTIVE:To report a case of treatment of bipolar depression and management of antidepressant-induced mania with a low-dose fluoxetine regimen.CASE SUMMARY:A 59-year-old white woman was admitted involuntarily to a New York State psychiatric center with a diagnosis of bipolar (type I) disorder, mixed, with psychotic features. Initial treatment with lithium, olanzapine, and clonazepam produced a remission of manic and psychotic symptoms. However, the patient remained clinically depressed. Addition of oral fluoxetine 10 mg every morning to her medication regimen was followed 22 days later by the development of a manic state. Reduction of the fluoxetine dosage to 10 mg twice weekly was associated with the attainment of euthymia in 18 days. Thirteen days after the fluoxetine dosage reduction, the patients fluoxetine blood concentration was 20 μg/L and the norfluoxetine concentration was reported as 53 μg/L.DISCUSSION:To our knowledge, this is the first published case that describes the association between a l...

Treatment of Bipolar Depression with Twice-Weekly Fluoxetine: Management of Antidepressant-Induced Mania

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A study of polypharmacy with second generation antipsychotics in patients with severe and persistent mental illness.

Gabapentin's Effect on Agitation in Severely and Persistently Mentally III Patients

Treatment of Bipolar Depression with Twice-Weekly Fluoxetine: Management of Antidepressant-Induced Mania