Abstract
Antipsychotic medications are used to treat many psychiatric conditions and are paramount for relapse prevention in patients with mental illnesses. Antipsychotic monotherapy (APM) is a commonly recommended approach, however there is no clear consensus on the use of antipsychotic polypharmacy (APP). A single-center retrospective review was conducted comparing readmission rates of behavioral health patients discharged on APP or APM between August 1st 2019 and July 31st 2021. The primary outcome was the one-year psychiatric readmission rate. Secondary outcomes included further readmission time frame stratification, olanzapine equivalent doses, and use of anticholinergic medications. The total readmission rate was 24.5% (24/98) in the APP group compared to 19.1% (107/560) in the APM group (p = 0.22). Patients discharged on APM were not found to have a statistically significant increase in readmission rate compared to patients discharged on APP. Further research is needed to assess the risks and benefits of APP.
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References
Baker, J., & Aebi, C. (2018). Comparison of readmission data between different categories of antipsychotic drugs at a state psychiatric hospital in Oregon. The mental health clinician, 7(3), 124–130. https://doi.org/10.9740/mhc.2017.05.124
Borlido, C., Remington, G., Graff-Guerrero, A., Arenovich, T., Hazra, M., Wong, A., Daskalakis, Z. J., & Mamo, D. C. (2016). Switching from 2 antipsychotics to 1 antipsychotic in schizophrenia: a randomized, double-blind, placebo-controlled study. The Journal of clinical psychiatry, 77(1), e14–e20. https://doi.org/10.4088/JCP.14m09321
Boskailo, E., Malkoc, A., McCurry, D. B., Venter, J., Drachman, D., & Ramos, G. M. (2017). Assessment of inpatient psychiatric readmission risk among patients discharged on an antipsychotic polypharmacy regimen: A retrospective cohort study. Acta medica academica, 46(2), 133–144. https://doi.org/10.5644/ama2006-124.198
Carnahan, R. M., Lund, B. C., Perry, P. J., & Chrischilles, E. A. (2006). Increased risk of extrapyramidal side-effect treatment associated with atypical antipsychotic polytherapy. Acta Psychiatrica Scandinavica, 113(2), 135–141. https://doi.org/10.1111/j.1600-0447.2005.00589.x
Constantine, R. J., Andel, R., McPherson, M., & Tandon, R. (2015). The risks and benefits of switching patients with schizophrenia or schizoaffective disorder from two to one antipsychotic medication: a randomized controlled trial. Schizophrenia research, 166(1–3), 194–200. https://doi.org/10.1016/j.schres.2015.05.038
Coupland, C., Hill, T., Dening, T., Morriss, R., Moore, M., & Hippisley-Cox, J. (2019). Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA internal medicine, 179(8), 1084–1093. https://doi.org/10.1001/jamainternmed.2019.0677
Dazzan, P., Morgan, K. D., Orr, K., Hutchinson, G., Chitnis, X., Suckling, J., Fearon, P., McGuire, P. K., Mallett, R. M., Jones, P. B., Leff, J., & Murray, R. M. (2005). Different effects of typical and atypical antipsychotics on grey matter in first episode psychosis: the AESOP study. Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology, 30(4), 765–774. https://doi.org/10.1038/sj.npp.1300603
Farrell, C., & Brink, J. (2020). The Prevalence and Factors Associated With Antipsychotic Polypharmacy in a Forensic Psychiatric Sample. Frontiers in psychiatry, 11, 263. https://doi.org/10.3389/fpsyt.2020.00263
Gallego, J. A., Bonetti, J., Zhang, J., Kane, J. M., & Correll, C. U. (2012). Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009.Schizophrenia research, 138(1),18–28. https://doi.org/10.1016/j.schres.2012.03.018
Gören, J. L., Parks, J. J., Ghinassi, F. A., Milton, C. G., Oldham, J. M., Hernandez, P., Chan, J., & Hermann, R. C. (2008). When is antipsychotic polypharmacy supported by research evidence? Implications for QI. Joint Commission journal on quality and patient safety, 34(10), 571–582. https://doi.org/10.1016/s1553-7250(08)34072-0
Hori, H., Yoshimura, R., Katsuki, A., Sugita, A. I., Atake, K., & Nakamura, J. (2013). Switching to antipsychotic monotherapy can improve attention and processing speed, and social activity in chronic schizophrenia patients. Journal of psychiatric research, 47(12), 1843–1848. https://doi.org/10.1016/j.jpsychires.2013.08.024
Kadra, G., Stewart, R., Shetty, H., MacCabe, J. H., Chang, C. K., Kesserwani, J., Taylor, D., & Hayes, R. D. (2018). Antipsychotic polypharmacy prescribing and risk of hospital readmission. Psychopharmacology (Berl), 235(1), 281–289. https://doi.org/10.1007/s00213-017-4767-6
Leucht, S., Samara, M., Heres, S., & Davis, J. M. (2016). Dose Equivalents for Antipsychotic Drugs: The DDD Method. Schizophrenia bulletin, 42 Suppl 1(Suppl 1), S90–S94. https://doi.org/10.1093/schbul/sbv167
Leucht, S., Samara, M., Heres, S., Patel, M. X., Furukawa, T., Cipriani, A., Geddes, J., & Davis, J. M. (2015). Dose Equivalents for Second-Generation Antipsychotic Drugs: The Classical Mean Dose Method. Schizophrenia bulletin, 41(6), 1397–1402. https://doi.org/10.1093/schbul/sbv037
Lin, C. H., Wang, F. C., Lin, S. C., Huang, Y. H., & Chen, C. C. (2017). A randomized, double-blind, comparison of the efficacy and safety of low-dose olanzapine plus low-dose trifluoperazine versus full-dose olanzapine in the acute treatment of schizophrenia. Schizophrenia research, 185, 80–87. https://doi.org/10.1016/j.schres.2017.01.004
Smith, R. L., Tveito, M., Kyllesø, L., Jukic, M. M., Ingelman-Sundberg, M., Andreassen, O. A., & Molden, E. (2020). Impact of antipsychotic polypharmacy on nonadherence of oral antipsychotic drugs - A study based on blood sample analyses from 24,239 patients. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology, 37, 64–69. https://doi.org/10.1016/j.euroneuro.2020.06.007
Tiihonen, J., Taipale, H., Mehtälä, J., Vattulainen, P., Correll, C. U., & Tanskanen, A. (2019). Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA psychiatry, 76(5), 499–507. https://doi.org/10.1001/jamapsychiatry.2018.4320
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Daniel Greer, Humberto R. Jimenez, and Astha Parikh. The first draft of the manuscript was written by Daniel Greer and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Greer, D., Parikh, A. & Jimenez, H.R. Readmission Rates of Patients Discharged on Antipsychotic Polypharmacy Compared to Antipsychotic Monotherapy. Community Ment Health J 59, 507–511 (2023). https://doi.org/10.1007/s10597-022-01034-5
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DOI: https://doi.org/10.1007/s10597-022-01034-5