Abstract
Most patients with schizophrenia take not only an antipsychotic but a host of additional psychiatric and medical medications. Often, complex psychiatric and medical regimens accrue over time that need to be periodically reviewed in order to minimize irrational polypharmacy that is costly and potentially dangerous. This chapter provides a clinical approach to psychiatric polypharmacy: how to assess it for appropriateness, how to fix complex regimens (deprescribe), and how to prevent unhelpful prescribing to begin with. Prescribing based on Hippocratic medicine is a safeguard against overprescribing: to use effective medicines safely for a disease and not merely for symptoms.
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Additional Resources
Website
http://www.choosingwisely.org/societies/american-psychiatric-association/ – The American Psychiatric Association has signed on to the choosing Wisely Campaign which represents an effort by the medical profession itself to limit overtreatment. The APA came up with a psychiatry-specific list of 5 reasonable things to avoid.
Articles
Ghaemi SN. Toward a Hippocratic psychopharmacology. Can J Psychiatry. 2008;53:189–96. – An excellent expose on the essence of Hippocratic medicine.
Freudenreich O, Kontos N, Querques J. Psychiatric polypharmacy: a clinical approach based on etiology and differential diagnosis. Harv Rev Psychiatry. 2012;20:79–85. – A more detailed examination of the four etiological categories that can lead to polypharmacy.
2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–94. – The “Beers criteria” from the American Geriatrics Society are a useful list for “potentially inappropriate” (their terminology) medications in elderly patients. Review this list for your elderly patients with schizophrenia.
Tiihonen J, Taipale H, Mehtala J, Vattulainen P, Correll CU, Tanskanen A. Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry. 2019;76:499–507. – An important contribution that comes to a different conclusion about polypharmacy: we can also err on the side of underprescribing and for some patients antipsychotic polypharmacy may indeed better (something I did not emphasize in this chapter).
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Freudenreich, O. (2020). Polypharmacy. In: Psychotic Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-29450-2_21
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DOI: https://doi.org/10.1007/978-3-030-29450-2_21
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