Polypharmacy and irrational combinations of psychotropics in chronic inpatients
background In chronic inpatients polypharmacy is common and sometimes the combinations of psychotropics are irrational from a theoretical point of view.
aims Registration of polypharmacy and irrational combinations in clinical practice.
methods In this descriptive study of 127 longstay patients in a psychiatric hospital we registrated the frequency of polypharmacy, the number of irrational combinations of psychotropics and the reasons to describe these combinations. We tried to find a relation with the type of housing (an indirect measure for the intensity of care) and to the dsm-iv diagnosis.
results We found the use of four or five psychotropics in 24% of the population, in these cases we found irrational combinations in 89%. This group mainly consisted of patients with (partial) therapy-resistant schizophrenia of the undifferentiated and disorganised subtype and with schizoaffective disorder. In the total group of users of four and five psychotropics we found relatively more premorbid personality disorders and mild mental retardation. The percentage of users of four and five psychotropics increased with the intensity of care. Irrational combinations were mainly the result of long-lasting treatment of complex symptomatology. Following literature, a list of possible treatments in case of therapy resistance and conduct disorders is given. The authors give recommendations for further research on addition with a second high-potency antipsychotic drug in the case of therapy resistance for clozapine, and for fostering the quality of prescribing low-potency antipsychotic drugs and benzodiazepines for addition in the case of conduct disorders.
conclusions Polypharmacy and irrational combinations occur frequently in chronic inpatients and seem inevitable.