2004] This study was limited by its retrospective design and sma

2004]. This study was limited by its retrospective design and small sample size. Documentation was often of poor quality and for many patients, information regarding clinical outcome was not recorded. When outcome and adverse effects were documented, validated rating scales were seldom used. The retrospective design dictated that there was no randomization or blinding of treatment, increasing the possibility of bias and confounding. SLAM’s catchment area has one of the highest incidences of psychiatric disease Inhibitors,research,lifescience,medical in England. Its nonrepresentative

nature therefore prevents these findings from being fully extrapolated to the general population. Electronic records only included patient notes since the year 2001. High variability in dosage and antipsychotic combinations, all of which have differing pharmacological profiles,

meant that assessing the effects of antipsychotic polypharmacy as a group was flawed. The absence of a comparator monotherapy Inhibitors,research,lifescience,medical group was a significant limitation to this study. It is therefore not possible to infer that clinical and safety outcomes recorded were due to effects of polypharmacy and not related to uncontrolled factors. It is fundamental that the long-term efficacy and safety of polypharmacy is established. However, it is not possible to find FAQ assess the almost infinite number of antipsychotic combinations Inhibitors,research,lifescience,medical prescribed. Instead, specific combinations most commonly used or already possessing some empirical backing should be evaluated in double-blind RCTs. When antipsychotic polypharmacy is used, it

Inhibitors,research,lifescience,medical should be the last resort after adequate monotherapy trials of at least two antipsychotics and clozapine have failed and the prescriber is confident that adherence to next medication has been satisfactory. The second antipsychotic should be gradually introduced, whilst frequently monitoring the patient for benefit and adverse effects. The Inhibitors,research,lifescience,medical patient should be regularly reviewed, using validated rating scales to assess psychopathology and neuroleptic adverse effects. Conclusion Antipsychotics were coprescribed largely in an attempt to improve symptoms and adverse effects in patients with inadequate response to monotherapy, despite a lack of empirical evidence to support this practice. Prior to the initiation of polypharmacy, many patients received one antipsychotic only, suggesting that coprescription is not always used as the last Anacetrapib resort when all other therapeutic options have been exhausted. Some patients prescribed antipsychotic polypharmacy did appear to benefit, although the majority of improvements were attributed to nonpsychotic symptoms. Adverse effects were also common. Prospective RCTs of specific antipsychotic combinations are required to assess long-term efficacy and safety implications, resolving some of the controversies surrounding antipsychotic polypharmacy.

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