Falls Church, VA—Despite efforts to reduce the rate of “antipsychotic polypharmacy,” at least 12% of patients released from state psychiatric hospitals are still prescribed multiple drugs for their condition, according to an analysis of U.S. data.

The study, which included data on more than 86,000 adult patients discharged from 160 state psychiatric inpatient hospitals during 2011, was published in the Journal of Psychiatric Practice.

The National Association of State Mental Health Program Directors Research Institute (NRI), which conducted the study, obtained data from the Behavioral Healthcare Performance Measurement System, which is a comprehensive proprietary national database maintained by the NRI and representing 80% of all state psychiatric hospitals.

“Antipsychotic polypharmacy continues at a high enough rate to impact nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals,” study authors write. The results “provide insights into quality initiatives that could help further reduce the use of antipsychotic polypharmacy and reduce practices that are not consistent with best-practice guidelines,” the researchers write.

Background information in the article notes that most schizophrenia treatment guidelines recommend against using antipsychotic polypharmacy except as a last resort. In 2011, the Joint Commission introduced performance measures to reduce antipsychotic polypharmacy, defining three situations where using more than one antipsychotic is scientifically validated:

• multiple failed attempts at single-drug treatment,
• adjusting doses to work toward single-drug therapy, or
• augmenting the effects of the antipsychotic drug clozapine.

On the other hand, taking more than one antipsychotic medication, the study points out, can increase the risk for complications—including drug interactions, medication side effects, and metabolic disorders—without necessarily improving outcomes. In addition, the greater complexity often lowers adherence with drug therapy, the authors add.

Data indicates that, of the discharged patients who were prescribed at least one antipsychotic medication, 18% were prescribed more than one antipsychotic. According to the results, the most common reason for antipsychotic polypharmacy was to “reduce symptoms,” cited for 37% of those patients. Yet, in only 36% of the polypharmacy patients was one of the three Joint Commission criteria met for appropriate use of multiple antipsychotics, the report states.

Among the strongest predictors of antipsychotic polypharmacy were two factors: a diagnosis of schizophrenia and an inpatient stay of 90 days or more.

That has widespread implications, because 40% of patients at state psychiatric inpatient hospitals have a diagnosis of schizophrenia, while nearly 20% experience a longer hospital stay which suggests “a high-risk population needing special attention,” according to the study.

“Antipsychotic polypharmacy continues at a high enough rate to affect nearly 10,000 patients with a diagnosis of schizophrenia each year in state psychiatric inpatient hospitals,” study authors write. “Further analysis of the clinical presentation of these patients may highlight particular aspects of the illness and its previous treatment that are contributing to practices outside the best-practice guideline. An increased understanding of trend data, patient characteristics, and national benchmarks provides an opportunity for decision-making that is sensitive to the patient’s needs and cognizant of the hospital’s accomplishments in adopting best practices.”

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