Antipsychotic medications are used to treat patients with mental disorders. The use of two or more drugs
in the treatment of a psychiatric condition is termed as 'psychiatric polypharmacy'.
Although, a lack of
consensus has been reported among researchers globally about the number
of medications that would quantify polypharmacy, nevertheless, it is
widely prevalent in clinical practice.
‘There is a lack of consensus among researchers globally about the number of medications that would quantify polypharmacy.’
The rationale for polypharmacy is
not clear. Etiologic factors are patient demographics (age, gender,
race, low socio-economic status), personality disorder
(obsessive-compulsive, borderline), psychiatric conditions (psychosis,
schizophrenia, affective or mood disorders), comorbidities, severity of
disease, treatment- refractoriness, prescribing practice, inpatient or
outpatient setting, concern for reduction of extra-pyramidal and other
Psychiatric polypharmacy is seen not only in adults but
also in youths. Among children and adolescents' the polypharmacy
correlates are age (13 -15 years), male gender, caucasian race, low
socio-economic status, medicaid or public insurance, disability, and
foster care or child custody outside of biological family.
polypharmacy is also associated with a diagnosis of behavioral disorder,
autism spectrum disorder, ADHD, conduct disorder/oppositional defiant
disorder, personality disorder, violence, tics, psychosis, affective and
The concurrent administration of multiple drugs increases the
risk of drug interactions and adverse effect including morbidity and
mortality. Psychiatric polypharmacy is also associated with cumulative
toxicity, poor medication adherence and treatment non-compliance. Thus,
psychiatric polypharmacy poses a significant public health problem.
However, not all polypharmacy is harmful.
Polypharmacy is proven to be
beneficial in patients with psychotic, mood or affective disorder having
dual diagnosis with substance abuse, personality disorder (obsessive
compulsive) and comorbid conditions including thyroid, pain or seizure
Combination therapy with different class of drugs
antidepressants or antipsychotics with different mechanism of action
have beneficial therapeutic consequences. Therefore, a better
understanding of physicians' rationale for polypharmacy, patient
tolerability and effectiveness of prescribing strategy is needed to
guide practitioners and to inform the development of evidence based