Polypharmacotherapy – when is it Treatment of the First orSecond Choice? Part I.

Overview

Data about treatment of schizoaffective and bipolar disorders are summarised. In both disordersthe frequent first choice is the combination of mood stabilizers and antipsychotics, respectiveantidepressants. In the 70’s lithium was very popular, in the 80’s anticonvulsants appeared and inthe 90’s atypical antipsychotics started to be in the focus of attention. It is not clear whetheratypical antipsychotics are mood stabilizers, because there is a lack of adequete studies. Theauthors data about the treatment of schizoaffective disorders are presented. The authors, usingretrospective chart analysis, found that in this indication antipsychotics were preferred. Onadmission mood stabilizers were used in 20/64 (31 %), only in 3/20 (15 %) as monotherapy and incombination, in 46/64 (72 %) antipsychotics were used. Atypical antipsychotics were preferred(33/46, 72 %) to conventional antipsychotics (21/46, 46 %). This ratio persisted on discharge. Ondischarge a higher number of patients were treated with antipsychotics (72 % vs 91 %), combinationsof antipsychotics with mood stabilizers (26 % vs 40 %) and combinations of antipsychotics(13 % vs 22 %). The most widely used atypical antipsychotic on admission was risperidone (in39 %), on discharge olanzapine (in 35 % of the total number of patients treated with atypicalantipsychotics).

Key words:
polypharmacotherapy, schizoaffective disorder, bipolar disorder, combinations, withmood stabilizers, atypical antipsychotics.