Patients With Schizophrenia Often Discharged on Multiple Medications Interview with:

Glorimar Ortiz, MS Senior Researcher/Statistician NRI-National Association of State Mental Health Program Directors Research Institute Falls Church, VA 22042

Glorimar Ortiz

Glorimar Ortiz, MS
Senior Researcher/Statistician
NRI-National Association of State Mental Health Program Directors Research Institute
Falls Church, VA 22042 What is the background for this study? What are the main findings? 

Response: Despite the lack of empirical evidence that antipsychotic polypharmacy produces greater outcomes to antipsychotic monotherapy, and that several clinical guidelines recommend against it, patients with a diagnosis of schizophrenia continue to being discharged on polypharmacy. Over the past few years, attempts have been made to lower the rate of antipsychotic polypharmacy throughout the country. Most of the existing literature on this topic are based on Medicaid claims data which exclude data for patients discharged from state psychiatric inpatient hospitals. Our study is very important because it is the first time that data on the use of antipsychotic medications are analyzed using a large sample of discharges from state psychiatric inpatient hospitals. These hospitals now have the opportunity to benchmark their antipsychotic medication use rate with national rates more accurately, and therefore, develop and implement performance improvement activities that are more precise. The study found that 12% of all discharges were prescribed two or more antipsychotic medications. Of those patients discharged on at least one antipsychotic medication, 18% were prescribed two or more antipsychotics. The study also found that patients with a schizophrenia diagnosis and an inpatient hospital stay of 3 months or longer are more likely of being discharged on polypharmacy, and that the main reason for this was to reduce patient’s symptoms. Antipsychotic polypharmacy affects nearly 10,000 patients with schizophrenia annually in state psychiatric inpatient hospitals. What should clinicians and patients take away from your report? 

Response: The ultimate take-home message of this study is that there is still a large number of patients who are being discharged from state psychiatric hospitals on multiple antipsychotic medications. There are a group of characteristics that increase the likelihood of being discharged on multiple antipsychotic medications, with the strongest factors being a diagnosis of schizophrenia and longer hospitalizations. Clinicians could use this information to develop and implement quality initiatives that could help further reduce the use of antipsychotic polypharmacy. Clinicians also reported using multiple antipsychotics primarily to reduce patient symptoms, which is currently not seen by the Joint Commission or the Centers for Medicare & Medicaid Services (CMS) as a justifiable reason for antipsychotic polypharmacy. What recommendations do you have for future research as a result of this study?

Response: This study focuses on antipsychotic medication practices at discharge. Further research could examine the number of antipsychotic medications on admission, changes in medications during hospital stay, and adherence to medication regimes involving multiple antipsychotic after discharge as this could guide best practices activities at the patient level. Our findings may also suggest that more research should be done on reasons for using of multiple antipsychotic medications for persons with schizophrenia, before performance measurement financial sanctions are imposed by accrediting agencies. Is there anything else you would like to add? 

Response: Prescribing multiple antipsychotic medications is a costly practice that is not evidence-based for most patients. This study reveals typical reasons that antipsychotic polypharmacy continues, and offers suggestions for investigating root causes of why prescribing practices often fail to meet required justifications.


GLORIMAR ORTIZ, VERA HOLLEN, LUCILLE SCHACHT.Antipsychotic Medication Prescribing Practices Among Adult Patients Discharged From State Psychiatric Inpatient Hospitals.Journal of Psychiatric Practice, 2016; 22 (4): 283 DOI:10.1097/PRA.0000000000000163

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Last Updated on July 21, 2016 by Marie Benz MD FAAD