Use of combinations of antipsychotics–Harms Patients: McLean & Leipzig

Use of combinations of antipsychotics–Harms Patients: McLean & Leipzig

Wed, 21 Sep 2005

Two additional studies provide additional evidence (coffin nails) demonstrating how psychiatry’s marriage of convenience gave birth to rotten fruit: specifically, under the influence of pharmaceutical companies, psychiatry plunged irresponsibly into practicing polypsychoparmacology.

The evidence from these studies corroborates that such drug cocktails harm patients’ quality of life–in other words, psychiatrists are doing harm.

From Harvard:

polytherapy was associated with high PANSS subscale scores of positive symptoms among affective psychosis, and relatively greater PANSS subscale ratings of excitement-agitation among patients diagnosed with schizophrenia

although polypharmacology is bad for patients, it is a spectacular income booster for drug manufacturers and hospitals.

total daily CPZ-eq doses at discharge averaged twice-greater with polytherapy, and hospitalization lasted 1.5 times longer

From University of Leipzig:*

Study results indicate that atypical antipsychotic drugs are not superior to conventional antipsychotics with regard to the effect on QOL

But when comparing bad medicine (atypical antipsychotics) to polytherapy– patients on polytherapy suffered more.

It would seem that doctors practicing polytherapy are poised for malpractice suits

What is missing from ALL psychiatric treatment evaluation studies is a comparison arm of non-drug therapeutic intervention.

Such an evaluation is the responsibility of NIMH: put psychopharmacology to the test by compaing each of the current available drugs vs. non-drug therapy vs. placebo

Only aremed with such evidence will psychiatrists be able to claim they know what they’re doing.

*AHRP has obtained a copy of this study–available upon request

Contact: Vera Hassner Sharav
212-595-8974

Hum Psychopharmacol. 2005 Aug 23; [Epub ahead of print] Use of combinations of antipsychotics: McLean Hospital inpatients, 2002.

Centorrino F, Fogarty KV, Sani G, Salvatore P, Cincotta SL, Hennen J, Guzzetta F, Talamo A, Saadeh MG, Baldessarini RJ.

Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, USA.

BACKGROUND: The empirical use of combinations of antipsychotic agents appears to be increasing with little research support for the relative efficacy, safety or cost-effectiveness of this practice. Such treatment was evaluated in hospitalized psychiatric patients. METHODS: Samples of consecutive inpatients treated with >/= 2 (‘polytherapy’) vs 1 antipsychotic (‘monotherapy’) were matched on age, sex, diagnosis and admission clinical ratings, and these groups were compared on total daily chlorpromazine-equivalent doses, days in hospital, and changes in clinical ratings between admission and discharge. RESULTS: The study sample included 69 polytherapy and 115 well-matched monotherapy subjects. Despite matching for initial CGI and GAF ratings, polytherapy was associated with high PANSS subscale scores of positive symptoms among affective psychosis, and relatively greater PANSS subscale ratings of excitement-agitation among patients diagnosed with schizophrenia. Estimated clinical improvement during hospitalization was similar among poly- and monotherapy patients, but total daily CPZ-eq doses at discharge averaged twice-greater with polytherapy, and hospitalization lasted 1.5 times longer. CONCLUSIONS: Antipsychotic polytherapy as well as the types of agents combined may reflect clinician responses to particular symptom patterns. The value of specific combinations of antipsychotic agents and their comparison with monotherapies requires specific, prospective, randomized and well-controlled trials that consider matching on clinical characteristics and truly comparable doses across regimens. Copyright (c) 2005 John Wiley & Sons, Ltd.

Qual Life Res. 2005 Jun;14(5):1275-89

The effects of antipsychotic treatment on quality of life of schizophrenic patients under naturalistic treatment conditions: an application of random effect regression models and propensity scores in an observational prospective trial.

Kilian R, & Angermeyer MC.

Department of Psychiatry, University of Leipzig, Leipzig, Germany.

The study examines the effect of different types of antipsychotic treatment on the health related quality of life (HRQL) of people with schizophrenia under naturalistic outpatient treatment conditions. In a prospective study design, 307 schizophrenic patients were followed over a period of 2.5 years. HRQL, clinical characteristics, and type of antipsychotic medication were assessed five times every 6 months. HRQL was assessed by the SF-36. Random effect regression models were computed for the SF-36 mental (MCS) and physical (PCS) component scores. Propensity scores were included in the regression models to reduce a possible sample selection bias.

Monotherapeutic treatment with new atypical neuroleptic drugs had a more positive effect on the mental health related quality of life (MCS) in comparison to treatment with polypharmacological treatment but not with oral conventional antipsychotics. Monopharmaceutical treatment with depot-antipsychotic drugs had a more positive effect on the physical health related quality of life (PCS) in comparison to polypharmacological treatment. Study results indicate that atypical antipsychotic drugs are not superior to conventional antipsychotics with regard to the effect on QOL. However, monopharmaceutical treatment can be assumed to be more effective in improving mental and physical related QOL than polypharmaceutical treatment.