Foster Adriana, King Jordanne
Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami (Foster, King); Citrus Health Network Inc., Hialeah, Florida (Foster, King).
Focus (Am Psychiatr Publ). 2020 Oct;18(4):375-385. doi: 10.1176/appi.focus.20190047. Epub 2020 Nov 5.
Physicians who treat patients with schizophrenia frequently encounter complex clinical situations not fully addressed by published treatment guidelines. Some of these situations lead to antipsychotic polypharmacy, often prescribed when clinical and social obstacles prevent access to clozapine and patients have had suboptimal responses to nonclozapine monotherapy. We offer our perspective on the place of antipsychotic polypharmacy in the current treatment guidelines for patients with schizophrenia. We summarize data on the prevalence of antipsychotic polypharmacy and describe common clinical situations in which this practice is encountered, along with the pharmacological underpinnings of this practice. We briefly review evidence on common risks of antipsychotic polypharmacy and describe the limited evidence for the possible benefits of such practice. Moreover, we take a look at alternative antipsychotic augmentation strategies that address all domains of psychosis.
治疗精神分裂症患者的医生经常会遇到已发布的治疗指南未完全涵盖的复杂临床情况。其中一些情况会导致抗精神病药物联合使用，通常是在临床和社会障碍阻碍使用氯氮平且患者对非氯氮平单一疗法反应欠佳时开具。我们就抗精神病药物联合使用在当前精神分裂症患者治疗指南中的地位发表我们的观点。我们总结了抗精神病药物联合使用的患病率数据，描述了出现这种用药方式的常见临床情况以及这种做法的药理学依据。我们简要回顾了抗精神病药物联合使用的常见风险的证据，并描述了这种做法可能带来的益处的有限证据。此外，我们探讨了针对精神病所有领域的替代性抗精神病增效策略。
