PMID- 27141289
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160504
LR  - 20201001
IS  - 2045-1253 (Print)
IS  - 2045-1261 (Electronic)
IS  - 2045-1253 (Linking)
VI  - 6
IP  - 2
DP  - 2016 Apr
TI  - Effectiveness of long-acting antipsychotics in clinical practice: 2. Effects of 
      antipsychotic polypharmacy on risperidone long-acting injection and 
      zuclopenthixol decanoate.
PG  - 66-76
LID - 10.1177/2045125315623584 [doi]
AB  - OBJECTIVES: Antipsychotic polypharmacy (APP) is common clinical practice. 
      Theoretically, APP runs the risk of additional side effects, drug interactions, 
      adherence and cost. A limited evidence base is emerging to support the 
      effectiveness of APP in clinical practice. Our companion paper highlighted the 
      extent of APP alongside commonly prescribed long-acting antipsychotic injections 
      (LAIs). We aimed to examine the effects of APP on discontinuation rates and 
      Clinical Global Impression (CGI) outcomes in patients commenced on risperidone 
      long-acting injection (RLAI) and zuclopenthixol decanoate. METHOD: LAI-naive 
      patients commenced on RLAI (n = 102) and zuclopenthixol decanoate(n = 105) were 
      identified using our electronic patient record (running from 2002) within NHS 
      Lanarkshire, Scotland, UK. This was a retrospective, electronic case note review 
      with an 18-month follow up. Patient groups were divided into those receiving the 
      LAI as the sole antipsychotic and those who were receiving additional oral 
      antipsychotic polypharmacy (APP) for at least 50% of the duration of the 
      treatment with their LAI. Kaplan-Meier statistics were calculated for 
      discontinuation rates. CGI severity and improvement scores were retrospectively 
      assigned by the investigating team. RESULTS: Antipsychotic polypharmacy occurred 
      with RLAI (37%) and zuclopenthixol decanoate (46%) and was associated with lower 
      discontinuation rates (statistical significant with zuclopenthixol for any cause 
      and adverse effects discontinuation). APP had no adverse outcomes on hospital 
      admissions or CGI ratings. Patients on APP did not have more severe, chronic or 
      treatment resistant illnesses. CONCLUSIONS: For RLAI and zuclopenthixol 
      decanoate, APP had some favourable outcomes when examining discontinuation rates 
      for any cause, and adverse effects. This was unexpected as we had considered APP 
      would signal illness chronicity and severity and be associated with increased 
      adverse effects resulting in early discontinuation. APP had no adverse outcomes 
      on assigned CGI improvement or mean end-point severity ratings for RLAI and 
      zuclopenthixol decanoate.
FAU - Cordiner, Matthew
AU  - Cordiner M
AD  - NHS Lanarkshire, Bellshill, UK.
FAU - Shajahan, Polash
AU  - Shajahan P
AD  - NHS Lanarkshire, Bellshill Clinic, Greenmoss Place, Bellshill ML4 1PS, UK.
FAU - McAvoy, Sarah
AU  - McAvoy S
AD  - NHS Lanarkshire, Bellshill, UK.
FAU - Bashir, Muhammad
AU  - Bashir M
AD  - NHS Lanarkshire, Bellshill, UK.
FAU - Taylor, Mark
AU  - Taylor M
AD  - NHS Lothian, Edinburgh, UK.
LA  - eng
PT  - Journal Article
DEP - 20160106
PL  - England
TA  - Ther Adv Psychopharmacol
JT  - Therapeutic advances in psychopharmacology
JID - 101555693
PMC - PMC4837966
OTO - NOTNLM
OT  - antipsychotic polypharmacy
OT  - antipsychotics
OT  - clinical effectiveness
OT  - discontinuation
OT  - long-acting antipsychotics
COIS- Conflict of interest statement: All the authors are employed by the NHS. MT has 
      received hospitality and fees from Janssen; Lundbeck; Otsuka; and Roche in the 
      last 3 years.
EDAT- 2016/05/04 06:00
MHDA- 2016/05/04 06:01
PMCR- 2016/04/01
CRDT- 2016/05/04 06:00
PHST- 2016/05/04 06:00 [entrez]
PHST- 2016/05/04 06:00 [pubmed]
PHST- 2016/05/04 06:01 [medline]
PHST- 2016/04/01 00:00 [pmc-release]
AID - 10.1177_2045125315623584 [pii]
AID - 10.1177/2045125315623584 [doi]
PST - ppublish
SO  - Ther Adv Psychopharmacol. 2016 Apr;6(2):66-76. doi: 10.1177/2045125315623584. 
      Epub 2016 Jan 6.