A total of 34% of antipsychotics first prescribed were depots and an atypical antipsychotic was added in 79% of cases. Further details are given in Figure 2. It was unclear which antipsychotic was prescribed first in 6 subjects. Figure 2. Sequence of prescribing. High-dose antipsychotic prescribing A total of 21 PR-619 in vitro patients (55%) were Inhibitors,research,lifescience,medical on a high-dose antipsychotic regime. In 7 patients, one of the antipsychotic medications was already prescribed at high dose. Clinical outcome Clinical outcome of coprescribing was documented for 26 subjects (68%). An improvement in hyperprolactinaemia, tardive dyskinesia and sedation was observed in three patients (8%). Further details are provided

in Figure 3. Figure 3. Clinical outcome (n). Adverse effects A total of 25 patients (66%) experienced one or more adverse effects associated with antipsychotic polypharmacy (see Figure 4) and Inhibitors,research,lifescience,medical 12 of these patients (48%) were prescribed high-dose

antipsychotic combinations. Figure 4. Adverse effects. Prescriber considerations to stopping polypharmacy Prescribers considered discontinuing antipsychotic coprescribing Inhibitors,research,lifescience,medical in 23 patients (61%). For four of these patients, definite plans were made to switch to a clozapine trial (n = 2) or to gradually remove one of the antipsychotics (n = 2). For the remaining 19 subjects, it was decided that coprescribing should continue. Reasons for this were documented for 17 individuals (see Table 2). During the course of polypharmacy, the prescriber had gradually removed the original antipsychotic (olanzapine) in two patients, but it had been restarted following a deterioration in mental state. Table

Inhibitors,research,lifescience,medical 2. Documented reasons for continuing Inhibitors,research,lifescience,medical to coprescribe antipsychotics. Discussion The main reason for initiating antipsychotic polypharmacy was to improve symptoms and clinical outcome, a finding that is in concordance with our earlier study [Taylor et al. 2002]. Patients’ prior antipsychotic prescribing histories varied amongst the sample. A considerable number had only tried 0–1 antipsychotics before initiating polypharmacy and less than half of individuals had been trialled on clozapine. These findings suggest that antipsychotic polypharmacy is not always used as the last resort when all other Liothyronine Sodium options have been exhausted. Furthermore, less than half of patients were trialled on at least two antipsychotics plus clozapine, implying that treatment resistance was not established for all other patients. The reluctance to use clozapine has been mirrored by various studies, one of which found that clozapine treatment was theoretically being delayed by an average of 5 years [Taylor et al. 2003]. Indeed 65% of patients were prescribed concurrent antipsychotics before their first trial of clozapine.