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Background: Despite
recommendations by guidelines to avoid antipsychotics combinations unless after
many trials of antipsychotic monotherapy, it is quite common practice to use
antipsychotic combinations. This practice leads to unnecessary expenses and
exposes the patient to severe adverse effects. The
usage of antipsychotic polypharmacy among psychiatric patients is widespread
nowadays. To date, there is a lack of empirical evidence to support its safety,
benefits, efficacy, risks and proper way of practicing. In Malaysia, despite
the high prevalence of antipsychotic polypharmacy, there is no local published
data. This study was conducted to determine the prescribing pattern of
antipsychotics and the proportion of antipsychotic polypharmacy and the
associated risks among psychiatric patients. Methodology: This retrospective, cross-sectional
study involved patients who were prescribed with antipsychotics polypharmacy
and was conducted at Hospital Kajang in Malaysia from January 2016 to December
2016. The assessment of polypharmacy usage and risk was based on a range of
prescribing and clinical outcomes including drug–drug interactions, medication
non-adherence, inappropriate prescribing, adverse drug events, hospitalization,
falls, functional decline, and mortality that are induced either by
combinations of antipsychotic medications or by monotherapy. Results: This
study included 100 patients with a total number of 120 cases (patients and
prescriptions). Among these cases, 62 cases were prescribed with one
antipsychotic medication and 58 cases were prescribed with antipsychotic
polypharmacy. The overall proportion of antipsychotic polypharmacy was 48%
which almost contributed half of cases. In addition to that, study found that
there was a significant and statistical association between duration of illness
and antipsychotic polypharmacy (P ? 0.05). Moreover, severe adverse effects
such as EPS and hyperpolactinemia, were induced by frequent use of
antipsychotic polypharmacy. On the hand, other side effects such as
hyperlipidemia, weight gain, and metabolic syndrome were associated with
antipsychotic monotherapy and antipsychotic polypharmacy, but this association
was not statistically significant. Conclusions: Overall, the proportion
of antipsychotic polypharmacy was high. Severe side effects were associated
with prescription of antipsychotic polypharmacy. Caution should be used in
prescribing antipsychotics for obese patient and those who having diabetes.
More information about the usage and the risk of polypharmacy antipsychotics is
needed to enhance their management and prevention.

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