Clinicians' Reasons for Antipsychotic Coprescribing

Background: Prescribing more than 1 antipsychotic is common but has received little supportive evidence in the literature. This study was designed to systematically survey clinicians about their rationale for prescribing more than 1 antipsychotic for specific patients.

Method: Patients with schizophrenia (diagnosed according to ICD-9 criteria from October 1, 1999, to September 30, 2000) at 2 Veterans Administration (VA) medical centers and their prescriptions for antipsychotics (filled within the VA system from June 1, 2000, through September 30, 2000) were identified from administrative databases. Clinicians for each patient with more than 1 antipsychotic prescription were interviewed using a structured questionnaire. After summarizing offered explanations, we compared patients prescribed 2 atypicals with those prescribed an atypical and a conventional.

Results: The treatment of 66 patients was reviewed. The 4 most common reasons for coprescription were reducing positive symptoms (61%), reducing negative symptoms (20%), decreasing total amount of medication (9%), and reducing extrapyramidal symptoms (5%). In 65% of patients (41/63), psychiatric symptoms were thought to have been refractory to antipsychotic monotherapy. In 39% of patients (N = 26), antipsychotic coprescription was intended to be transitional, but in only 46% of these patients (N = 12) had this transition been completed after 6 to 12 months.

Conclusion: Prescribers for patients receiving more than one antipsychotic were frequently able to cite plausible and specific target symptoms they were attempting to address with this practice.