Table 2.
Prescribers’ Level of Justification for Antipsychotic Polypharmacy (Rating 0–10).
| Justification for Antipsychotic Polypharmacy | Total (N=44) | High APP (>10%) (N=21) |
Low APP (≤ 10%) (N=23) |
F-Value | P-value |
|---|---|---|---|---|---|
| Antipsychotic Treatment/History | |||||
| Cross titration | 9.2±1.4 | 9.6±0.9 | 8.9±1.7 | 3.25 | 0.078 |
| Augmentation after failed CLZ | 8.2±2.2 | 8.6±1.6 | 7.9±2.6 | 1.14 | 0.29 |
| Augmentation due to intolerance to CLZ | 7.7±2.6 | 7.8±2.3 | 7.7±2.8 | 0.042 | 0.84 |
| Augmentation after 3 failed AP trial | 6.3±3.1 | 7.0±2.7 | 5.6±3.4 | 2.13 | 0.15 |
| Aborted cross titration | 5.3±2.8 | 5.9±2.5 | 4.7±3.1 | 1.91 | 0.17 |
| Different route of administration | 5.1±3.3 | 5.5±2.8 | 4.7±3.7 | 0.61 | 0.44 |
| Reached upper dose limit of 1st AP | 4.5±3.1 | 4.9±2.9 | 4.1±3.3 | 0.72 | 0.40 |
| Augmentation after 2 failed AP trial | 4.4±3.1 | 5.1±3.1 | 3.7±3.1 | 2.04 | 0.16 |
| One AP believed insufficient for relapse | 3.9±3.3 | 4.1±3.6 | 3.8±3.1 | 0.072 | 0.79 |
| Augmentation after 1 failed AP trial | 3.0±3.0 | 3.1±2.7 | 2.9±3.3 | 0.062 | 0.80 |
| Improving Outcomes | |||||
| Treatment of comorbid condition | 5.3±2.8 | 6.0±2.1 | 4.6±3.3 | 2.92 | 0.095 |
| Enhance effect | 5.1±2.9 | 5.7±3.1 | 4.6±2.8 | 1.56 | 0.22 |
| Minimize adverse events | 4.5±3.3 | 5.1±3.2 | 3.9±3.4 | 1.62 | 0.21 |
| Different target symptoms | 4.4±2.6 | 5.0±2.6 | 3.9±2.5 | 2.13 | 0.15 |
| Reduce dose of 1st AP | 3.7±2.8 | 4.3±3.1 | 3.1±2.5 | 2.05 | 0.16 |
| Reduce number of non-AP medications | 3.0±2.5 | 3.3±2.4 | 2.7±2.5 | 0.61 | 0.44 |
| Speed up effect | 2.5±2.3 | 3.0±2.5 | 2.4±2.1 | 1.87 | 0.18 |
| Level of Evidence for efficacy of APP | |||||
| Double blind placebo controlled trials | 8.0±2.0 | 7.7±1.8 | 8.3±2.1 | 1.13 | 0.29 |
| Open label trials | 4.7±1.9 | 5.0±2.0 | 4.3±1.9 | 1.63 | 0.12 |
| Case report | 3.7±2.4 | 4.0±2.4 | 3.5±2.5 | 0.42 | 0.52 |
| Other | |||||
| Different Pharmacology | 5.1±3.0 | 5.3±2.8 | 4.9±3.2 | 0.21 | 0.65 |
| Family/patient choice | 4.2±2.6 | 4.9±2.7 | 3.4±2.5 | 3.75 | 0.07 |
| Recommended by prior treating clinician | 4.3±2.5 | 5.1±2.4 | 3.6±2.7 | 4.21 | 0.046 |
| Prescriber habit | 2.9±2.7 | 2.9±2.5 | 2.9±2.9 | 0.0094 | 0.92 |
| Poor communication between services | 2.1±2.7 | 2.8±3.4 | 1.5±2.1 | 2.20 | 0.14 |
| Marketing pressures | 1.2±1,8 | 1.3±2.0 | 1.2±1.6 | 0.042 | 0.84 |
AP: antipsychotic; APP: Antipsychotic Polypharmacy Prescriber; CLZ: clozapine