Related Experiment Video
Updated: Jun 27, 2026
10:32
Development of a Virtual Reality Assessment of Everyday Living Skills
Published on: April 23, 2014
Polypharmacy with second-generation antipsychotics: a review of evidence
Anand K Pandurangi1, Alican Dalkilic
1Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA. apandurangi@mcvh-vcu.edu
Journal of Psychiatric Practice
|December 6, 2008
Summary
Polypharmacy with second-generation antipsychotics (SGAs) is common in practice, but lacks strong evidence from controlled trials. Further research is needed to guide clinical use for specific patient needs.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Practice
Background:
- Polypharmacy involving second-generation antipsychotics (SGAs) is frequently observed in clinical settings.
- The pharmacological rationale and supporting evidence for SGA polypharmacy remain areas of ongoing investigation.
Purpose of the Study:
- To review the prevalence of polypharmacy with SGAs.
- To examine the pharmacological reasons behind SGA polypharmacy.
- To evaluate the evidence supporting or refuting SGA polypharmacy.
Main Methods:
- A comprehensive literature search of PubMed was conducted from 1966 to October 2006.
- Included were clinical trial reports, case reports, and reviews, excluding non-antipsychotic augmentation and combinations with first-generation antipsychotics.
- Data from 75 reports on SGA polypharmacy were extracted and analyzed, with a focus on randomized controlled trials and larger case series.
Main Results:
- The prevalence of SGA polypharmacy varies significantly (3.9% to 50%) across different clinical settings and patient populations.
- Despite its common use, robust evidence from blinded, randomized, controlled trials supporting SGA polypharmacy is limited.
- Case reports and specific designs offer some, albeit modest, support for certain combinations.
Conclusions:
- SGA polypharmacy is prevalent, yet lacks substantial high-quality evidence.
- Evidence-based algorithms are recommended to guide clinical decisions rather than outright prohibition.
- Future research should focus on efficacy trials for treatment-resistant schizophrenia, comorbid conditions, and acute care settings.
Related Concept Videos
01:28Drug Therapy
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
01:21Antipsychotic Drugs: Typical and Atypical Agents
Antipsychotic drugs are classified into first-generation (typical) drugs including phenothiazines; and second-generation (atypical) drugs. Chlorpromazine hydrochloride (Thorazine), a phenothiazine derivative, broadly impacts the central, autonomic, and endocrine systems. This drug, along with typical agents like haloperidol (Haldol), primarily works by antagonizing D2 receptors, thus reducing dopaminergic neurotransmission. However, typical antipsychotics can cause side effects such as sedation...
01:28Psychosis and Antipsychotic Drugs: Overview
The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic symptoms in all...
01:26Psychosis: Goals of Pharmacotherapy
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation. For...
01:21Antipsychotic Drugs: Therapeutic Uses and Side Effects
Antipsychotic drugs primarily block dopamine and serotonin receptors and cholinergic, adrenergic, and histaminergic receptors, thereby reducing hallucinations and delusions in conditions like schizophrenia. However, they can trigger unwanted extrapyramidal effects such as dystonias, Parkinson-like symptoms, and tardive dyskinesia.
Despite these side effects, antipsychotics are used therapeutically for various purposes, including managing schizophrenia, preventing nausea and vomiting, curbing...
Despite these side effects, antipsychotics are used therapeutically for various purposes, including managing schizophrenia, preventing nausea and vomiting, curbing...
01:23Antidepressant Drugs: MAOIs and Other Agents
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...