[Merits and Demerits of High-dose Psychotropic Polypharmacy in Schizophrenia from Guidelines]

The problem of high-dose psychotropic polypharmacy has been pointed out for a longtime in schizophrenia, being referred to at the Annual Meeting of the Society in 2011. The fre- quency of high-dose psychotropic polypharmacy is much higher in Japan compared with other countries. The polypharmacy rate is about 65% for anti-psychotic drugs, and rates of high- dose antipsychotics are 30% or higher. The rates of combination therapy using anti-Parkinson drugs, anti-anxiety drugs/sleeping pills, and mood stabilizers with antipsychotics have also been reported to be 30-80% or higher. In 2014, a reduction of medical fees for multi-drug prescriptions of psychotropic drugs was made, but it is still too early to assess its impact. Against this background, we introduced the Guidelines for Pharmacological Therapy of Schizophrenia, created by The Japanese Society of Neuropsychopharmacology. We describe how high-dose psychotropic polypharmacy has been used to treat schizophrenia in Japan in these guidelines, being the first evidence-based guidelines using the Minds method. Further- more, a schizophrenic case with cognitive decline who received polypharmacy is presented. In addition, the EGUIDE project for the purpose of education and dissemination of these guide- lines is considered. It is our hope that patients with schizophrenia can receive more appropriate treatment.