Objective: Antipsychotic drug polypharmacy, the practice of using more than one antipsychotic drug to manage psychotic disorders, is an increasing practice, although controversial. This study examined current prescribing trends in antipsychotic drug polypharmacy. Methods: The study combined 2002 through 2004 data from the National Ambulatory Medical Care Survey to investigate the ;proportion of patients that were prescribed multiple compared to single antipsychotics. Patterns of use for conventional relative to atypical antipsychotic drugs were also examined. Logistic regression was used to explore relationships among patient and provider characteristics and the prescription of multiple antipsychotic drugs.
Results: Antipsychotic monotherapy was prescribed for 91.8% (N=762) of patients meeting study criteria, compared to 8.2% (N=68) of patients who were prescribed multiple antipsychotic drugs. Patients who were non-White were more likely to receive multiple antipsychotic drugs compared to White individuals. Patients whose method of payment was reported as Medicare were up to twice as likely to receive multiple antipsychotic drugs compared to those with private insurance. Likewise, the Medicaid payment status was associated with an increased likelihood of antipsychotic polypharmacy, with those covered by Medicaid found to be three times as likely to be prescribed multiple antipsychotic drugs. The patient’s age and gender, and the physician specialty demonstrated no association with antipsychotic polypharmacy in an ambulatory care setting.
Conclusions: The influence of patient race and payment source on antipsychotic prescribing patterns is worrisome and warrants further investigation.