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Published in: Community Mental Health Journal 6/2010

01-12-2010 | Original Paper

Trends in Adult Antipsychotic Polypharmacy: Progress and Challenges in Florida’s Medicaid Program

Authors: Robert J. Constantine, Ross Andel, Rajiv Tandon

Published in: Community Mental Health Journal | Issue 6/2010

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Abstract

We studied trends in antipsychotic polypharmacy over a 4 year period in order to see if a change occurred when a statewide quality improvement program aimed at reducing the practice was implemented. Antipsychotic polypharmacy prevalence rates were calculated for eight 6-month periods for enrollees with schizophrenia and schizoaffective disorder and for those with all other diagnoses. Prevalence increased from 1/2003 to 12/2004 and then declined for 4 successive 6 month periods beginning in the 1/2005–6/05 period when the program began. Piecewise linear regression results for both diagnostic groups confirmed that the change in the likelihood of antipsychotic polypharmacy during the four 6 month periods before program implementation were significantly different than during the four 6 month periods following implementation. While it is impossible to control for the effects of all variables in evaluating the impact of any system wide intervention the data suggest that the program did help to reduce the use of antipsychotic polypharmacy.
Literature
go back to reference American Psychiatric Association. (2004). Practice guidelines for the treatment of patients with schizophrenia. American Journal of Psychiatry, 161(Supplement), 1–56. American Psychiatric Association. (2004). Practice guidelines for the treatment of patients with schizophrenia. American Journal of Psychiatry, 161(Supplement), 1–56.
go back to reference Barbui, C., Nose, M., Mazzi, M. A., Thornicroft, G., Schene, A., Becker, T., et al. (2006). Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries. International Clinical Psychopharmacology, 21(6), 355–362.CrossRefPubMed Barbui, C., Nose, M., Mazzi, M. A., Thornicroft, G., Schene, A., Becker, T., et al. (2006). Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries. International Clinical Psychopharmacology, 21(6), 355–362.CrossRefPubMed
go back to reference Biancosino, B., Barbui, C., Marmai, L., Doná, S., & Grassi, L. (2005). Determinants of antipsychotic polypharmacy in psychiatric inpatients: A prospective study. International Clinical Psychopharmacology, 20(6), 305–309.CrossRefPubMed Biancosino, B., Barbui, C., Marmai, L., Doná, S., & Grassi, L. (2005). Determinants of antipsychotic polypharmacy in psychiatric inpatients: A prospective study. International Clinical Psychopharmacology, 20(6), 305–309.CrossRefPubMed
go back to reference Broekema, W. J., de Groot, I. W., & van Harten, P. N. (2007). Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study. Pharmacy World & Science, 29(3), 126–130.CrossRef Broekema, W. J., de Groot, I. W., & van Harten, P. N. (2007). Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study. Pharmacy World & Science, 29(3), 126–130.CrossRef
go back to reference Centorrino, F., Goren, J. L., Hennen, J., Salvatore, P., Kelleher, J. P., & Baldessarini, R. J. (2004). Multiple versus single antipsychotic agents for hospitalized psychiatric patients: Case-control study of risks versus benefits. American Journal of Psychiatry, 161(4), 700–706.CrossRefPubMed Centorrino, F., Goren, J. L., Hennen, J., Salvatore, P., Kelleher, J. P., & Baldessarini, R. J. (2004). Multiple versus single antipsychotic agents for hospitalized psychiatric patients: Case-control study of risks versus benefits. American Journal of Psychiatry, 161(4), 700–706.CrossRefPubMed
go back to reference Chakos, M. H., Glick, I. D., Miller, A. L., Hamner, M. B., Miller, D. D., Patel, J. K., et al. (2006). Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE Trial. Psychiatric Services, 57(8), 1094–1101.CrossRefPubMed Chakos, M. H., Glick, I. D., Miller, A. L., Hamner, M. B., Miller, D. D., Patel, J. K., et al. (2006). Baseline use of concomitant psychotropic medications to treat schizophrenia in the CATIE Trial. Psychiatric Services, 57(8), 1094–1101.CrossRefPubMed
go back to reference Clark, R. E., Bartels, S. J., Mellman, T. A., & Peacock, W. J. (2002). Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorders: Implications for state mental health policy. Schizophrenia Bulletin, 28(1), 75–84.PubMed Clark, R. E., Bartels, S. J., Mellman, T. A., & Peacock, W. J. (2002). Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorders: Implications for state mental health policy. Schizophrenia Bulletin, 28(1), 75–84.PubMed
go back to reference Clinical practice guidelines. (2005). Treatment of schizophrenia. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 50:(13 Suppl 1), 7S–57S. Clinical practice guidelines. (2005). Treatment of schizophrenia. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 50:(13 Suppl 1), 7S–57S.
go back to reference Constantine, R. J., Richard, S., Surlea, R., et al. (2006). Optimizing pharmacotherapy of schizophrenia: Tools for the psychiatrist. Current Psychosis and Therapeutics Reports, 4(1), 5–11.CrossRef Constantine, R. J., Richard, S., Surlea, R., et al. (2006). Optimizing pharmacotherapy of schizophrenia: Tools for the psychiatrist. Current Psychosis and Therapeutics Reports, 4(1), 5–11.CrossRef
go back to reference Correll, C. U. (2008). Antipsychotic polypharmacy, part 1: Shotgun approach or targeted cotreatment? American Society of Clinical Psychopharmacology, 69(4), 674–675. Correll, C. U. (2008). Antipsychotic polypharmacy, part 1: Shotgun approach or targeted cotreatment? American Society of Clinical Psychopharmacology, 69(4), 674–675.
go back to reference Elie, D., Poirier, M., Chianetta, J., Durand, M., Gregoire, C., & Grignon, S. (2009). Cognitive effects of antipsychotic dosage and polypharmacy: A study with the BACS in patients with schizophrenia and schizoaffective disorder. Journal of Psychopharmacology, 1–8. Elie, D., Poirier, M., Chianetta, J., Durand, M., Gregoire, C., & Grignon, S. (2009). Cognitive effects of antipsychotic dosage and polypharmacy: A study with the BACS in patients with schizophrenia and schizoaffective disorder. Journal of Psychopharmacology, 1–8.
go back to reference Faries, D., Ascher-Svanum, H., Zhu, B., Correll, C., & Kane, J. (2005). Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry [Electronic Resource], 5(1), 26.CrossRef Faries, D., Ascher-Svanum, H., Zhu, B., Correll, C., & Kane, J. (2005). Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry [Electronic Resource], 5(1), 26.CrossRef
go back to reference Freudenreich, O., & Goff, D. C. (2002). Antipsychotic combination therapy in schizophrenia: A review of efficacy and risks of current combinations. Acta Psychiatrica Scandinavica, 106(5), 323–330.CrossRefPubMed Freudenreich, O., & Goff, D. C. (2002). Antipsychotic combination therapy in schizophrenia: A review of efficacy and risks of current combinations. Acta Psychiatrica Scandinavica, 106(5), 323–330.CrossRefPubMed
go back to reference Ganesan, S., Taylor, R., Rabheru, K., Forbes, I., Dumontet, J., & Procyshyn, R. M. (2008). Antipsychotic polypharmacy does not increase the risk for side effects. Schizophrenia Research, 98(1), 323–324.CrossRefPubMed Ganesan, S., Taylor, R., Rabheru, K., Forbes, I., Dumontet, J., & Procyshyn, R. M. (2008). Antipsychotic polypharmacy does not increase the risk for side effects. Schizophrenia Research, 98(1), 323–324.CrossRefPubMed
go back to reference Ganguly, R., Kotzan, J. A., Miller, L. S., Kennedy, K., & Martin, B. C. (2004). Prevalence, trends, and factors associated with antipsychotic polypharmacy among medicaid-eligible schizophrenia patients, 1998–2000. The Journal of Clinical Psychiatry, 65(10), 1377–1388.CrossRefPubMed Ganguly, R., Kotzan, J. A., Miller, L. S., Kennedy, K., & Martin, B. C. (2004). Prevalence, trends, and factors associated with antipsychotic polypharmacy among medicaid-eligible schizophrenia patients, 1998–2000. The Journal of Clinical Psychiatry, 65(10), 1377–1388.CrossRefPubMed
go back to reference Gilmer, T. P., Dolder, C. R., Folsom, D. P., Mastin, W., & Jeste, D. V. (2007). Antipsychotic polypharmacy trends among medicaid beneficiaries with schizophrenia in San Diego County, 1999–2004. Psychiatric Services, 58(7), 1007–1010.CrossRefPubMed Gilmer, T. P., Dolder, C. R., Folsom, D. P., Mastin, W., & Jeste, D. V. (2007). Antipsychotic polypharmacy trends among medicaid beneficiaries with schizophrenia in San Diego County, 1999–2004. Psychiatric Services, 58(7), 1007–1010.CrossRefPubMed
go back to reference Goff, D. C., & Freudenreich, O. (2004). Focus on polypharmacy in schizophrenia: does anyone truly benefit? The International Journal of Neuropsychopharmacology/Official Scientific Journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 7(2), 109–111. Goff, D. C., & Freudenreich, O. (2004). Focus on polypharmacy in schizophrenia: does anyone truly benefit? The International Journal of Neuropsychopharmacology/Official Scientific Journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 7(2), 109–111.
go back to reference Goren, J. L., Parks, J. J., Ghinassi, F. A., Milton, C. G., Oldham, J. M., Hernandez, P., et al. (2008). When is antipsychotic polypharmacy supported by research evidence? Implications for QI. Joint Commission Journal on Quality and Patient Safety, 34(10), 571–582.PubMed Goren, J. L., Parks, J. J., Ghinassi, F. A., Milton, C. G., Oldham, J. M., Hernandez, P., et al. (2008). When is antipsychotic polypharmacy supported by research evidence? Implications for QI. Joint Commission Journal on Quality and Patient Safety, 34(10), 571–582.PubMed
go back to reference Hardin, J., & Hilbe, J. (2002). Generalized estimating equations. Danvers, MA: CRC Press.CrossRef Hardin, J., & Hilbe, J. (2002). Generalized estimating equations. Danvers, MA: CRC Press.CrossRef
go back to reference Hori, H., Noguchi, H., Hashimoto, R., Nakabayashi, T., Omori, M., Takahashi, S., Tsukue, R., Anami, K., Hirabayashi, N., Harada, S., Saitoh, O., Iwase, M., Kajimoto, O., Takeda, M., Okabe, S., & Kunugi, H. (2006). Antipsychotic medication and cognitive function in schizophrenia. Hori, H., Noguchi, H., Hashimoto, R., Nakabayashi, T., Omori, M., Takahashi, S., Tsukue, R., Anami, K., Hirabayashi, N., Harada, S., Saitoh, O., Iwase, M., Kajimoto, O., Takeda, M., Okabe, S., & Kunugi, H. (2006). Antipsychotic medication and cognitive function in schizophrenia.
go back to reference Ito, H., Koyama, A., & Higuchi, T. (2005). Polypharmacy and excessive dosing: psychiatrists’ perceptions of antipsychotic drug prescription. The British Journal of Psychiatry: The Journal of Mental Science, 187, 243–247.CrossRef Ito, H., Koyama, A., & Higuchi, T. (2005). Polypharmacy and excessive dosing: psychiatrists’ perceptions of antipsychotic drug prescription. The British Journal of Psychiatry: The Journal of Mental Science, 187, 243–247.CrossRef
go back to reference Joukamaa, M., Heliovaara, M., Knekt, P., Aromaa, A., Raitasalo, R., & Lehtinen, V. (2006). Schizophrenia, neuroleptic medication and mortality. British Journal of Psychiatry, 188(2), 122–127.CrossRefPubMed Joukamaa, M., Heliovaara, M., Knekt, P., Aromaa, A., Raitasalo, R., & Lehtinen, V. (2006). Schizophrenia, neuroleptic medication and mortality. British Journal of Psychiatry, 188(2), 122–127.CrossRefPubMed
go back to reference Kreyenbuhl, J., Valenstein, M., McCarthy, J. F., Ganoczy, D., & Blow, F. C. (2006). Long-term combination antipsychotic treatment in VA patients with schizophrenia. Schizophrenia Research, 84(1), 90–99.CrossRefPubMed Kreyenbuhl, J., Valenstein, M., McCarthy, J. F., Ganoczy, D., & Blow, F. C. (2006). Long-term combination antipsychotic treatment in VA patients with schizophrenia. Schizophrenia Research, 84(1), 90–99.CrossRefPubMed
go back to reference Lelliott, P., Paton, C., Harrington, M., Konsolaki, M., Sensky, T., & Okocha, C. (2002). The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients. Psychiatric Bulletin, 26(11), 411–414.CrossRef Lelliott, P., Paton, C., Harrington, M., Konsolaki, M., Sensky, T., & Okocha, C. (2002). The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients. Psychiatric Bulletin, 26(11), 411–414.CrossRef
go back to reference Lewis, S. B. T. D. L., et al. (2006). Randomized controlled trial of effect of prescription of clozapine verses other second-generation antipsychotic drugs in treatment resistant schizophrenia. Schizophrenis Bulletin, 32(4), 715–723.CrossRef Lewis, S. B. T. D. L., et al. (2006). Randomized controlled trial of effect of prescription of clozapine verses other second-generation antipsychotic drugs in treatment resistant schizophrenia. Schizophrenis Bulletin, 32(4), 715–723.CrossRef
go back to reference Loosbrock, D. L., Zhao, Z., Johnstone, B. M., & Morris, L. S. (2003). Antipsychotic medication use patterns and associated costs of care for individuals with schizophrenia. The Journal of Mental Health Policy and Economics, 6(2), 67–75.PubMed Loosbrock, D. L., Zhao, Z., Johnstone, B. M., & Morris, L. S. (2003). Antipsychotic medication use patterns and associated costs of care for individuals with schizophrenia. The Journal of Mental Health Policy and Economics, 6(2), 67–75.PubMed
go back to reference McCue, R. E., Waheed, R., & Urcuyo, L. (2003). Polypharmacy in patients with schizophrenia. The Journal of Clinical Psychiatry, 64(9), 984–989.CrossRefPubMed McCue, R. E., Waheed, R., & Urcuyo, L. (2003). Polypharmacy in patients with schizophrenia. The Journal of Clinical Psychiatry, 64(9), 984–989.CrossRefPubMed
go back to reference McEvoy, J. P., Meyer, J. M., Goff, D. C., Nasrallah, H. A., Davis, S. M., Sullivan, L., et al. (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research, 80(1), 19–32.CrossRefPubMed McEvoy, J. P., Meyer, J. M., Goff, D. C., Nasrallah, H. A., Davis, S. M., Sullivan, L., et al. (2005). Prevalence of the metabolic syndrome in patients with schizophrenia: baseline results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial and comparison with national estimates from NHANES III. Schizophrenia Research, 80(1), 19–32.CrossRefPubMed
go back to reference Miller, A. L., & Craig, C. S. (2002). Combination antipsychotics: pros, cons, and questions. Schizophrenia Bulletin, 28(1), 105–109.PubMed Miller, A. L., & Craig, C. S. (2002). Combination antipsychotics: pros, cons, and questions. Schizophrenia Bulletin, 28(1), 105–109.PubMed
go back to reference Morrato, E. H., Dodd, S., Oderda, G., Haxby, D. G., Allen, R., & Valuck, R. J. (2007). Prevalence, utilization patterns, and predictors of antipsychotic polypharmacy: Experience in a Multistate medicaid population, 1998–2003. Clinical Therapeutics: The International Peer-Reviewed Journal of Drug Therapy, 29(1), 183–195. Morrato, E. H., Dodd, S., Oderda, G., Haxby, D. G., Allen, R., & Valuck, R. J. (2007). Prevalence, utilization patterns, and predictors of antipsychotic polypharmacy: Experience in a Multistate medicaid population, 1998–2003. Clinical Therapeutics: The International Peer-Reviewed Journal of Drug Therapy, 29(1), 183–195.
go back to reference National Institute for Clinical Excellence. (2002). Schizophrenia: Core interventions in the treatment and management of schizophrenia in primary and secondary care: Clinical Guideline 1. National Institute for Clinical Excellence. (2002). Schizophrenia: Core interventions in the treatment and management of schizophrenia in primary and secondary care: Clinical Guideline 1.
go back to reference Procyshyn, R. M., Kennedy, N. B., Tse, G., & Thompson, B. (2001). Antipsychotic polypharmacy: A survey of discharge prescriptions from a tertiary care psychiatric institution. The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 46(4), 334–339. Procyshyn, R. M., Kennedy, N. B., Tse, G., & Thompson, B. (2001). Antipsychotic polypharmacy: A survey of discharge prescriptions from a tertiary care psychiatric institution. The Canadian Journal of Psychiatry/La Revue Canadienne De Psychiatrie, 46(4), 334–339.
go back to reference Rush, A. J., Crismon, M. L., Kashner, T. M., Toprac, M. G., Carmody, T. J., Trivedi, M. H., et al. (2003). Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design. The Journal of Clinical Psychiatry, 64(4), 357–369.CrossRefPubMed Rush, A. J., Crismon, M. L., Kashner, T. M., Toprac, M. G., Carmody, T. J., Trivedi, M. H., et al. (2003). Texas Medication Algorithm Project, phase 3 (TMAP-3): rationale and study design. The Journal of Clinical Psychiatry, 64(4), 357–369.CrossRefPubMed
go back to reference Sernyak, M. J., & Rosenheck, R. (2004). Clinicians’ reasons for antipsychotic coprescribing. Journal of Clinical Psychiatry, 65(12), 1597–1600.CrossRefPubMed Sernyak, M. J., & Rosenheck, R. (2004). Clinicians’ reasons for antipsychotic coprescribing. Journal of Clinical Psychiatry, 65(12), 1597–1600.CrossRefPubMed
go back to reference Sim, K., Su, A., Fujii, S., Yang, S. Y., Chong, M. Y., Ungvari, G. S., et al. (2004). Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. British Journal of Clinical Pharmacology, 58(2), 178–183.CrossRefPubMed Sim, K., Su, A., Fujii, S., Yang, S. Y., Chong, M. Y., Ungvari, G. S., et al. (2004). Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. British Journal of Clinical Pharmacology, 58(2), 178–183.CrossRefPubMed
go back to reference Stahl, S. M. (2004). Focus on Antipsychotic polypharmacy: Evidence-based prescribing or prescribing-based evidence? International Journal of Neuropsychopharmacology, 7(2), 113–116.CrossRefPubMed Stahl, S. M. (2004). Focus on Antipsychotic polypharmacy: Evidence-based prescribing or prescribing-based evidence? International Journal of Neuropsychopharmacology, 7(2), 113–116.CrossRefPubMed
go back to reference Suzuki, T., Uchida, H., Tanaka, K. F., Tomita, M., Tsunoda, K., Nomura, K., et al. (2003). Reducing the dose of antipsychotic medications for those who had been treated with high-dose antipsychotic polypharmacy: an open study of dose reduction for chronic schizophrenia. International Clinical Psychopharmacology, 18(6), 323–329.CrossRefPubMed Suzuki, T., Uchida, H., Tanaka, K. F., Tomita, M., Tsunoda, K., Nomura, K., et al. (2003). Reducing the dose of antipsychotic medications for those who had been treated with high-dose antipsychotic polypharmacy: an open study of dose reduction for chronic schizophrenia. International Clinical Psychopharmacology, 18(6), 323–329.CrossRefPubMed
go back to reference Suzuki, T., Uchida, H., Watanabe, K., Nakajima, S., Nomura, K., Takeuchi, H., et al. (2008). Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia: An open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidone. Human Psychopharmacology: Clinical and Experimental, 23(6), 455–463.CrossRef Suzuki, T., Uchida, H., Watanabe, K., Nakajima, S., Nomura, K., Takeuchi, H., et al. (2008). Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia: An open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidone. Human Psychopharmacology: Clinical and Experimental, 23(6), 455–463.CrossRef
go back to reference Tapp, A. (2003). Combination antipsychotic therapy in clinical practice. Psychiatric Services, 54(4), 574a.CrossRef Tapp, A. (2003). Combination antipsychotic therapy in clinical practice. Psychiatric Services, 54(4), 574a.CrossRef
go back to reference Tranulis, C. (2008). Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Safety, 31(1), 7–20.CrossRefPubMed Tranulis, C. (2008). Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature. Drug Safety, 31(1), 7–20.CrossRefPubMed
go back to reference Valuck, R. J., Morrato, E. H., Dodd, S., Oderda, G., Haxby, D. G., & Allen, R. (2007). How expensive is antipsychotic polypharmacy? Experience from five US state medicaid programs. Current Medical Research and Opinion, 23(10), 2567–2576.CrossRefPubMed Valuck, R. J., Morrato, E. H., Dodd, S., Oderda, G., Haxby, D. G., & Allen, R. (2007). How expensive is antipsychotic polypharmacy? Experience from five US state medicaid programs. Current Medical Research and Opinion, 23(10), 2567–2576.CrossRefPubMed
go back to reference Waddington, J. L., Youssef, H. A., & Kinsella, A. (1998). Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. British Journal of Psychiatry, 173, 325–329.CrossRefPubMed Waddington, J. L., Youssef, H. A., & Kinsella, A. (1998). Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. British Journal of Psychiatry, 173, 325–329.CrossRefPubMed
go back to reference Weissman, E. M. (2002). Antipsychotic prescribing practices in the veterans healthcare administration–New York metropolitan region. Schizophrenia Bulletin, 28(1), 31–42.PubMed Weissman, E. M. (2002). Antipsychotic prescribing practices in the veterans healthcare administration–New York metropolitan region. Schizophrenia Bulletin, 28(1), 31–42.PubMed
go back to reference Zhu, B., Ascher-Svanum, H., Faries, D. E., Correll, C. U., & Kane, J. M. (2008). Cost of antipsychotic polypharmacy in the treatment of schizophrenia. BMC Psychiatry, 8, 19.CrossRefPubMed Zhu, B., Ascher-Svanum, H., Faries, D. E., Correll, C. U., & Kane, J. M. (2008). Cost of antipsychotic polypharmacy in the treatment of schizophrenia. BMC Psychiatry, 8, 19.CrossRefPubMed
Metadata
Title
Trends in Adult Antipsychotic Polypharmacy: Progress and Challenges in Florida’s Medicaid Program
Authors
Robert J. Constantine
Ross Andel
Rajiv Tandon
Publication date
01-12-2010
Publisher
Springer US
Published in
Community Mental Health Journal / Issue 6/2010
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-009-9288-2

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