Polypharmacy

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Polypharmacy refers to the simultaneous treatment of an illness, with two or more medications, that share a similar mechanism of action and therapeutic effect. A common reason doctors use this technique is to gain a greater or a more rapid therapeutic effect than achieved with monotherapy. Also, the multiple medications prescribed help to treat the wide range of symptoms associated with the mental illness. Polypharmacy in treatment- resistant patients is considered “common practice” in some mental illnesses. It is widely used in the treatment of Schizophrenia, through the use of antipsychotics medications, although there is a known risk of severe adverse reactions in the patient. The long-term effects of polypharmacy are largely unknown because most studies are short-term and fail to evaluate patients over extended periods of time.

S.G. demonstrated multiple adverse side effects that resulted from polypharmacy and previous serum levels of Clozaril. The patient has a past medical history of seizures secondary to Clozaril levels greater than 700. Currently, he is taking 450 milligrams, orally at bedtime. Levels are monitored frequently and a dosing limitation was set to prevent further adverse effects. S.G. also suffers with the movement disorder, tardive dyskinesia (TD), caused by high doses of Haldol (haloperidol), used during his initial medication trails. It is a chronic and persistent disorder. S.G’s neuroleptic induced tardive dyskinesia is further classified as simple stereotypy, meaning the involuntary movement is confined to only one body part. During our conversations, he made rhythmic and repetitive movements with his tongue and at times this made it noticeably difficult for him to communicate. The patient’s current medication regimen included multiple drug classifications such as an antipsychotic, an antiparkison agent, an anticonvulsant (prescribed for off-label to treatment of mood stabilization), an antihypertensive, a beta2-adrenergic agonist...
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