Polypharmacy in the treatment of schizophrenic patients in three University Centers in the Federation of Bosnia and Herzegovina (F/BH).

BACKGROUND: Polypharmacy in psychiatry is becoming the rule rather than the exception. Using more drugs at same time usually occurs where single drugs are considered insufficiently effective. SUBJECTS AND METHODS: The sample consisted of 216 patients: 85 from Sarajevo, and 44 and 87 respectively from Mostar and Tuzla. All schizophrenic patients who were hospitalised in three University Centers of F/BiH (Sarajevo, Tuzla, Mostar) on a particular day are included in the study. This included patients of both sexes (131 (60.65%) males and 85 females (39.35%)), 20-60 ages, who were on antipsychotic treatment with an established diagnosis of schizophrenia by the treating psychiatrist. The research was performed in the year 2004. The census of patients was conducted simultaneously in all three Centers, using a questionnaire in which all routine prescribed antipsychotics were registered, as the common method of the administration, and the doses as well saving as data for other medications that were simultaneously prescribed to the patients that day. RESULTS: Within the total sample the most frequently applied classical antipsychotics were haloperidol, promazine and from the group of new antipsychotics clozapine. The most frequently used other medications were biperidine and diazepam. The administration of all medication was followed through recording of individual doses, daily doses and frequency of administration. There are statistically significant differences regarding the frequency of biperidine use between the centers (p=0.008). CONCLUSION: In three University Clinical Centers of the Federation of Bosnia and Herzegovina (Sarajevo, Tuzla and Mostar), the applied rule is that more drugs in the treatment of schizophrenic psychosis and doing polypharmacy is the inevitable approach to treatment. The concept behind the polypharmacy is based on the fact that antipsychotic drugs do not cover all the symptoms of schizophrenic psychosis, and that additional medications may correct iatrogenic side effects caused by antipsychotic drugs. It is expected that the new atypical antipsychotics will treat much broader symptoms of psychosis and will not cause extrapyramidal side effects, as do the typical antipsychotics.