Dr Kerryn Armstrong Psychiatrist, Cape Town

Antipsychotic agents form the mainstay of treatment for
many patients with serious mental illness. These agents
are used in a range of psychiatric disorders, including the
schizophrenia spectrum, bipolar disorder, and substanceinduced
disorders. Local and international clinical practice
guidelines for the treatment of schizophrenia1, 2 advocate
antipsychotic monotherapy as the routine approach.
Guidelines recommend avoiding antipsychotic polypharmacy
(APP), which can be defined as co-prescription of
more than one antipsychotic drug for a given patient.3
Exceptions to this may be when APP is required for short
periods when switching agents or in treatment-resistant
cases, when augmentation of clozapine with another antipsychotic
agent may be considered, although supporting
evidence for this remains weak.4, 5 Treatment guidelines
recommend use of antipsychotics as part of treatment
options in bipolar disorder, but do not advocate an APP
approach.