Comparison of antipsychotic prescribing practices following failure of antipsychotic monotherapy in the acute care setting.

Introduction: Numerous strategies exist following antipsychotic monotherapy failure including transition to another antipsychotic, dosing above FDA recommendations, or dual antipsychotic therapy. This study described antipsychotic prescribing practices on an acute psychiatry unit following antipsychotic monotherapy failure and compared outcomes to determine if any strategy resulted in superior short-term outcomes. Methods: This retrospective chart review assessed postintervention time to discharge for patients with schizophrenia or schizoaffective disorder requiring therapy change following treatment failure. Secondary outcomes included 30-day readmission rate, length of stay, and discharge chlorpromazine equivalents. Results: There were no differences in number of past antipsychotic trials between groups (4.8 vs 4.5; Discussion: This study found that following failure of antipsychotic monotherapy, transition to an alternative antipsychotic was associated with decreased mean time to discharge as compared to dual antipsychotic therapy. Further studies are needed to assess long-term clinical implications of these findings.