Switching from Antipsychotic Polypharmacy to Monotherapy in Hebephrenic Schizophrenia: A Case Study
DOI:
https://doi.org/10.61194/jhlqr.v6i1.905Keywords:
Hebephrenic Schizophrenia, hebephrenic schizophrenia; polypharmacy; monotherapy; antipsychotic; medication adherence, Monotherapy, Antipsychotic, Medication AdherenceAbstract
Schizophrenia is a chronic psychiatric disorder that imposes a substantial burden on patients and caregivers. Antipsychotic polypharmacy remains a common clinical practice to manage persistent positive and negative symptoms, although growing evidence indicates it does not significantly improve treatment outcomes and may instead increase adverse effects, treatment costs, and non-adherence. This case study aimed to describe the clinical benefits and rational considerations of switching from antipsychotic polypharmacy to monotherapy in a patient with hebephrenic schizophrenia. A 37-year-old woman with a 20-year history of hebephrenic schizophrenia was observed. She had previously received a combination of chlorpromazine and trifluoperazine with trihexyphenidyl for extrapyramidal symptom prevention. Clinical evaluations were performed to assess therapeutic effects, side effects, and medication adherence before and after the switch to chlorpromazine monotherapy. During the polypharmacy phase, the patient experienced several side effects, including insomnia, restlessness, irritability, and mild extrapyramidal symptoms. After transitioning to monotherapy with an adjusted chlorpromazine dose, she showed notable improvement in psychotic symptoms, sleep quality, and social functioning without severe adverse reactions. Medication adherence increased as the patient reported greater comfort and tolerance with a single-drug regimen. This case suggests that switching from antipsychotic polypharmacy to monotherapy can reduce side effects, improve adherence, and maintain clinical stability. Rational and individualized use of antipsychotics should be prioritized to achieve better long-term outcomes and quality of life in schizophrenia management.
References
Association, A. P. (2020). The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia (3rd ed.). https://doi.org/10.1176/appi.books.9780890424841
Association, W. M. (2013). Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
Cahyaningsih, D., & Syahrul, H. (2019). Hebephrenic schizophrenia: Diagnostic and therapeutic challenges. Medika Jurnal Kedokteran dan Kesehatan, 8(1), 158–161.
Correll, C. U., Rubio, J. M., & Kane, J. M. (2020). What is the risk-benefit ratio of long-term antipsychotic treatment in schizophrenia? World Psychiatry, 19(3). https://doi.org/10.1002/wps.20793
Dwidiyanti, M., & Sari, S. P. (2019). Medication adherence and relapse prevention in schizophrenia through mindfulness therapy. Jurnal Ilmu Keperawatan Jiwa, 2(1), 79–82.
Gallego, J. A., Bonetti, J., Zhang, J., Kane, J. M., & Correll, C. U. (2012). Prevalence and correlates of antipsychotic polypharmacy: A systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia Research, 138(1), 18–28. https://doi.org/10.1016/j.schres.2012.03.018
Green, J., & Thorogood, N. (2022). Qualitative methods for health research (5th ed.). Sage Publications.
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthoj, B., & Gattaz, W. F. (2021). & World Federation of Societies of Biological Psychiatry (WFSBP. The World Journal of Biological Psychiatry, 22(4), 255–276. https://doi.org/10.1080/15622975.2020.1839420
Hashimoto, K., Soraoka, H., Yamada, H., Ono, H., & Uchida, H. (2023). Change of prescription patterns for patients with schizophrenia during admission: A real-world prescribing survey. BMC Psychiatry, 23. https://doi.org/10.1186/s12888-023-04972-w
Hatta, K., Ikuta, S., Iwata, K., Uchida, H., & Tani, K. (2018). Antipsychotic polypharmacy in schizophrenia: An evolving treatment paradigm. International Journal of Neuropsychopharmacology, 21(4). https://doi.org/10.1093/ijnp/pyx109
Keks, N., Schwartz, D., & Hope, J. (2019). Stopping and switching antipsychotic drugs. Australian Prescriber, 42(5). https://doi.org/10.18773/austprescr.2019.050
Kim, J., Lee, M., Cho, S., Lee, J., Kim, Y., & Kim, C. E. (2022). Comparative effectiveness of antipsychotic monotherapy and polypharmacy in treatment-resistant schizophrenia: A nationwide study. Schizophrenia Research, 241. https://doi.org/10.1016/j.schres.2022.01.050
Lawrence, C., Roberts, C., Galides, C., Chamberlain, S. R., & Hou, R. (2024). Antipsychotic polypharmacy and high-dose therapy compared to monotherapy: A systematic review. Journal of Psychopharmacology, 39(2). https://doi.org/10.1177/02698811231214123
Lin, S. K. (2021). Antipsychotic polypharmacy: Current evidence and clinical controversies. International Journal of Neuropsychopharmacology, 24(3). https://doi.org/10.1093/ijnp/pyaa087
Maslim, R. (2019). Clinical use of psychotropic drugs. Atma Jaya University Press.
Mubin, M. F., Jiwa, K., Semarang, M., Fadhilah, N., & Hidayat, W. (2019). Relationship between medication adherence and relapse among schizophrenia patients. Jurnal Farmasetis, 8(1), 21–24.
National Institute for Health and Care Excellence (NICE). (2023). https://www.nice.org.uk/guidance/cg178
Organization, W. H. (2023). Schizophrenia: Key facts. https://www.who.int/news-room/fact-sheets/detail/schizophrenia
Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17(3). https://doi.org/10.1002/wps.20567
Takeuchi, H., Kantor, N., Uchida, H., Suzuki, T., & Remington, G. (2022). Immediate vs gradual discontinuation of antipsychotics in patients with schizophrenia: A systematic review and meta-analysis. Schizophrenia Bulletin, 48(2). https://doi.org/10.1093/schbul/sbab102
Tiihonen, J., Taipale, H., Mehtälä, J., Vattulainen, P., Correll, C. U., & Tanskanen, A. (2019). Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry, 76(5). https://doi.org/10.1001/jamapsychiatry.2018.4320
Velligan, D. I., Sajatovic, M., Hatch, A., Kramata, P., & Docherty, J. P. (2017). Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness. Patient Preference and Adherence, 11. https://doi.org/10.2147/PPA.S124658
Yin, R. K. (2018). Case study research and applications: Design and methods (6th ed.). Sage Publications.
Yulianty, M. D., Cahaya, N., & Srikartika, V. M. (2017). Adverse effects of antipsychotic polypharmacy in schizophrenia: A hospital-based study. Jurnal Sains Farmasi & Klinis, 3(2). https://doi.org/10.29208/jsfk.2017.3.2.95
Zhang, Y., Chen, L., Zhang, S., Li, H., & Wang, Y. (2022). Efficacy of antipsychotic monotherapy and polypharmacy in schizophrenia: A real-world analysis. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.860713
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