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Reducing Psychotropic Polypharmacy Cheat Sheet by

Recommendations for Reducing Psychotropic Polypharmacy
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Reducing Psycho­tropic Polyph­armacy

1. Trea­tment with a single psycho­tropic medication (monot­her­apy) is the first-line treatment approach. Prescr­ibers should ensure the dose and duration of monoth­erapy trials are adequate, and consistent with eviden­ce-­based guidel­ines.
2. Nonp­har­mac­ologic therap­ies, for instance cognitive behavioral therapy for insomnia, anxiety, or depres­sion, are well-r­ese­arched and effective for management of symptoms. Psycho­social interv­entions should be considered as an altern­ative strategy to polyph­armacy for symptom control and improved well being.
3. Consumers who are prescribed multiple psycho­tropics within or across classes should be engaged by their prescr­ibers in a conver­sation about the risks associated with their regimen, and the benefits of making a change. Reducing polyph­armacy should be considered if clinically approp­riate.
4. For consumers receiving more than one agent from the same class, periodic efforts should be made to taper off medica­tions and to streamline the pharma­cology once the consumer is doing well.
5. Gradual medication tapers are recomm­ended when discon­tinuing medica­tions. Medication changes are tolerated best by consumers when the changes proceed slowly. A common clinical practice is to change a medication by no more than 1/3 of the current dose, no more frequently than every 2-3 weeks.
6. Psycho­edu­cat­ion in varied formats should be available to all consumers. Brochures, scientific summaries, inform­ation sessions, and ongoing medication education groups can be helpful in providing inform­ation for consumers and promote dialogue with prescr­ibers.
7. Consumers and families will benefit from supportive services from the clinic during periods of medication change. These services may include frequent check-in calls with the clinic nurse, increased appoin­tment frequency with the prescriber and therapist, medication groups with other consumers, and psycho­edu­cation about side effects or symptoms likely to be experi­enced. Specific interv­entions for management of changes in well being may be developed by the clinical staff to provide clients with tools to use during the change.
8. Rating scales filled out by the client can be very helpful during medication changes. Rating scales can educate consumers in unders­tanding and observing symptom conste­lla­tions over time; and provide clinicians with accurate longit­udinal inform­ation about the effect of medication change or discon­tin­uation on symptoms and function.
9. If, after careful review, the prescriber and consumer decide to begin or continue polyph­armacy
 ­ ­ ­ a. Comb­ining medication from the same class, for example antips­ych­otics, should only be considered after a series of failed monoth­erapy trials.
 ­ ­ ­ b. There should be a clear indication and clear target symptoms identi­fied for each medication prescr­ibed.
 ­ ­ ­ c. When adding a second medica­tion, consider an agent with a different mechanism of action.

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