Antipsychotics have been utilized as the standard
treatment for
schizophrenia regardless of illness phase where
antipsychotic monotherapy (APM) is routinely recommended as the
gold standard rather than
antipsychotic polypharmacy (APP). However, approximately 20 to 40% of
patients with
schizophrenia do not respond to APM based on randomized controlled clinical trials and large
practical clinical trials indicating that the subgroup of
patients with
schizophrenia would need differential
treatment approaches beyond traditional
treatment strategies such as APM. Numerous studies have supported the use of APP in particular for
patients with certain clinical situations including failure to show
efficacy or tolerability from
treatment with APM, need for different
treatment for targeting specific symptom domains, severe illness, failure to
treatment with
clozapine, skepticism about following
treatment guidelines, or cross titration periods. Furthermore, recent large
cohort studies and
practical clinical trials have proposed more benefits of APP rather than APM in terms of
rehospitalization,
mortality, and specific symptoms. APP has recently become more widely utilized and recognized as one of the next
treatment strategies to clinicians for
patients with
schizophrenia. Some experts have already proposed the revision of
treatment guidelines incorporating APP as evidence-based
treatment option for certain
patients with
schizophrenia. Taken together, APP now deserves an evidence-based and acceptable
treatment strategy, not an empirical or preferential
treatment approach for
treatment of
schizophrenia in contemporary clinical practice.