ORIGINAL ARTICLE Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics H. Rittmannsberger 1 , U. Meise 3 , K. Schauflinger 1 , E. Horvath 2 , H. Donat 2 , H. Hinterhuber 3 1 Upper Austrian Provincial Mental Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15 A-4020 Linz, Austria ; 2 Psychiatric Department, Kaiser Franz Josef Hospital Vienna, Austria ; 3 Psychiatric University Clinic Innsbruck, Austria (Remise 12 March 1998 ; revise 10 August 1998 ; accepted 16 September 1998) Summary – There are great variations in the way psychotropic drugs are prescribed. Most experts are in favour of psychopharmacological monotherapy, but little is known about the extent to which it is actually practised. A survey of the psychopharmacological medication of all patients under treatment was carried out in three Austrian psychiatric clinics of various types on two separate days. A psychiatric university clinic, the psychiatric department of a general hospital and a regional mental hospital were selected for the survey. It was established that only 8% to 22% of the patients underwent psycho-pharmacological monotherapy and that the patients received 2.2 to 3.3 psychotropics on average. Five to 22% of the patients received five or more psychotropic agents. The results are presented in more detail in relation to the diagnoses of schizophrenia and depression. The rare occurence of monotherapy might be due to unsound treatment regimens in some instances, but much more to a general trend in psychiatry fostering polydrug use. © Elsevier, Paris psychotropic drugs / monotherapy / polypharmacy / psychiatric inpatients INTRODUCTION Although psychotropic drugs have been in use for over 30 years and have been the subject of intense scientific research, there are still great variations in the way they are prescribed in terms of dosage level, indication and combination with other psychopharmacological agents. Most experts are in favour of psychopharmaco- logical monotherapy and this is also stressed in the textbooks of psychiatry (e.g., [3, 6, 19, 28, 34]). On the other hand there are various instances in which polyp- harmacy is considered to be necessary: the administra- tion of sleeping medication, sedative and anxiolytic agents in the event of high levels of agitation and danger to the patient himself or others, the administration of phase prophylactics in addition to acute treatment, and combination therapy in the case of therapy resistance, e.g., the many types of augmentation strategies. So the question remains, to what extent the principal aim of psychopharmacologic monotherapy is actually prac- tised. In comparison with the vast number of publications on psychotropic drugs as a whole, the literature avail- able on such pharmaco-epidemiological issues is lim- ited. Where research has been carried out in this field, the results are in most cases considered to deviate from the required standard. The main criticism is that mono- therapy recommendations are not followed and too many psychotropic drugs are prescribed. A survey of such studies (table I) shows that only a few hospitals succeed in meeting the demand for monotherapy to any degree. These are mainly university institutions which often tend to treat a selective patient population. In the non-universitarian institutions there also seems to be a trend to lower rates of monotherapy in more recent years. Eur Psychiatry 1999 ; 17 : 1–8 © Elsevier, Paris