Adjunctive Versus Monotherapeutic Treatment for Schizophrenia: Addressing Antipsychotic Side Effects

In the article by Joo-Cheol Shim, M.D., Ph.D., et al., published in the September 2007 issue of the Journal, aripiprazole was added to haloperidol to evaluate the benefcial effects on haloperidol-induced hyperprolactinemia. The authors pointed out that switching is “not always possible in clinical practice, especially if the patient has responded well to the antipsychotic that produced the hyperprolactinemia” (1, p. 1404). The addition of aripiprazole significantly decreased prolactin levels and improved negative symptoms, sleep, and extrapyramidal side effects. The authors attributed these effects to aripiprazole’s unique mechanism(s) of action (2). We do not take issue with the scientific merit of this study but are concerned with the clinical implications, specifically the apparent promotion and justification of the adjunctive use of aripiprazole.