The concept of polypharmacy has generated much argument and this is has now come to a head with specific symposia and now a CINP thematic meeting. Briefly, those in academia, pharmacy and general adult practice tend to frown on this whereas the forensic members rely on it. Steven Stahl has even famously called it “the dirty little secret”.

More recently the concept of rational polypharmacy has arisen where the clicinician can justify his prescriptions. All of this depends on treating a named condition eg schizophrenia. Indeed affective disorders are often treated with polypharmacy and many physical conditions are routinely given polypharmacy.

If we assume that Kraepelin was wrong about his original assertion that there is a schism and whether other conditions are also not proven like personality disorders, then patients can simply be treated by their symptoms without a diagnosis. There are many advantages to this like the abolition of stigma but more importantly this allows the use of traditional drugs used for other conditions like lithium or anti manic agents to be used as required according to response rather than for specific diagnoses. There are other advantages eg in research and especially genetics.

The presentation examines this in detail with some real life examples.