REVIEW ARTICLE *Corresponding Author: Pharmacotherapy of Schizophrenia: Ploypharmacy Approaches (original) (raw)
Related papers
Pharmacotherapy of Schizophrenia: Ploypharmacy Approaches
Acta Medica Iranica, 2010
Schizophrenia is a debilitating illness, rating as one of the leading causes of lost years of quality of life. The illness imposes a disproportionate burden on patients and their families, healthcare systems and society. Pharmacological management is the cornerstone of treatment of schizophrenia, and antipsychotics, both first generation of antipsychotics and second generation of antipsychotics, are efficacious in reducing levels of psychopathology in acute episodes of schizophrenia. Clearly a need for innovative treatment strategies in schizophrenia that will ensure increased effectiveness against negative symptoms and cognitive dysfunction dysfunction. Therefore, in majority of cases polypharmacy is one of the effective approaches. This review focused on polypharmacy in the treatment of schizophrenia and in particular negative symptoms.
Revising polypharmacy to a single antipsychotic regimen for patients with chronic schizophrenia
The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 2004
Antipsychotic polypharmacy has been empirically used and a recent trend in favour of that mode of therapy has been suggested for the treatment of schizophrenia. The clinical efficacy, however, still remains to be clarified. In order to critically evaluate the usefulness of such kind of psychopharmacotherapy, antipsychotic combination regimen (polypharmacy) was switched to a treatment with the single main antipsychotic (monotherapy) in cross-tapered fashion, while approximately maintaining the total amount, for patients with chronic schizophrenia. Patients had been treated with an average of three antipsychotics and maintained with the same antipsychotic polypharmacy regimen for more than 6 months before the entry. They were followed up with an antipsychotic monopharmacy and evaluated at 24 wk after completion of switching. Forty-seven patients were recruited for this study. Of 44 patients for whom evaluation was possible, 24 (54.5%) remained stable, while 10 (22.7%) showed improveme...
Bulletin of Clinical Psychopharmacology, 2012
Comparison of polypharmacy in schizophrenia and other psychotic disorders in outpatient and inpatient treatment periods: a naturalistic one year follow-up study Objective: Polypharmacy of antipsychotic drugs has been increasing although there are not enough evidence based data and recommendations in the treatment algorithms. The current study differs from cross-sectional studies as it aimed at observing the same patient population during their in-and outpatient periods for one year follow-up and investigated the frequency of polypharmacy and related factors in terms of clinical correlates and equivalent doses. Method: The patients admitted to Psychiatry Service of Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara in the 2008-09 period with the diagnosis of schizophrenia and other psychotic disorders (n=261) were reviewed and patients with regular follow up visits in the outpatient clinic (n=192) were included in the study. At the end of the first year, participants were evaluated for their treatment compliance, use of polypharmacy, drug doses, and severity of the disorder. Results: The rate of polypharmacy was 52.1% (n=100) at the time of discharge from hospital while it was 44.3% (n=85) during the one year-follow up visit (χ 2 =2.97, df=1, p=0.001). The polypharmacy and monotherapy groups were not statistically different in terms of comorbidity, disorder and treatment duration, number of previous hospitalizations, type of admission, and general medical condition. However, the monotherapy and polypharmacy groups were statistically different in terms of the use of antipsychotic type. The ratio of patients with severe disorder was statistically higher in the inpatient group. While the clinical severity impression (CGI) of patients in remission did not change during the follow-up period, the moderate to severe patient groups' severity increased during that time. Drug compliance of the polypharmacy group was statistically lower than the monotherapy group both in the inpatient (χ 2 =12.99; df=1; p=0.001) and outpatient (χ 2 =12.81; df=1; p=0.001) periods. Adverse event frequency was the same for both groups. Adverse events and lack of efficacy were the most frequent reasons for drug prescription change. Both inpatients and outpatients receiving antipsychotic combination therapy had statistically higher equivalent antipsychotic drug doses. Severity scores of inpatients receiving combination therapy were higher than the patients receiving other drug regimens Conclusion: Use of polypharmacy is limited in good clinical practice guidelines but surveys on clinical practices show that the use of polypharmacy is more frequent than the suggested levels in the guidelines. On the other hand, use of clozapine and long-term effective antipsychotics are below the incidence of suggested groups. In order to guide clinicians better, schizophrenia treatment algorithms need to emphasize the use of clozapine and long acting antipsychotics more.
Pharmacological treatment of schizophrenia and other psychotic disorders
American Psychological Association eBooks, 2019
associated with poor clinical outcomes. Comprehensive, integrated pharmacological and psychosocial treatments have been shown to improve these outcomes. While a growing number of studies suggest that second-generation antipsychotic medications may have beneficial effects on the treatment of co-occurring sub
Important Issues in the Drug Treatment of Schizophrenia
Schizophrenia Bulletin, 1980
The large body of research demonstrating the effectiveness of antipsychotic drugs in the treatment of acute schizophrenia is selectively reviewed. Research evidence relevant to the following issues is assessed; indications for selective treatment; characteristics of drug responders and nonresponders; indications for high dosage phenothiazine treatment; indications for maintenance therapy; benefits and risks of antipsychotic drugs. Recommendations are made concerning anas of psychopharmacologic research that require further development.
Pharmacological Treatment of Schizophrenia
A Guide to Treatments that Work, 2007
Schizophrenia is a chronic mental disorder with a lifetime prevalence rate of approximately 1%. The first antipsychotic drug, chlorpromazine, was introduced in 1954, followed by several similar drugs. With the later introduction of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, antipsychotic drugs have come to be classified as conventional (chlorpromazine-like) or atypical (clozapine-like). Both of these broad classes of medications have been demonstrated to safely improve psychotic symptoms in the acute phase of the illness and reduce risk of relapse in the maintenance phase of treatment. The atypical antipsychotics offer hope for enhanced efficacy in the treatment of schizophrenic psychopathology with a reduced burden of extrapyramidal motor dysfunction. Because of the limited efficacy of antipsychotic medication in resolving the full range of schizophrenic psychopathology, adjunctive treatments are often used to reduce morbidity. Concomitant medica...
Acta Psychiatrica Scandinavica, 2007
treatment of negative symptoms of schizophrenia: therapeutic opportunity or Cul-de-sac? Objective: Negative symptoms of schizophrenia are debilitating and they contribute to poor outcome in schizophrenia. Initial enthusiasm that second-generation antipsychotics would prove to be powerful agents to improve negative symptoms has given way to relative pessimism that the effects of current pharmacological treatments are at best modest. Method: A review of the current Ôstate-of-playÕ of pharmacological treatments for negative symptoms in schizophrenia. Results: Treatment results to date have been largely disappointing. The evidence for efficacy of second-generation antipsychotics is reviewed. Conclusion: The measurement and treatment trials methodology for the evaluation of negative symptoms need additional refinement before therapeutic optimism that better treatments for negative symptoms can be realized.
The Pharmacologic Treatment of Schizophrenia: A Progress Report
Schizophrenia Bulletin, 1983
Pharmacologic agents currently used or being studied for the treatment of schizophrenia are reviewed. Neuroleptic medications are still the mainstay of treatment, but recent studies suggest new approaches to dosage and to the treatment of acute psychosis. Lithium is beneficial in psychotic illnesses with acute onset and a remitting course, regardless of the acute psychotic symptoms. Antidepressant agents may ameliorate depression in psychotic patients, but do not improve psychotic symptoms or social withdrawal. Propranolol's reported antipsychotic action has not been confirmed by controlled studies, but the drug may have a role in treating organic psychoses. The benzodiazepines, clonidine, and carbamazepine all merit more investigation as possible treatments for psychosis. The implications of differential treatment response among schizophrenic patients are discussed.
Current perspectives in treating negative symptoms of schizophrenia: A narrative review (Review)
Experimental and Therapeutic Medicine, 2021
The negative symptoms of schizophrenia are an unmet treatment target as currently approved treatments mostly control positive symptoms. The persistence of these symptoms holds back the patient's reinstatement in society, making them incapable of fulfilling their social, professional, or family roles. There is overwhelming research evidence suggesting that the negative symptoms of schizophrenia are associated with poorer functioning and lower quality of life than positive symptoms, confirming the need for developing new treatments for this particular category of symptoms. This present review aims to review clinical trials addressing novel pharmacological approaches addressing primary negative symptoms of schizophrenia. We overview both monotherapies, first-generation and second-generation antipsychotics, and add-on therapies, including psychostimulants, anti-inflammatory drugs, antidepressants, molecules targeting glutamatergic, cholinergic or serotonergic systems and hormones. Our findings suggest that the primary negative symptoms of schizophrenia may be mitigated by adjunctive therapies, and we highlight the pharmacological agents that have proven superior efficacy. Novel compounds such as cariprazine and MIN-101, to date, show promising results, but large clinical trials are needed to test their efficacy and safety.