Pharmacological treatment of schizophrenia and other psychotic disorders (original) (raw)
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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...
The Mount Sinai Conference on the Pharmacotherapy of Schizophrenia
Schizophrenia Bulletin, 2002
This report summarizes the recommendations from a consensus meeting that focused on specific questions regarding the pharmacotherapy of schizophrenia. The issues were selected because there was evidence that experts had recently disagreed about the evidence supporting a particular practice or when there were substantial variations in a clinical practice indicating that there was disagreement among clinicians. The group of experts was able to reach a consensus regarding the evidence base pertaining to the following issues: First generation (FGAs) and second generation (SGAs) antipsychotics as first line agents; the duration of antipsychotic trials; the effectiveness of clozapine and other agents for treatment refractory schizophrenia; risk of tardive dyskinesia on FGAs and SGAs; differences among antipsychotics for different dimensions of psychopathology; and side effect monitoring for various antipsychotics.
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.
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.
The future of pharmacotherapy for schizophrenia
World psychiatry : official journal of the World Psychiatric Association (WPA), 2003
Although enormous progress has been made in the treatment of schizophrenia, and the use of existing pharmacologic agents can have a dramatic effect on the short- and long-term management of the disorder, enormous challenges and unmet needs continue to exist. Despite the introduction of a second generation of antipsychotic medications, many patients continue to derive inadequate benefits from available agents. Negative symptoms and cognitive dysfunction, and decrements in psychosocial and vocational functioning, often continue to persist despite our best available treatments. Medication adherence remains a constant challenge and has not been dramatically improved by the new-generation antipsychotic drugs. Since all currently marketed antipsychotic agents possess some degree of dopamine antagonist effects, the role of other neurotransmitters in the primary antipsychotic activity remains largely unclear. It is possible that different domains of disease effects might benefit from differ...
Schizophrenia …, 2008
Data from two major government-funded studies of comparative antipsychotic effectiveness in schizophrenia contradict the widely prevalent belief that the newer second-generation medications are vastly superior to the older first-generation drugs. This has caused uncertainty among patients, clinicians and policy-makers about the relative utility of first-and second-generation antipsychotic agents in its treatment. To reduce confusion and provide a contextual understanding of the new data, the World Psychiatry Association Section on Pharmacopsychiatry comprehensively reviewed the literature on the comparative effectiveness of different antipsychotic treatments for schizophrenia and developed this update. Utilizing data from the approximately 1,600 randomized controlled trials of antipsychotic treatment in schizophrenia, we applied the two indirect and one direct method to comparing the effectiveness of 62 currently-available antipsychotic agents. The subclasses of 51 first-generation and 11 secondgeneration antipsychotics were both found to be very heterogeneous, with substantial differences in side-effect profiles among members. Second-generation antipsychotic agents were found to be inconsistently more effective than first-generation agents in alleviating negative, cognitive, and depressive symptoms and had a lower liability to cause tardive dyskinesia; these modest benefits were principally driven by the ability of second-generation antipsychotics to provide equivalent improvement in positive symptoms along with a lower risk of causing extrapyramidal side-effects. Clozapine was found to be more efficacious than other agents in treatment-refractory schizophrenia. There were no consistent differences in efficacy among other second-generation antipsychotic agents; if such differences exist, they are likely small in magnitude. Dosing was found to be a key variable in optimizing effectiveness of both first-and second-generation antipsychotic agents. There was enormous individual variability in antipsychotic response and vulnerability to various adverse effects. In contrast to their relatively similar efficacy in treating positive symptoms, there were substantial differences among both first-and second-generation antipsychotic agents with regard to their propensity to cause extrapyramidal, metabolic and other adverse effects; second-generation agents have a lower liability to cause acute extrapyramidal symptoms and tardive dyskinesia along with a tendency to cause greater metabolic side-effects than firstgeneration agents. Based on these data about the comparative effectiveness of different antipsychotic treatment options, we summarize elements of current best antipsychotic practice for the treatment of schizophrenia and discuss the role of government and the pharmaceutical industry in obtaining and disseminating information which can facilitate best practice.
The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements
2010
In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of firstepisode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.
New Drug Treatment Strategies in Schizophrenia: Editorial Introduction
Schizophrenia Bulletin, 1983
The recognition of both the value and limitations of antipsychotic drug treatment has led to research on effective alternative strategies for treatment. The authors review assumptions underlying such strategies and introduce five articles pertinent to the topic. These articles address: the use of drugs other than antipsychotic neuroleptics; the use of reduced dosages of antipsychotic drugs; the initiation of antipsychotic drugs early during periods of symptom exacerbation to prevent full relapse; the use of psychosocial treatment strategies in relation to drug treatment; and the development of antipsychotic drugs following models based on restitutive systems in the brain.