Pharmacological Treatment of Schizophrenia

2007 ◽  
pp. 203-242 ◽  
Author(s):  
Zafar Sharif ◽  
Daniel Bradford ◽  
Scott Stroup ◽  
Jeffrey Lieberman
Keyword(s):  
Antipsychotic Drugs ◽  
Full Range ◽  
Maintenance Phase ◽  
Motor Dysfunction ◽  
Psychotic Symptoms ◽  
Pharmacological Agents ◽  
Lifetime Prevalence Rate ◽  
Glutamate Agonists ◽  
Concomitant Medications ◽  
Extrapyramidal Motor

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 medications such as benzodiazepines, lithium, carbamazepine, valproic acid, antidepressants, glutamate agonists, and dopamine agonists have been used alone and in combination with antipsychotic drugs in order to improve treatment response. In this chapter, we review controlled trials of the pharmacological agents used to treat schizophrenia.

Pharmacological Treatments for Schizophrenia

2015 ◽  
Author(s):  
Atheir I. Abbas ◽  
Jeffrey A. Lieberman
Keyword(s):  
First Generation ◽  
Antipsychotic Drugs ◽  
Full Range ◽  
Maintenance Phase ◽  
Psychotic Symptoms ◽  
Pharmacological Treatments ◽  
Pharmacological Agents ◽  
Limited Efficacy ◽  
Lifetime Prevalence Rate ◽  
Risk Of Relapse

Schizophrenia, a chronic mental disorder, has a lifetime prevalence rate of approximately 1%. The first antipsychotic drug, chlorpromazine, was introduced in 1954, followed by several similar drugs. With the introduction of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and more recently paliperidone, iloperidone, asenapine, and lurasidone, antipsychotic drugs are often classified as first generation or typical (chlorpromazine-like) versus second generation or atypical (clozapine-like), although the distinction between the two classes, particularly with respect to efficacy, is not as meaningful as initially believed. Both classes have been demonstrated to safely improve psychotic symptoms in the acute phase of the illness and to reduce the risk of relapse in the maintenance phase of treatment. Because of the limited efficacy of antipsychotics in resolving the full range of schizophrenic psychopathology, adjunctive treatments are often used to reduce morbidity. This chapter reviews controlled trials of the pharmacological agents used to treat schizophrenia.

scholarly journals A comparative study of effectiveness, safety and cost effectiveness of olanzapine, risperidone and aripiprazole therapy in schizophrenia

2020 ◽  
Vol 9 (5) ◽  
pp. 786
Author(s):  
Pooja R. Kanani ◽  
Ajita Pillai
Keyword(s):  
Cost Effectiveness ◽  
Antipsychotic Drugs ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Psychotic Symptoms ◽  
Average Dose ◽  
Psychiatric Hospitalizations ◽  
Score Analysis ◽  
Risperidone Group

Background: Schizophrenia is the most common psychotic disorder and responsible for approximately half of long-term psychiatric hospitalizations. Antipsychotic medications reduce the psychotic symptoms and prevent relapses. The choice of drug for treatment of schizophrenia depends on many issues, including effectiveness, cost, side-effect burden, availability, and tolerability. Many studies have compared antipsychotic drugs with one another, but no broad consensus has been reached. Our study compares the clinical effectiveness, safety and cost effectiveness of atypical antipsychotics in our setting.Methods: This was an observational, prospective study in which schizophrenia patients receiving either olanzapine, risperidone or aripiprazole were enrolled. Patients were followed up for 3 months. Evaluation of effectiveness was done by analysing mean reduction in PANSS score. Analysis of ADRs was done using WHO causality scale and Hartwig and Siegel severity scale. Cost analysis was done by comparing all three groups in term of cost range of antipsychotic drugs per improvement in PANSS score during the study period.Results: In the present study, the average dose of antipsychotic drugs received by a patient per day was 8.83±2.98 mg in olanzapine group, 4.76±1.12 mg in risperidone group and 20.43±8.5 mg in aripiprazole group. Mean reduction in PANSS score from baseline to 12 weeks was 23.79% in olanzapine group, 25.41% in risperidone group and 24.65% in aripiprazole group. Conclusions: All the groups were equally effective in reduction in PANSS score while risperidone was the most cost effective.

Prevalence of Obesity in Patients Receiving Depot Antipsychotics

1988 ◽  
Vol 153 (2) ◽  
pp. 214-217 ◽  
Author(s):  
T. Silverstone ◽  
Glenyss Smith ◽  
Elizabeth Goodall
Keyword(s):  
Antipsychotic Drugs ◽  
Clinical Importance ◽  
Chronic Schizophrenia ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
London Borough ◽  
Prevalence Of Obesity ◽  
Depot Neuroleptic ◽  
Depot Antipsychotics

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

2016 ◽  
Vol 33 (S1) ◽  
pp. S546-S546 ◽  
Author(s):  
H. Maatallah ◽  
H. Ben Ammar ◽  
M. Said ◽  
A. Aissa
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Symptoms ◽  
Review Of Literature ◽  
Blood Cell Count ◽  
Life Threatening ◽  
Dsm Iv ◽  
Competing Interest

IntroductionAntipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.Objective and methodsDefine epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.Case reportPatient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.ConclusionThis case report shows the importance of hematological monitoring during the course of typical or atypical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Antipsychotic drugs increase Neuregulin1b1 serum levels in first-episode drug-naïve patients and chronic schizophrenia with suggestions for improving the treatment of psychotic symptoms

2021 ◽  
Author(s):  
Haidong Yang ◽  
Wen Pan ◽  
Wenhuan Xiao ◽  
Man Yang ◽  
Jianchun Xu ◽  
...  
Keyword(s):  
Antipsychotic Drugs ◽  
Chronic Schizophrenia ◽  
Serum Levels ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Therapeutic Effects ◽  
Pathophysiological Mechanism ◽  
Healthy Controls ◽  
Drug Naïve

Abstract Background: Neuregulin1 (NRG1) plays a role in neuronal migration, regulation of synaptic plasticity, and neural survival, and has been considered to be among the candidate genes for schizophrenia. This study focused on the variations in serum NRG1b1 levels following antipsychotic treatment and the relationship between NRG1b1 level and improvements in psychotic symptoms in first-episode drug-naïve (FEDN) patients and chronic schizophrenia.Methods: A total of 100 patients with schizophrenia were recruited and compared with 79 matched healthy controls. All patients had been drug-naïve for at least four weeks. Serum NRG1b1 levels and positive and negative syndrome scale (PANSS) scores were measured at the baseline and after four weeks. Serum NRG1b1 levels were measured using sandwich enzyme-linked immunosorbent assays (ELISA).Results: Baseline NRG1b1 levels were significantly lower in the patients with schizophrenia compared with the healthy controls. NRG1b1 levels increased significantly following antipsychotic treatment. NRG1b1 levels gradually increased with declining PANSS scores and its three subscales during antipsychotic therapy. The levels of NRG1b1 increased significantly in responders after four weeks of treatment, although non-responders showed no such effect. Correlation analyses showed that the levels of NRG1b1 were negatively correlated with the duration of illness and positively correlated with improvement in symptoms.Conclusion: The levels of serum NRG1b1 and the therapeutic effects gradually increased following treatment, indicating that NRG1b1 may be an indicator of therapy, and that it may also be associated with the pathophysiological mechanism causing schizophrenia, although this possible pathway requires further investigation. Antipsychotic drugs increase Neuregulin1b1 serum levels in first-episode drug-naïve patients and chronic schizophrenia with suggestions for improving the treatment of psychotic symptoms

scholarly journals Antipsychotic Drugs Reverse MK801-Inhibited Cell Migration and F-actin Condensation by Modulating the Rho Signaling Pathway in B35 Cells

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yi-Chyan Chen ◽  
Fu-Ming Tsai ◽  
Mao-Liang Chen
Keyword(s):  
Cell Migration ◽  
Antipsychotic Drugs ◽  
Neuronal Cells ◽  
Coiled Coil ◽  
Psychotic Symptoms ◽  
Cell Nuclei ◽  
Signaling Regulation ◽  
Myosin Light Chain 2 ◽  
Pathway Regulation ◽  
Regulatory Effects

Background and Aim. MK801-induced psychotic symptoms and also the Ras homolog family member A (RhoA) expression and cell division control protein 42 (cdc42) mRNA modulation in the rat brain have been investigated. Antipsychotic drugs (APDs) have been reported to induce Rho GDP-dissociation inhibitor (RhoGDI) pathway regulation related to cytoskeleton reorganization in neuronal cells. It will be necessary to clarify the effects of APDs on MK801-induced RhoGDI signaling regulation in neuronal cells. Methods. B35 neuronal cells were treated with MK801 for 7 days then treated with MK801 in combination with haloperidol or clozapine for a further 7 days. Cell migration, F-actin condensation, and RhoGDI signaling regulation were examined to investigate the regulatory effects of MK801, haloperidol, and clozapine in B35 neuronal cells. Results. MK801 reduced B35 cell migration, whereas both haloperidol and clozapine reversed the reduction in cell migration induced by MK801. Haloperidol and clozapine restored F-actin condensation after it was diminished by MK801 in B35 cell nuclei. MK801 increased the RhoGDI1 and RhoA expression, which was diminished by the addition of haloperidol and clozapine. MK801 reduced the CDC42 expression, which was restored by haloperidol and clozapine. MK801 reduced the Rho-associated coiled-coil containing protein kinase 1 (ROCK1), profilin1 (PFN1), and neuronal Wiskott–Aldrich Syndrome protein (N-WASP) expression, which was further reduced by haloperidol and clozapine. MK801 also increased the phosphorylated myosin light chain 2 (p-MLC2), postsynaptic density protein 95 (PSD-95), and c-jun expression, which was decreased by haloperidol and clozapine. p21 (RAC1-) activated kinase 1 (PAK1) expression was not affected by MK801.

Use of atypical antipsychotic drugs in old age psychiatry

2002 ◽  
Vol 8 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Walter Pierre Bouman ◽  
Gill Pinner
Keyword(s):  
Mood Disorders ◽  
Elderly People ◽  
Old Age ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Psychotropic Medications ◽  
Psychotic Symptoms ◽  
Organic Psychoses ◽  
Old Age Psychiatry

Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.

Antipsychotic and anticholinergic drugs

2012 ◽  
pp. 1208-1231
Author(s):  
Herbert Y. Meltzer ◽  
William V. Bobo
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Drug Induced ◽  
Atypical Antipsychotic Drugs ◽  
Normal Limits ◽  
Psychotic Features

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.

scholarly journals Maintenance Treatment of Bipolar Disorder with Ziprasidone in Adjunctive Use with Lithium or Valproate

2012 ◽  
Vol 4 ◽  
pp. CMT.S7369 ◽  
Author(s):  
Steven L. Dubovsky ◽  
Amelia N. Dubovsky
Keyword(s):  
Bipolar Disorder ◽  
Antipsychotic Drugs ◽  
Mood Stabilizer ◽  
Manic Episode ◽  
Mood Stabilizers ◽  
Psychotic Symptoms ◽  
Comorbid Conditions ◽  
Recurrence Rates ◽  
Atypical Antipsychotic Drug ◽  
A Current

Ziprasidone is a second generation (“atypical”) antipsychotic drug that has been used alone and as an adjunct to standard mood stabilizers to reduce recurrence rates in bipolar disorder. Approval of ziprasidone as an adjunct to lithium or valproate in 2009 was based on an industry sponsored study of 584 outpatients with a current or recent manic episode; 240 of these subjects were randomized to adjunctive ziprasidone or placebo and 138 completed a six month trial. Patients enrolled in maintenance studies did not have refractory mood disorders, comorbid conditions or risk of dangerousness. Maintenance ziprasidone augmentation is an option for patients who do not respond to a single mood stabilizer rapidly, and possibly for those with residual psychotic symptoms, but there are insufficient data to prefer this approach to combinations of mood stabilizers or augmentation with other agents. Ziprasidone is generally well tolerated, with less sedation and weight gain than many other antipsychotic drugs; it should be taken with food. Primary interactions of concern are with other serotonergic medications, MAO inhibitors, and other medications that prolong the QT interval.

scholarly journals Acute psychotic disorders induced by topiramate: report of two cases

2002 ◽  
Vol 60 (2A) ◽  
pp. 285-287 ◽  
Author(s):  
Florindo Stella ◽  
Dorgival Caetano ◽  
Fernando Cendes ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
The Other ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Visual Hallucinations ◽  
Psychomotor Agitation ◽  
Full Remission ◽  
Epileptic Patients ◽  
Severe Anxiety

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

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