Doubtful association of antipsychotic polypharmacy and high dosage with cognition in chronic schizophrenia

Kontis, Dimitrios; Theochari, Eirini; Kleisas, Spyridon; Kalogerakou, Stamatina; Andreopoulou, Angeliki; Psaras, Rafael; Makris, Yannis; Karouzos, C.; Tsaltas, Eleftheria

doi:10.1016/j.pnpbp.2010.07.029

Cited by 29 publications

(19 citation statements)

References 66 publications

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“…For instance, a few studies have reported that above a certain antipsychotic daily dose, schizophrenia patients show worse performance on neurocognitive tests (Elie et al, 2010;Hori et al, 2006), but others have not (Kontis et al, 2010). In the present study there were no significant correlation between the daily dose and performance on the Block Design, the Raven's, or mental rotation, but we have found a positive association with brain activations during the mental rotation task in the two groups.…”

Section: Discussioncontrasting

confidence: 69%

Clozapine and visuospatial processing in treatment-resistant schizophrenia

Bourque

Lakis

Champagne

et al. 2013

Cognitive Neuropsychiatry

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Present results suggest better visuospatial processing in the NTR relative to the TR-C group. This difference could be attributed to the treatment resistance itself or a lack of beneficial effect of clozapine relative to other atypical antipsychotics in ameliorating nonverbal abilities. Future studies of the relationship between clozapine and cognition, as well as between treatment resistance and cognition, are warranted.

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Section: Discussioncontrasting

confidence: 69%

Clozapine and visuospatial processing in treatment-resistant schizophrenia

Bourque

Lakis

Champagne

et al. 2013

Cognitive Neuropsychiatry

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“…Furthermore, Hori 98 examined 67 patients with chronic schizophrenia and 92 healthy controls and found that patients on APP or high doses had lower cognitive performance. Conversely, only Kontis 99 , in a cross-sectional study, found no difference in cognitive performance in patients with APP compared to patients on antipsychotic monotherapy.…”

Section: Resultsmentioning

confidence: 90%

Safety and tolerability of antipsychotic polypharmacy

Gallego

Nielsen

Hert³

et al. 2012

Expert Opinion on Drug Safety

170

142

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Introduction Antipsychotic polypharmacy (APP), the concomitant use of ≥2antipsychotics, is common in clinical practice. Prior reviews have focused on the efficacy of APP, but no systematic review exists regarding the safety and tolerability of this practice. Areas covered in this review We conducted a systematic review of adverse effects associated with APP. Case series with ≥2 patients, chart reviews, naturalistic, data base, cohort and randomized studies that reported on the association between APP in general or specific APP combinations and global or specific adverse effect were included. We discuss methodological limitations of available studies and provide recommendations for clinicians and future research. Expert Opinion Across mostly small and uncontrolled studies, APP has been associated with increased global side effect burden, rates of Parkinsonian side effects, anticholinergic use, hyperprolactinemia, sexual dysfunction, hypersalivation, sedation/somnolence, cognitive impairment, and diabetes. Effects on akathisia and mortality were inconclusive. Although some combinations, particularly aripiprazole augmentation of an agent with greater side effect burden, may reduce weight gain, dyslipidemia, hyperprolactinemia and sexual dysfunction, APP should remain a last resort treatment option after monotherapy, switching and non-antipsychotic combinations have failed. More and high quality data are needed to further inform the individualized risk-benefit evaluation of APP.

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“…[20] A number of studies have shown that second-generation antipsychotics were the most commonly prescribed antipsychotic medication. [2122] A recent study by Monshat et al . (2010)[23] observed that second-generation antipsychotic medications were the most widely used agents (79% in 2004, 99% in 2007) of all other types of antipsychotics.…”

Section: Resultsmentioning

confidence: 99%

Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia

Shrivastava

Johnston

Terpstra

et al. 2012

Indian J Psychiatry

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Background:It is not clear if the role of antipsychotics in long-term clinical and functional recovery from schizophrenia is correlated. The pattern of use is a major aspect of pharmacotherapy in long-term follow-ups of schizophrenia. The aim of this study was to examine patterns of antipsychotic usage in patients with longstanding psychosis and their relationship to social outcomes.Materials and Methods:We conducted a cross-sectional study on a cohort from a long-term outcome study. Participants were 116 first episode schizophrenia patients from Mumbai, India, who had more than 80% compliance, as reported by relatives. Patients were assessed on antipsychotic medication use and on clinical and functional parameters.Results:There was a high compliance rate (72%). Most patients (77%) used atypical antipsychotics; only 10 (8.6%) patients were taking typical antipsychotics. There were no among-drug differences in the percentage of patients meeting the recommended dose: Clozapine (200–500 mg), Riseperidone (4.0–6.0 mg), Olanzapine (10–20 mg), Quetiapine (400–800 mg), Aripiprazole (15–30 mg), Ziprasidone (120–160 mg); an equivalent dosage of Chlorpromazine (300–600 mg) did not differ amongst any atypical antipsychotic subgroup. Also, we did not find any significant differences in recovery on Clinical Global Impression Severity scale (CGIS), Quality of Life (QOL), or Global Assessment of Functioning (GAF) between groups of antipsychotic drugs.Conclusion:This study shows that most patients suffering from schizophrenia, in a long-term follow-up, use prescribed atypical antipsychotics within the recommended limits. Also, the chlorpromazine equivalence dosages do not differ across antipsychotic medications. The outcomes on clinical and functional parameters are also similar across all second-generation antipsychotics.

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Doubtful association of antipsychotic polypharmacy and high dosage with cognition in chronic schizophrenia

Cited by 29 publications

References 66 publications

Clozapine and visuospatial processing in treatment-resistant schizophrenia

Clozapine and visuospatial processing in treatment-resistant schizophrenia

Safety and tolerability of antipsychotic polypharmacy

Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia

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