Drug treatment developments in schizophrenia and bipolar mania: latest evidence and clinical usefulness

Abstract

Schizophrenia and bipolar disorder are often highly debilitating with chronic courses, and psychotropic drugs represent cornerstones in the treatment. The primary aim of the review was to summarize the latest evidence with regards to the efficacy and effectiveness of drug treatment of schizophrenia and the manic phases of bipolar disorder. Schizophrenia systematic reviews conclude that antipsychotic drugs are effective in treating overall symptoms of psychosis and in preventing relapse. Some of the newer agents, the secondgeneration antipsychotics (SGAs), have demonstrated superiority compared with the older first-generation drugs and other SGAs but side-effect differences among the drugs are of a greater magnitude than effect differences. The pragmatic randomized trials of effectiveness have shown a longer time until treatment discontinuation for olanzapine compared with other antipsychotics. Cohort studies have found superiority for the long-acting injection formulations compared with the oral formulations of the drugs, and lower total mortality risk in users of antipsychotics compared with non-users. In bipolar mania SGAs have shown superior antimanic efficacy compared with other mood-stabilizing drugs. In conclusion antipsychotics, in particular some of the SGAs, seem to be drugs of first choice for both schizophrenia and bipolar mania. This perspective review focused on mean effects but the group means may not always be particularly useful as schizophrenia and bipolar mania are biologically heterogeneous disorders with large inter-individual variations in drug response and tolerance. In patients with a prior drug history the different pharmacological and clinical profiles may be exploited in subsequent choices of drugs.

Can authorities take advantage of the availability of generic atypical antipsychotic drugs? Findings from Sweden and potential implications

“…No appreciable change in the utilisation of risperidone, following generic availability in Sweden, mirrors the situation seen in Austria, Belgium, Scotland, Spain and Ireland . This may reflect the advice from organisations such as NICE in the UK, the Medical Directors Council of the National Association of State Mental Health Program Directors in the USA, the conclusions from various Cochrane reviews and the CATIE studies, that treatment with atypical antipsychotic drugs should be tailored to the individual patient, which is seen in practice . This may also reflect the fact that no specific demand‐side measures were instigated nationally or regionally in Sweden to encourage the prescribing of oral generic risperidone first line, where appropriate.…”

“…There has also been growing use of atypical antipsychotic drugs in wider populations including patients with bipolar disorders …”

Constructing the Immune Signature of Schizophrenia for Clinical Use and Research; An Integrative Review Translating Descriptives Into Diagnostics

“…Although dopamine D2-receptor blocking antipsychotic drugs play a major role in the treatment of psychotic disorders (13), new treatment options are strongly needed, above all for the cognitive and negative symptoms of schizophrenia. D2-blockers offer symptomatic relief for delusions and hallucinations and efficient relapse prevention to a majority of users (14), but a disease-modifying effect in schizophrenia has not been found. Immune-modulating treatments might target pathological processes more proximal to the roots of the psychotic disorder than is the case for the current D2-receptor blocking drugs, and accordingly may be able to treat not only symptoms.…”

Integrative Genomic–Epigenomic Analysis of Clozapine-Treated Patients with Refractory Psychosis

“…We included patients with psychosis that met the clinical criteria of SZ, BD, or SD, but we should consider that these disorders constitute a well-recognized clinical spectrum. In relation to this, there are clinical and epidemiological studies considering SZ and BD as a single major psychosis phenotype, demonstrating the shared genetic liability and overlapping polygenic component of the two illnesses [ 80 , 81 ]. SD has been less investigated but shows substantial familial overlap with both SZ and BD [ 82 ].…”