Non-clozapine antipsychotic combinations for treatment-resistant schizophrenia

Yow, Alex; Jayaram, Mahesh

doi:10.1002/14651858.cd012523

Cited by 2 publications

(6 citation statements)

References 37 publications

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“…Seu diagnóstico é feito a partir do reconhecimento de um conjunto de sinais e sintomas e da exclusão de outras causas que justifiquem tais manifestações. [1][2][3][4][5]16] O tratamento recomendado para este transtorno pela maioria das diretrizes, inclusive pela Diretriz Terapêutica do Ministério da Saúde, consiste inicialmente em antipsicótico em monoterapia, escolhido com base no perfil de segurança e tolerabilidade de cada paciente. Em casos refratários a pelo menos 2 ensaios, com duração de pelo menos 6 semanas, com antipsicóticos diferentes e em dose adequada, é indicado tentar clozapina.…”

Section: Introductionunclassified

revisão do tratamento da esquizofrenia: monoterapia vs associação de antipsicóticos

Bertoni

Leal

2023

Debates em Psiquiatria

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Introdução: O tratamento farmacológico da esquizofrenia com a associação de antipsicóticos é uma prática bastante comum, ainda que não haja evidências científicas consolidadas que a fundamentem, tampouco haja orientação nesse sentido, nas diretrizes de tratamento clínico. Objetivo: Avaliar os benefícios e os riscos do uso da associação de antipsicóticos em comparação ao uso de antipsicótico em monoterapia para o tratamento de esquizofrenia. Metodologia: Foi realizada uma revisão na literatura em busca de estudos científicos que comparassem o uso de antipsicóticos em monoterapia com a associação de antipsicóticos para o tratamento da esquizofrenia. Resultados: Na maioria dos estudos não houve diferenças no controle de sintomas entre os grupos. No entanto, observou-se menor frequência de reagudizações de sintomas e redução das hospitalizações nos pacientes em tratamento com antipsicótico em monoterapia. Além disso, houve menos efeitos adversos em pacientes com essa opção terapêutica. A adesão foi menor com a troca do tratamento com associação de antipsicóticos para antipsicótico em monoterapia. Porém a mudança foi bem tolerada, sendo que, em quase todos os pacientes, foram observados resultados favoráveis. Conclusões: O tratamento da esquizofrenia e do transtorno esquizoafetivo com antipsicótico em monoterapia apresenta um controle de sintomas semelhante ao tratamento com associação de antipsicóticos. Entretanto, em monoterapia é menor a ocorrência de efeitos colaterais, reagudizações e hospitalizações. Portanto, esta revisão reforça que, na prática clínica, o tratamento farmacológico da esquizofrenia, assim como do transtorno esquizoafetivo, deve priorizar uso de antipsicóticos em monoterapia.

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Section: Introductionunclassified

revisão do tratamento da esquizofrenia: monoterapia vs associação de antipsicóticos

Bertoni

Leal

2023

Debates em Psiquiatria

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“…In schizophrenia, AVHs are commonly treated with first or second generation antipsychotic (SGA) medication (Yow & Jayaram, ). Studies conducted in youth with first‐episode psychosis have shown a greater tolerability and efficacy for SGA medications, but no difference in outcome according to medication type (Datta, Kumar, Wright, Furtado, & Russell, ; Kumar, Datta, Wright, Furtado, & Russell, ).…”

Section: Introductionmentioning

confidence: 99%

“…The clinically significant side‐effects from, and long‐term complications associated with, antipsychotic medications suggest that they should be used only when there is a clear clinical indication for treatment, such as clinical distress, behavioural disturbance or functional impairment associated with positive psychotic symptoms (Pagsberg et al, ). Despite this, one third of patients with schizophrenia have treatment resistant hallucinations and delusions and 10%to 50% of patients are prescribed combination antipsychotics to address this lack of response to medication (Yow & Jayaram, ). Moreover, 49% to 67% of first‐episode psychosis patients will relapse at least once due factors such as non‐adherence (Di Capite, Upthegrove, & Mallikarjun, ; Pelayo‐Terán et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…In schizophrenia, AVHs are commonly treated with first or second generation antipsychotic (SGA) medication (Yow & Jayaram, 2017 The clinically significant side-effects from, and long-term complications associated with, antipsychotic medications suggest that they should be used only when there is a clear clinical indication for treatment, such as clinical distress, behavioural disturbance or functional impairment associated with positive psychotic symptoms (Pagsberg et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, one third of patients with schizophrenia have treatment resistant hallucinations and delusions and 10%to 50% of patients are prescribed combination antipsychotics to address this lack of response to medication (Yow & Jayaram, 2017). Moreover, 49% to 67% of firstepisode psychosis patients will relapse at least once due factors such as non-adherence (Di Capite, Upthegrove, & Mallikarjun, 2018;Pelayo-Terán et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial

Chanen

Betts

Jackson

et al. 2019

Early Intervention Psych

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Aim Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. Method VERBATIM is a 12‐week, triple‐blind, single‐centre, parallel groups randomised controlled trial, with a 27‐week follow‐up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. Results The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. Conclusion The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.

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Non-clozapine antipsychotic combinations for treatment-resistant schizophrenia

Cited by 2 publications

References 37 publications

revisão do tratamento da esquizofrenia: monoterapia vs associação de antipsicóticos

revisão do tratamento da esquizofrenia: monoterapia vs associação de antipsicóticos

Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial

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