The Texas Medication Algorithm Project Antipsychotic Algorithm for Schizophrenia

Miller, Alexander L.; Hall, Catherine S.; Boyer, Robert; Buckley, Peter F.; Chiles, John A.; Conley, Robert R.; Crismon, M. Lynn; Ereshefsky, Larry; Essock, Susan M.; Finnerty, Molly; Marder, Stephen R.; Miller, Del D.; McEvoy, Joseph P.; Rush, A. John; Saeed, Sy Atezaz; Schooler, Nina R.; Shon, Steven P.; Stroup, T. Scott; Tarin-Godoy, Bernardo

doi:10.4088/jcp.v65n0408

Cited by 180 publications

(110 citation statements)

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“…However, despite dissemination of evidence-based treatment guidelines for schizophrenia that strongly endorse the use of clozapine (7)(8)(9), the extent of its use in the United States remains well below the estimated prevalence of treatment-resistant schizophrenia (10,11).…”

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confidence: 99%

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Kreyenbuhl¹,

Marcus²,

West³

et al. 2008

FOC

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Objective-This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported.Methods-Psychiatrists participating in a nationally representative mailed survey (N=209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year.Results-Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Conclusions-Consistent NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken.A substantial proportion of patients with schizophrenia, estimated at 10% to 30% of outpatients, are considered resistant to standard antipsychotic treatment (1-3). In an inpatient population of one state psychiatric hospital, roughly one-half of patients with schizophrenia were determined to be treatment resistant on the basis of inadequate response to two different antipsychotic medication trials of at least six weeks' duration (4). Treatment-resistant patients often exhibit persistent residual disability and impaired quality of life and incur significant health care costs despite sustained adherence with antipsychotic medications (2).Clozapine is the only antipsychotic medication with demonstrated efficacy for treating positive symptoms in treatment-resistant schizophrenia (1,5,6). However, despite dissemination of evidence-based treatment guidelines for schizophrenia that strongly endorse the use of clozapine (7-9), the extent of its use in the United States remains well below the estimated prevalence of treatment-resistant schizophrenia (10,11).Clinicians faced with a patient who does not respond to or cannot tolerate standard antipsychotic therapy are left with few treatment options. One option is to switch the patient to another antipsychotic agent in hopes that its receptor profile will prove beneficial (12-14). However, a considerable...

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mentioning

confidence: 99%

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Kreyenbuhl¹,

Marcus²,

West³

et al. 2008

FOC

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“…Novamente, caso haja resposta, o paciente deve prosseguir com o respectivo antipsicótico. Caso isto não ocorra, alguns algoritmos, como o TMAP, 2 propõem que se faça uma terceira tentativa, desta vez com antipsicóticos de primeira geração (fase 1 c) (D).…”

Section: Avaliação Do Risco-benefício Dos Antipsicóticos De Segunda Gunclassified

“…Em relação aos antipsicóticos de primeira geração (APG), os ASG têm a vantagem de causar menos efeitos colaterais extrapiramidais, tais como parkinsonismo, distonias, acatisia e discinesia tardia e, além disso, têm maior efeito nos sintomas negativos da esquizofrenia (A). Os ASG são, atualmente, preconizados como tratamento de primeira linha na esquizofrenia [1][2][3][4] (A) e também no tratamento da mania bipolar (A). [5][6] Entretanto, apesar das vantagens em relação aos APG, verificouse que o uso dos ASG está associado a um aumento importante de peso e alterações metabólicas, como as dislipidemias, síndrome metabólica (SM) e diabetes (A).…”

Section: Introductionunclassified

Consenso Brasileiro sobre antipsicóticos de segunda geração e distúrbios metabólicos

Elkis

Gama

Suplicy³

et al. 2008

Rev. Bras. Psiquiatr.

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“…Guidelines for the treatment of schizophrenia such as the American Psychiatric Association 13 or algorithms such as the Texas Medication Algorithm Project (TMAP) 14 have established that after the failure of two or three treatments on atypical antipsychotics, the patient should be considered as having RS. This has been considered to make the patient a good candidate for treatment with clozapine, the only drug approved for RS.…”

Section: Definitions Of Rs Based On Algorithmsmentioning

confidence: 99%

“…Non-pharmacological treatments 1) ECT and TMS Despite the fact that ECT is recommend as an augmentation strategy for clozapine non-responders in some guidelines 13 or algorithms such as the TMAP 14 or the IPAP (www.ipap.org), there only few studies providing evidence of efficacy for this intervention.…”

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Esquizofrenia refratária

Elkis

Meltzer

2007

Rev. Bras. Psiquiatr.

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A b s t r a c t Objective: The aim of the present paper is to review the various aspects of refractory schizophrenia regarding issues such as definitions, clinical aspects, psychobiological correlates, pharmacological and non-pharmacological treatment options and predictors of treatment response. Method: Medline search as well as articles of the authors. Results and Conclusions: Refractory schizophrenia affects at least one third of patients with schizophrenia and the best evidence shows that is monotherapy with clozapine remains the mainstay for the treatment of such condition. Antipsychotic polipharmacy is not supported by current evidence and recent clinical trials have shown that clozapine augmentation with antipsychotics has no benefit over placebo.Descriptors: Schizophrenia/therapy; Drug utilization review; Clinical protocols; Pharmacologic actions; Treatment outcome Resumo Objetivo: O propósito deste artigo é o de revisar vários aspectos da esquizofrenia refratária levando em conta questões relacionadas a definição, aspectos clínicos, correlatos psicobiológicos, tratamentos farmacológicos e não farmacológicos, assim como preditores de resposta terapêutica. Método: Pesquisa no Medline, assim como artigos dos autores. Resultados e Conclusões: Pelo menos um terço dos pacientes com esquizofrenia são refratários a tratamento com antipsicóticos e as evidências apontam a clozapina em monoterapia como a principal opção nesses casos. A politerapia com antipsicóticos não tem apoio em evidências. Ensaios clínicos recentes mostraram que a potencialização da clozapina com outros antipsicóticos não é superior ao placebo.

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The Texas Medication Algorithm Project Antipsychotic Algorithm for Schizophrenia

Cited by 180 publications

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Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Adding or Switching Antipsychotic Medications in Treatment-Refractory Schizophrenia

Consenso Brasileiro sobre antipsicóticos de segunda geração e distúrbios metabólicos

Esquizofrenia refratária

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