Valproate for schizophrenia

Abstract

There is limited evidence, based on a number of trials, that the augmentation of antipsychotics with valproate may be effective for overall clinical response, and also for specific symptoms, especially in terms of excitement and aggression. However, this evidence was entirely based on open RCTs. Moreover, valproate was associated with a number of adverse events among which sedation and dizziness appeared significantly more frequently than in the control groups. Further randomised studies which are blinded are necessary before any clear recommendation can be made. Ideally these would focus on people with schizophrenia and aggression, on those with treatment-resistant forms of the illness and on those with schizoaffective disorders.

Use of antidepressants and mood stabilizers in persons with first-episode schizophrenia

“…Antipsychotics affect especially positive symptoms, whereas for negative symptoms and cognitive impairment, they are less effective [3]. Antidepressant (AD) or mood stabilizer (MS) use as adjuvants to antipsychotics has been investigated in treatment for symptoms such as depressive and negative symptoms [4] and aggression [5], but they are rarely recommended in clinical guidelines due to lack of high quality evidence of their efficacy [3,6,7]. Evidence on benefits in clinical trials is mixed which was represented by a recent study reporting that add-on citalopram was associated with reduced levels of negative symptoms but had no impact on depressive symptoms [8].…”

Clozapine‐induced hepatitis confirmed by rechallenge

“…19 There is some evidence that augmenting antipsychotics with valproate may also be effective, especially when aggression is a feature. 20 Mirtazapine is another augmenting option and is one we actually trialled prior to rechallenge with clozapine as evidence has shown that it may have a positive overall effect on a patient's mental state. 21 Despite numerous augmenting agents having been trialled there is a lack of high quality evidence t o m a k e a n y s p e c i f i c recommendations.…”

Complex visual hallucinatory experience in an elderly blind woman with glaucoma: revisiting Charles Bonnet syndrome

“…Although there is no specific recommended pharmacological treatment guideline, several agents including antipsychotics, anticonvulsants, anti‐anxiety, and selective serotonin inhibitors are widely used for the treatment of CBS with variable results . The evidence is limited to support the effectiveness of valproate monotherapy in the treatment of psychosis, and it is typically used as an adjuvant particularly for the symptoms of aggression, excitement, and tardive dyskinesia . Nonetheless, valproate was chosen for this patient due to a more favorable side effect profile compared to carbamazepine, which would also require benzodiazepine administration to maximize its therapeutic effect and thus pose many potential risks due to her geriatric status .…”

“…The evidence is limited to support the effectiveness of valproate monotherapy in the treatment of psychosis, and it is typically used as an adjuvant particularly for the symptoms of aggression, excitement, and tardive dyskinesia [17,18]. Nonetheless, valproate was chosen for this patient due to a more favorable side effect profile compared to carbamazepine, which would also require benzodiazepine administration to maximize its therapeutic effect and thus pose many potential risks due to her geriatric status [14,16].…”