ANTYPSYCHOTICS IN SCHIZOPHRENIA TREATMENT – LITERATURE REVIEW
Keywords:
antipsychotics, schizophrenia therapy, side effects of antipsychotic therapy
Abstract
Aim. To analyze the administration of antipsychotics as main pharmaceuticals in treatment of schizophrenia as chronic mental disease involving several positive, negative, cognitive, and affective symptoms resulting in disorganization of mental activity and mental disadaptation in patients. Results. We have found the data on the absence of significant differences in efficacy of antipsychotics relative to positive symptoms and mental disorganization symptoms except for advantages of clozapine in the treatment of resistant cases. It shown that the therapy efficacy from the position of treatment of negative, depressive, and cognitive symptoms is determined depending on: (1) how the reduction of positive symptoms (delirium and hallucinations) improves the secondary symptoms of disease, and (2) how side extrapyramidal effects (EPSE) and side anticholinergic effects are corrected by drugs administered to influence EPSE aggravating the mentioned symptoms. There is a reasonable opinion that strong antipsychotics that do not have accompanying extrapyramidal actions and do not require the combined anticholinergic therapy have huge therapeutic advantages. Conclusion. It is found that having much in common in efficacy all antipsychotics greatly differ in rate and intensity of side effects. Contrary to belief that second-generation antipsychotics (so called atypical antipsychotics) are normally considered the drugs with less risk of extrapyramidal actions and higher risk of metabolic side effects in comparison with traditional antipsychotics; the significant variability of frequency of these and other side effects of these two types of drugs indicates that such categorical distinguishing of pharmaceuticals is not clinically justified. The choice of antipsychotic should be based on individual preferences of patients, their therapeutic response to the previous treatment, history of presence and specifics of antipsychotic side effects, medical data on risk factors, level of compliance to the prescribed treatment, and, especially, the profile of side effects of various antipsychotics.References
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3. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, et al. Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. J Clin Psychiatry, 2004, vol. 65(2), pp. 267–272. DOI: 10.4088/JCP.v65n0219
4. Chakos M., Lieberman J., Hoffman E. Effectiveness of Second-Generation Antipsychotics in Patients with Treatment-Resistant Schizophrenia: A Review and Meta-Analysis of Randomized Trials. Am J Psychiatry, 2001, vol. 158(4), pp. 518–526. DOI: 10.1176/appi.ajp.158.4.518
5. Correll C.U., Rummel-Kluge C., Corves C. Antipsychotic Combinations vs Monotherapy in Schizophrenia: A Meta-Analysis of Randomized Controlled Trials. Schizophr Bull., 2009, vol. 35(2), pp. 443–457. DOI: 10.1093/schbul/sbn018
6. De Hert M., Correll C.U., Cohen D. Do Antipsychotic Medications Reduce or Increase Mortality in Schizophrenia? A Critical Appraisal of the FIN-11 Study. Schizophr Res., 2010, vol. 117(1), pp. 68–74. DOI: 10.1016/j.schres.2009.12.029
7. Delay J., Deniker P., Karl J. Traitement Des Etats D’Excitation et D’Agitation Par Une Methode Medicamenteuse Derive De L’Hibernotherapie. Ann Medicopsychol., 1952, vol. 119, pp. 267–273.
8. Dixon L.B., Dickerson F., Bellack A.S. Schizophrenia Patient Outcomes Research Team (PORT). The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophr Bull., 2010, vol. 36(1), pp. 48–70. DOI: 10.1093/schbul/sbp115
9. Emsley R., Rabinowitz J., Medori R. Time Course for Antipsychotic Treatment Response in First-Episode Schizophrenia. Am J Psychiatry, 2006, vol. 163(4), pp. 743–745. DOI: 10.1176/ajp.2006.163.4.743
10. Fischer-Barnicol D., Lanquillon S., Haen E. Working Group ‘Drugs in Psychiatry.’ Typical and Atypical Antipsychotics – the Misleading Dichotomy: Results from the Working Group ‘Drugs in Psychiatry’ (AGATE). Neuropsychobiology, 2008, vol. 57(1–2), pp. 80–87. DOI: 10.1159/000135641
11. Glassman A.H., Bigger J.T.Jr. Antipsychotic Drugs: Prolonged QTc Interval, Torsade De Pointes, and Sudden Death. Am J Psychiatry, 2001, vol. 158(11), pp. 1774–1782. DOI: 10.1176/appi.ajp.158.11.1774
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14. Hegarty J.D., Baldessarini R.J., Tohen M. One Hundred Years of Schizophrenia: A Meta-Analysis of the Outcome Literature. Am I Psychiatry, 1994, vol. 151(10), pp. 1409–1416. DOI: 10.1176/ajp.151.10.1409
15. Hill S.K., Bishop J.R., Palumbo D. Effect of Second-Generation Antipsychotics on Cognition: Current Issues and Future Challenges. Expert Rev Neurother., 2010, vol. 10(1), pp. 43–57. DOI: 10.1586/ern.09.143
16. Hugenholtz G.W., Heerdink E.R., Stolker J.J. Haloperidol Dose when Used as Active Comparator in Randomized Controlled Trials with Atypical Antipsychotics in Schizophrenia: Comparison with Officially Recommended Doses. J Clin Psychiatry, 2006, vol. 67(6), pp. 897–903. DOI: 10.4088/JCP.v67n0606
17. Kahn R.S., Fleischhacker W.W., Boter H. EUFEST Study Group. Effectiveness of Antipsychotic Drugs in First-Episode Schizophrenia and Schizophreniform Disorder: an Open Randomised Clinical Trial. Lancet, 2008, vol. 371(9618), pp. 1085–1097. DOI: 10.1016/S0140-6736(08)60486-9
18. Kane J., Honigfeld G., Singer J. Clozapine for the Treatment-Resistant Schizophrenic: a Double-Blind Comparison with Chlorpromazine. Arch Gen Psychiatry, 1988, vol. 45(9), pp. 789–796. DOI: 10.1001/archpsyc.1988.01800330013001
19. Kane J.M., Leucht S., Carpenter D. Expert Consensus Panel for Optimizing Pharmacologic Treatment of Psychotic Disorders. The Expert
Consensus Guideline Series. Optimizing Pharmacologic Treatment of Psychotic Disorders. Introduction: Methods, Commentary, and Summary. J Clin Psychiatry, 2003, vol. 64 (suppl 12), pp. 5–19.
20. Kane J.M. Tardive Dyskinesia Circa 2006. Am J Psychiatry, 2006, vol. 163(8), pp. 1316–1318. DOI: 10.1176/ajp.2006.163.8.1316
21. Kapur S., Zipursky R., Jones C. Relationship Between Dopamine D(2) Occupancy, Clinical Response, and Side Effects: a Double-Blind PET Study of First-Episode Schizophrenia. Am J Psychiatry, 2000, vol. 157(4), pp. 514–520. DOI: 10.1176/appi.ajp.157.4.514
22. Kapur S., Remington G. Dopamine D(2) Receptors and Their Role in Atypical Antipsychotic Action: Still Necessary and May Even be Sufficient. Biol Psychiatry, 2001, vol. 50(11), pp. 873–883. DOI: 10.1016/S0006-3223(01)01251-3
23. Kapur S., Mizrahi R., Li M. From Dopamine to Salience to Psychosis-Linking Biology, Pharmacology and Phenomenology of Psychosis. Schizophr Res., 2005, vol. 79(1), pp. 59–68. DOI: 10.1016/j.schres.2005.01.003
24. Keefe R.S., Bilder R.M., Davis S.M. Neurocognitive Working Group. Neurocognitive Effects of Antipsychotic Medications in Patients with Chronic Schizophrenia in the CATIE Trial. Arch Gen Psychiatry, 2007, vol. 64(6), pp. 633–647. DOI: 10.1001/archpsyc.64.6.633
25. Kinon B.J., Chen L., Ascher-Svanum H. Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Respons in the Treatment of Schizophrenia. Neuropsychopharmacology, 2010, vol. 35(2), pp. 581–590. DOI: 10.1038/npp.2009.164
26. Leucht S., Barnes T.R.E., Kissling W. Relapse Prevention in Schizophrenia with New-Generation Antipsychotics: a Systematic Review and Exploratory Meta-Analysis of Randomized, Controlled Trials. Am J Psychiatry, 2003, vol. 160(7), pp. 1209–1222. DOI: 10.1176/appi.ajp.160.7.1209
27. Leucht S., Busch R., Hamann J. Early-Onset Hypothesis of Antipsychotic Drug Action: a Hypothesis Tested, Confirmed and Extended. Biol Psychiatry, 2005, vol. 57(12), pp. 1543–1549. DOI: 10.1016/j.biopsych.2005.02.023
28. Leucht S., Corves C., Arbter D. Second-Generation Versus First-Generation Antipsychotic Drugs for Schizophrenia: a Meta-Analysis. Lancet, 2009, vol. 373(9657), pp. 31–41. DOI: 10.1016/S0140-6736(08)61764-X
29. Leucht S., Arbter D., Engel R.R. How Effective are Second-Generation Antipsychotic Drugs? A Meta-Analysis of Placebo-Controlled Trials. Mol Psychiatry, 2009, vol. 14(4), pp. 429–447. DOI: 10.1038/sj.mp.4002136
30. Leucht S., Komossa K., Rummel-Kluge C. A Meta-Analysis of Head-to-Head Comparisons of Second-Generation Antipsychotics in the Treatment of Schizophrenia. Am J Psychiatry, 2009, vol. 166(2), pp. 152–163. DOI: 10.1176/appi.ajp.2008.08030368
31. Lieberman J.A., Stroup T.S., McEvoy J.P. Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. N Engl J Med., 2005, vol. 353(12), pp. 1209–1223. DOI: 10.1056/NEJMoa051688
32. McEvoy J.P., Lieberman J.A., Stroup T.S. CATIE Investigators. Effectiveness of Clozapine Versus Olanzapine, Quetiapine, and Risperidone in Patients with Chronic Schizophrenia Who did not Respond to Prior Atypical Antipsychotic Treatment. Am J Psychiatry, 2006, vol. 163(4), pp. 600–610. DOI: 10.1176/ajp.2006.163.4.600
33. Meltzer H.Y., Alphs L., Green A.I. International Suicide Prevention Trial Study Group. Clozapine Treatment for Suicidality in Schizophrenia: International Suicide Prevention Trial (Inter-SePT). Arch Gen Psychiatry, 2003, vol. 60(1), pp. 82–91. DOI: 10.1001/archpsyc.60.1.82
34. Nasrallah H.A., Tandon R. Classic Antipsychotic Medications. American Psychiatric Press Textbook of Psychopharmacology. 4th ed. Washington, DC: American Psychiatric Press, 2009, pp. 533–554.
35. Newcomer J.W., Haupt D.W. The Metabolic Effects of Antipsychotic Medications. Can J Psychiatry, 2006, vol. 51(8), pp. 480–491.
36. Ozbilen M., Adams C.E. Systematic Overview of Cochrane Reviews for Anticholinergic Effects of Antipsychotic Drugs. J Clin Psychopharmacol., 2009, vol. 29(2), pp. 141–146. DOI: 10.1097/JCP.0b013e31819a91f1
37. Ran M.S., Chan CL-W., Chen EY-H. Differences in Mortality and Suicidal Behaviour Between Treated and Never-Treated People with Schizophrenia in Rural China. Br J Psychiatry, 2009, vol. 195(2), pp. 126–131. DOI: 10.1192/bjp.bp.108.055301
38. Rankupalli B., Tandon R. Practicing Evidence-Based Psychiatry, Applying a Study’s Findings: the Threats to Validity Approach. Asian J Psychiatr., 2010, vol. 3(1), pp. 35–40. DOI: 10.1016/j.ajp.2010.01.002
39. Ray W.A., Chung C.P., Murray K.T. Atypical Antipsychotic Drugs and the Risk of Sudden Cardiac Death. N Engl J Med., 2009, vol. 360(3), pp. 225–235. DOI: 10.1056/NEJMoa0806994
40. Saha S., Chant D., McGrath J. A Systematic Review of Mortality in Schizophrenia: is the Differential Mortality Gap Worsening Over Time? Arch Gen Psychiatry, 2007, vol. 64(10), pp. 1123–1131. DOI: 10.1001/archpsyc.64.10.1123
41. Salimi K., Jarskog L.F., Lieberman J.A. Antipsychotic Drugs for First Episode Schizophrenia: a Comparative Review. CNS Drugs., 2009, vol. 23(10), pp. 837–855. DOI: 10.2165/11314280-000000000-00000
42. Smith M., Hopkins D., Peveler R.C. First- v Second- Generation Antipsychotics and Risk for Diabetes in Schizophrenia: Systematic Review and Meta-Analysis. Br J Psychiatry, 2008, vol. 192, pp. 406–411. DOI: 10.1192/bjp.bp.107.037184
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References on translit
Published
2016-09-01
How to Cite
Stoychev, K., Ivanov, K., Kojuharov, C., Khrusafov, D., Alexandrova, M., & Barkashka, D. (2016). ANTYPSYCHOTICS IN SCHIZOPHRENIA TREATMENT – LITERATURE REVIEW. Human. Sport. Medicine, 16(3), 25-36. https://doi.org/10.14529/hsm160304
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Clinical and Experimental Medicine
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