Adjunctive Treatments in Schizophrenia: Pharmacotherapies and Electroconvulsive Therapy

Abstract

Substantial proportions of patients with schizophrenia do not achieve acceptable levels of response with antipsychotic therapy alone, which commonly leads clinicians to use additional somatic interventions. This article reviews the literature on the use of adjunctive pharmacological treatments and electroconvulsive therapy (ECT) in schizophrenia. The authors find that, despite a large volume of literature, it is difficult to draw conclusions or treatment recommendations from available data because of small sample sizes and widely divergent study designs. At present, there is little firm evidence that adding adjunctive agents to standard neuroleptics will dramatically change the somatic treatment of schizophrenia. The most promising adjunctive agents are benzodiazepines, lithium, and carbamazepine, as well as antidepressants and ECT for affective symptoms. Future inpatient research on adjunctive treatments should be multicenter studies, followed by long-term outpatient trials that assess quality-of-life issues as well as symptom relief.

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

“…Reviewing the relevant published literature led Braga and Petrides (2005) and Haskett and Loo (2010) to much the same opinion: the combination of ECT and antipsychotic medication may be a useful option for patients with schizophrenia that has proved unresponsive to pharmacological interventions, and its adverse effect profile does not seem different from that seen with ECT alone. Johns and Thompson (1995) considered that there was a need for further research to delineate the specific role of ECT in schizophrenia, with studies targeting illness characterized by affective symptoms or a poor response to standard treatment, and seeking to establish whether it potentiates the effects of antipsychotic medication. The particular combination of ECT and clozapine was proposed and tested as a treatment strategy a couple of decades ago (Fink, 1990;Klapheke, 1991Klapheke, , 1993Meltzer, 1990) and has been reported as being safe.…”

Changes in the Treatment of Acute Psychosis in a German Public Hospital from 1998 to 2004

“…This result can be interpreted by the intention, to achieve a stabilization of affective symptoms and reduction of impulsive, aggressive and agitated behaviour [29]. Among national and international guidelines there is currently debate about this treatment option [17,30].…”

Current perspectives in the treatment of resistant schizophrenia

“…It may produce its beneficial effect by its ability to treat akathisia, increasing antipsychotic serum levels, decreasing anxiety symptoms. [92]Glycine and D cycloserine: Much interest has surrounded the use of glycine and partial agonists acting through the glycine site on NMDA receptors in the treatment of negative symptoms in schizophrenia. High doses of glycine (30-60 mg/day) have shown improvement in negative symptoms when added to antipsychotic medication.…”

“…It may produce its beneficial effect by its ability to treat akathisia, increasing antipsychotic serum levels, decreasing anxiety symptoms. [92]…”