Guidelines for the Pharmacotherapy of Schizophrenia in Adults

Remington, Gary; Addington, Donald; Honer, William G.; Ismail, Zahinoor; Raedler, Thomas J.; Teehan, Michael D.

doi:10.1177/0706743717720448

Cited by 250 publications

(273 citation statements)

References 111 publications

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“…Rather, studies screening the serum and CSF for the aforementioned antibodies in chronic and treatment-resistant schizophrenia patients are needed to address this question. Doing so in treatment-resistant patients, and particularly in clozapine-resistant patients, is especially important, as few evidence-based treatment options exist beyond clozapine in the context of treatment resistance [9], and those identified as having a clinically actionable autoimmune component to their illness may benefit from immunotherapy. Moreover, treatment-resistant patients may represent an enriched population with respect to the presence of anti-neuronal antibodies, as such individuals presumably have unique pathophysiological characteristics underlying their illness, in comparison to those who respond to antipsychotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…This is important given that the treatments for the two disorders differ; whereas schizophrenia is primarily managed using antipsychotic medications that have variable actions on an array of neurotransmitter receptors [9], AE is known to respond to treatments targeting the immune system, including steroids, intravenous immunoglobulin, and plasmapheresis. As such, it is imperative that psychiatrists consider the possibility of AE when confronted by atypical signs and/or symptoms that are inconsistent with a diagnosis of a primary psychotic disorder.…”

Section: Introductionmentioning

confidence: 99%

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Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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Schizophrenia is a phenotypically heterogeneous and poorly understood disorder. While its etiology is likely multifactorial, immune system dysfunction has increasingly been implicated in its development. As hallucinations and delusions occur frequently and prominently in autoimmune encephalitis (AE), numerous studies have sought to determine whether a small subset of individuals diagnosed with schizophrenia possess anti-neuronal antibodies implicated in AE. Exploring this possibility is of clinical relevance, as identifying individuals with AE who have been misdiagnosed as having a primary psychotic disorder may allow for the implementation of appropriate immune-related therapies as early as possible in the course of the illness, in order to optimize outcomes, reduce illness chronicity, and minimize adverse events. This qualitative review serves to provide an overview of the existing literature on this topic, as well as to update previously published reviews. Although there is some evidence to suggest that in rare cases AE may be misdiagnosed as a primary psychotic disorder, particularly early in the course of the illness, numerous methodological differences between studies likely account for the highly variable findings, and interpretation of the results is particularly limited by a paucity of cerebrospinal fluid data. Moreover, the prevalence of misdiagnosis in chronic and treatment-resistant populations remains understudied. This is particularly problematic, as treatment resistance may represent an enriched population with respect to the presence of anti-neuronal antibodies, and given that such patients have few evidence-based treatment options available to them beyond clozapine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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“…The patient was diagnosed with treatment-resistant schizophrenia (TRS) according to TRS guidelines (insufficient response to at least two sequential, different antipsychotic medications of adequate doses taken over an adequate time period) [30, 31] after these two antipsychotic medications were found to be ineffective, and was therefore treated with clozapine monotherapy which was gradually increased to 600 mg daily (clozapine and norclozapine blood levels were in the normal range). Psychotic symptomatology initially improved, but persecutive thoughts and anxiety reappeared.…”

Section: Case Reportmentioning

confidence: 99%

Dandy-Walker Malformation-Like Condition Revealed by Refractory Schizophrenia: A Case Report and Literature Review

et al. 2018

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Introduction: Dandy-Walker malformation is a rare congenital malformation involving cystic dilatation of the fourth ventricle, enlarged posterior fossa, complete or partial agenesis of the cerebellar vermis, elevated tentorium cerebelli, and hydrocephalus. Previous research highlighted a possible role for the cerebellum in schizophrenia as well as the contribution of underlying brain malformations to treatment resistance. Here, we present a case of a Dandy-Walker malformation-like condition revealed by a refractory schizophrenia in a 24-year-old male patient. We also conduct a literature review of all previously published case reports or case series of co-occurring posterior fossa abnormalities and schizophrenia or psychosis using a PubMed search query to better understand the potential link between these two disorders. Case Presentation: A 9-month hospital stay was needed to address the treatment-resistant psychotic symptoms, and the patient continued to experience moderate symptoms despite the prescription of various antipsychotic and antidepressant medications. After an irregular initial medical follow-up, the patient is currently treated with 350 mg daily clozapine and 20 mg daily prazepam and still exhibits moderate anxiety without delirious thoughts, however allowing him to re-enroll at the university. Regarding the literature, 24 cases published between 1996 and 2017 were identified, reviewed and compared to the present case report. Discussion: This case report and literature review further illuminates the pathophysiology of psychotic disorders including the potential role of the cerebellum, reinforces the importance of a multidisciplinary approach for the neurological and psychiatric management of patients with schizophrenia, and highlights optimal pharmacological management strategies for treatment-resistant schizophrenia.

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“…Various guidelines have been published for the treatment of psychiatric disorders. [1][2][3][4][5][6][7][8] In many countries, psychiatrists usually treat patients based on treatment guidelines. However, evidence-based treatment guidelines for psychiatric disorders were not developed in Japan until 10 years ago; as a result, Japanese psychiatrists were likely to base clinical decisions on their own experiences.…”

Section: Discussionmentioning

confidence: 99%

“…The 'Guideline for Pharmacological Therapy for Schizophrenia' emphasizes that antipsychotic monotherapy should be considered as a first-line treatment for all patients with schizophrenia and that clozapine should be used for treatment-resistant schizophrenia, similar to the guidelines of other countries. 1,4,[6][7][8] However, Japanese psychiatrists are more likely than psychiatrists in other countries to adjunctively prescribe multiple antipsychotics and other psychotropics, such as benzodiazepines, instead of antipsychotics monotherapy. 11,13,14 In addition, fewer treatment-resistant schizophrenia patients in Japan take clozapine.…”

Section: Discussionmentioning

confidence: 99%

Improvement of psychiatrists’ clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ project: A nationwide dissemination, education, and evaluation study

Takaesu

Watanabe

Numata

et al. 2019

Psychiatry Clin Neurosci

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Aim Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. Methods Four hundred thirteen out of 461 psychiatrists attended two 1‐day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants’ clinical knowledge of the treatment guidelines using self‐completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants’ demographics and their clinical knowledge scores. Results The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. Conclusion Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants’ clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.

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Guidelines for the Pharmacotherapy of Schizophrenia in Adults

Cited by 250 publications

References 111 publications

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Dandy-Walker Malformation-Like Condition Revealed by Refractory Schizophrenia: A Case Report and Literature Review

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