Lithium Augmentation Fails to Reduce Symptoms in Poorly Responsive Schizophrenic Outpatients

Schulz, S. Charles; Thompson, Paul A.; Jacobs, Marc; Ninan, Philip T.; Robinson, Delbert G.; Weiden, Peter J.; Yadalam, K; Glick, Ira D.; Odbert, Carol

doi:10.4088/jcp.v60n0604

Cited by 27 publications

(8 citation statements)

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“…The combination of antipsychotics with mood stabilizers is mainly applied in cases of inadequate response to antipsychotic monotherapy mostly in terms of positive, negative, and aff ective symptoms, as well as aggression. Still, the majority of randomized controlled trials reported no signifi cant benefi cial eff ects of the combination of antipsychotics (fl uphenazine, haloperidol, pimozide) with lithium on psychotic symptoms [15,33,53,62,66,72] ( • ▶ Table 2 ). Further studies, in which patients with schizoaff ective psychosis were also recruited, showed better improvement with lithium augmentation treatment compared to antipsychotic monotherapy at least in some symptoms, for instance, anxiety [7, 29, 37, 60 -62] .…”

Section: Augmentation Strategiesmentioning

confidence: 99%

Combination Therapy in the Treatment of Schizophrenia

Wolff-Menzler

Hasan²,

Malchow³

et al. 2010

Pharmacopsychiatry

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Section: Augmentation Strategiesmentioning

confidence: 99%

Combination Therapy in the Treatment of Schizophrenia

Wolff-Menzler

Hasan²,

Malchow³

et al. 2010

Pharmacopsychiatry

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“…Fi een studies provided information about severity, out of which 11 described their participants as chronic or non-responsive to previous treatment. Only two studies, Mattes 1984 andSchulz 1999, were undertaken in the community; all others were carried out with people who were in hospital at the beginning of the trial.…”

Section: Participantsmentioning

confidence: 99%

“…Several studies examined specific groups of participants. Biederman 1979 studied participants with "motor hyperactivity" or elevated mood, Hogarty 1995 examined participants with "persistent distress and/ or anxiety", Simpson 1976 analysed a chronic group with tardive dyskinesia, and Brockington 1978; Collins 1991;Feng 2006;He 2010;Hogarty 1995;Small 1975;Small 2001;Schulz 1999;Simhandl 1996; and Wilson 1993 included only treatment-resistant participants according to a variety of criteria.…”

Section: Participantsmentioning

confidence: 99%

Lithium for schizophrenia

Leucht

Helfer

Dold

et al. 2015

Cochrane Database of Systematic Reviews

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The evidence base for the use of lithium in schizophrenia is limited to 22 studies of overall low methodological quality. There is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. There is some GRADE low quality evidence that augmentation of antipsychotics with lithium is effective, but the effects are not significant when more prone-to-bias open RCTs are excluded. Nevertheless, further large and well-designed trials are justified. These should concentrate on two target groups: (1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, and (2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.

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“…Lithium generally has limited efficacy and may even worsen symptoms when given alone to patients with schizophrenia, so it is not surprising that it displayed no augmentative efficacy in two studies when added to haloperidol or fluphenazine in treatment-resistant patients [57,79]; however, the evidence is not entirely consistent. Another study by Terao et al reported that lithium was associated with the improvement of depressive or anxious symptoms when added to antipsychotics, although no effects were observed with regard to negative symptoms [72].…”

Section: Lithium Augmentationmentioning

confidence: 99%

Sense and non-sense of polypharmacy: increasing efficacy, decreasing compliance?

Boyer

2003

Eur. psychiatr.

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The objective in managing patients with schizophrenia is to provide effective control of symptoms and enable the patient to reintegrate into society. Pharmacotherapy should, therefore, aim to provide optimum symptom control with minimal side effects using a simple dosage regimen. Ideally, this would be achieved through the use of a single agent. Some patients are successfully managed with a single antipsychotic drug, but it is often necessary or thought to be necessary to use a combination of agents to provide effective treatment. One European survey reported that most patients receive two to three psychotropic agents on average, but at least 5-22% receive five or more agents [53]. Unfortunately, the addition of more agents increases the risk of drug interactions, adverse events and non-compliance. This is amplified by the paucity of evidence-based medicine currently available to guide physicians in the use of combinations of agents, and the tendency of polypharmaceutical practice to be mostly driven by personal preference, clinical experience and marketing. This article therefore briefly looks at the feasibility of using various drug classes as adjunctive therapy in patients with schizophrenia.

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Lithium Augmentation Fails to Reduce Symptoms in Poorly Responsive Schizophrenic Outpatients

Cited by 27 publications

References 0 publications

Combination Therapy in the Treatment of Schizophrenia

Combination Therapy in the Treatment of Schizophrenia

Lithium for schizophrenia

Sense and non-sense of polypharmacy: increasing efficacy, decreasing compliance?

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