Lithium in Chronic Schizophrenia

221

105

A systematic approach to the evaluation and characterization of treatment resistance in schizophrenia has become increasingly important since the introduction of clozapine, risperidone, and olanzapine. The need for accurate evaluation will increase with the introduction of the next generation of antipsychotic medications. People with schizophrenia may manifest a poor response to therapy secondary to intolerance of medication, poor compliance, or inappropriate dosing, as well as true resistance of their illness to antipsychotic drug therapy. Clinicians facing the decision of when to change from one antipsychotic to another must clearly understand the appropriate length of a trial and what target symptoms respond to antipsychotics in order to maximize the response in patients with treatment-resistant schizophrenia.

Section: Drug Therapy For Treatment Resistancementioning

confidence: 99%

Evaluation of Treatment-Resistant Schizophrenia

Conley

Boyer

1997

221

105

“…Collectively these seven studies document that lithium alone is inferior to neuroleptics as a first-line agent in acutely psychotic patients but may be useful as an adjunct to neuroleptics in some patients with schizophrenia or schizoaffective illness. The three studies (Small et al 1975;Growe et al 1979;Carmen et al 1981) that examined the role of lithium as an adjunctive treatment in patients with symptoms resistant to neuroleptics were well designed. All used strict diagnostic criteria (Research Diagnostic Criteria [RDC;Spitzer et al 1978] or Feighner Criteria [Feighner et al 1972]) and employed a PBO-controlled, multiple crossover design whereby patients received two separate, 4-week trials of lithium alternating with two 4-week periods of PBO treatment.…”

Section: CDmentioning

confidence: 99%

When Symptoms Persist: Choosing Among Alternative Somatic Treatments for Schizophrenia

Christison

Kirch

Wyatt

1991

168

Many patients with schizophrenia continue to have significant disabling symptoms despite adequate trials of different types and doses of traditional neuroleptics. Clinicians treating these neuroleptic-resistant patients must look to other treatments in the hope of providing some relief. The literature on many of the alternative treatments is too scanty for firm conclusions. We offer criteria for deciding which treatments may warrant consideration. We review the evidence for the eight treatments we found to meet these criteria and discuss clinical points salient to their use in this population. Although not always conclusive, the data do offer clues for treatment guidelines and an approach to choosing among the available treatments is suggested.

“…Christison et al (1991) report that lithium may be useful as an adjunct to neuroleptics in some patients with schizophrenia or schizoaffective illness. These reviewers believe that the three studies in neuroleptic-resistant patients (Small et al 1975; Growe et al 1979; Carmen et al 1981) were all well designed, with placebo-controlled multiple crossover treatment trials, each of 4-weeks duration, in a well-diagnosed group of patients with either schizophrenia or schizoaffective illness. The Small et al (1975) and Carmen et al (1981) studies both report clear clinical improvement in one-third to one-half of their patients in multiple spheres ranging from positive symptoms to social competence.…”

Section: Resultsmentioning

confidence: 99%

Adjunctive Treatments in Schizophrenia: Pharmacotherapies and Electroconvulsive Therapy

Johns

Thompson

1995

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.