my personal edition > schizophrenia > news


  E-Mail this DGReview to a colleague

DGReview

Combinations of Atypical Antipsychotics Appear Effective in Treatment-Resistant Schizophrenia and Schizoaffective Disorder

Combinations of atypical antipsychotic medications appear to be well tolerated and may be effective in the management of treatment refractory schizophrenia and schizoaffective disorder, according to the findings of a new literature review on the subject.

Between 20% and 40% of patients with schizophrenia exhibit an inadequate response to antipsychotic medications. This appears to be the case with both "typical" and "atypical" antipsychotic medications. Clinicians now readily combine an atypical with a typical antipsychotic or combine 2 atypical antipsychotics; however, scientific evidence evaluating this practice is limited.

To clarify this issue further, Vladimir Lerner, MD, with the University of the Negev, Be'er-Sheva, Israel, and colleagues reviewed the published clinical data on treatment-resistant schizophrenic and schizoaffective patients managed with combinations of atypical antipsychotic medication.

The researchers conducted a computerised MEDLINE literature search covering an 18-year period (1985-2003). All pertinent papers on the subject of the use of combination atypical antipsychotic medication in the management of treatment-resistant schizophrenia and schizoaffective disorder were obtained with subsequent analysis and discussion of the retrieved data.

They selected 29 case reports and case series reports (172 patients) and 1 double-blind placebo-controlled trial (28 patients) describing the use of combination atypical antipsychotic medication in the treatment of resistant schizophrenic and schizoaffective patients.

Combinations used included clozapine-risperidone; clozapine-sulpiride; clozapine-olanzapine; clozapine-quetiapine; olanzapine-sulpiride; olanzapine-quetiapine; risperidone-olanzapine; risperidone-quetiapine.

Combinations appeared to be beneficial and to reduce positive symptoms and occasionally negative symptoms. Significant adverse effects, while rare, were reported in a few cases and appeared to be similar to those of monotherapeutic regimens.

Summarised results of publications reporting on combined therapy indicate minimal to substantial benefit observed in 85.5% of patients. Only 11.0% either did not demonstrate any improvement or demonstrated deterioration of mental state; in 7 cases there are no data. A total of 82.0% of patients did not demonstrate any side effects. The remaining 18.0% exhibited various problems, including hypersalivation, akathisia (mild), exacerbation of hoarding behaviour, and neuroleptic malignant syndrome.

"Combinations of 'atypical' antipsychotic medications are well tolerated in the most reviewed reports and may be effective in the management of treatment refractory schizophrenia and schizoaffective disorder," Dr. Lerner and colleagues conclude. "However, further double- blind placebo-controlled trials are required in order to test and confirm these observations," they note.


Prog Neuropsychopharmacol Biol Psychiatry 2004;28:89-98. "Combination of "atypical" antipsychotic medication in the management of treatment-resistant schizophrenia and schizoaffective disorder"

E-Mail this DGReview to a colleague

To print, use this version