Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia: An open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidone

Takefumi Suzuki, Hiroyuki Uchida, Koichiro Watanabe, Shinichiro Nakajima, Kensuke Nomura, Hiroyoshi Takeuchi, Akira Tanabe, Gohei Yagi, Haruo Kashima

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: To evaluate the effectiveness of antipsychotic polypharmacy in a methodologically sound manner. Methods: In this open-label study, 17 patients with treatment-refractory schizophrenia, who failed to respond to a sequential monotherapy with olanzapine, quetiapine and risperidone, were subsequently treated with a combination therapy with olanzapine plus risperidone for at least 8 weeks. Results: Seven responded according to the primary endpoint defined as the post-treatment Brief Psychiatric Rating Scale being less than 70% of the pretreatment values, and they were classified as such an average of 10 weeks after the initiation of polypharmacy. Two of them were successful in a later conversion to monotherapy. None dropped out prematurely. Four (out of 13 inpatients) got better enough to be discharged from the hospital, while six patients did not show any response. The Global Assessment of Functioning score improved from 37.1 to 53.0 in responders (mean maximum dose: olanzapine 12.9 mg; risperidone 3.14 mg), while it showed non-significant changes among others (mean maximum dose: olanzapine 14.5 mg; risperidone 5.50 mg). Body weight, prolactin, and total cholesterol increased significantly. Conclusions: Antipsychotic polypharmacy might be sometimes helpful for difficult populations but at the cost of adverse effects. More studies of antipsychotic combination therapy versus clozapine, augmentation strategies or tenacious longer-term monotherapy are warranted for refractory schizophrenia.

Original languageEnglish
Pages (from-to)455-463
Number of pages9
JournalHuman Psychopharmacology
Volume23
Issue number6
DOIs
Publication statusPublished - 2008 Aug

Fingerprint

olanzapine
Polypharmacy
Risperidone
Antipsychotic Agents
Schizophrenia
Brief Psychiatric Rating Scale
Clozapine
Therapeutics
Prolactin
Inpatients
Cholesterol
Body Weight
Quetiapine Fumarate
Population

Keywords

  • Antipsychotic polypharmacy
  • Olanzapine
  • Open-label clinical trial
  • Risperidone
  • Treatment-refractory schizophrenia

ASJC Scopus subject areas

  • Pharmacology
  • Psychology(all)
  • Neuroscience(all)
  • Pharmacology (medical)
  • Psychiatry and Mental health
  • Neurology
  • Clinical Neurology

Cite this

@article{0061d1403b5b42d0a1e7e85b3dd6a0b3,
title = "Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia: An open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidone",
abstract = "Objective: To evaluate the effectiveness of antipsychotic polypharmacy in a methodologically sound manner. Methods: In this open-label study, 17 patients with treatment-refractory schizophrenia, who failed to respond to a sequential monotherapy with olanzapine, quetiapine and risperidone, were subsequently treated with a combination therapy with olanzapine plus risperidone for at least 8 weeks. Results: Seven responded according to the primary endpoint defined as the post-treatment Brief Psychiatric Rating Scale being less than 70{\%} of the pretreatment values, and they were classified as such an average of 10 weeks after the initiation of polypharmacy. Two of them were successful in a later conversion to monotherapy. None dropped out prematurely. Four (out of 13 inpatients) got better enough to be discharged from the hospital, while six patients did not show any response. The Global Assessment of Functioning score improved from 37.1 to 53.0 in responders (mean maximum dose: olanzapine 12.9 mg; risperidone 3.14 mg), while it showed non-significant changes among others (mean maximum dose: olanzapine 14.5 mg; risperidone 5.50 mg). Body weight, prolactin, and total cholesterol increased significantly. Conclusions: Antipsychotic polypharmacy might be sometimes helpful for difficult populations but at the cost of adverse effects. More studies of antipsychotic combination therapy versus clozapine, augmentation strategies or tenacious longer-term monotherapy are warranted for refractory schizophrenia.",
keywords = "Antipsychotic polypharmacy, Olanzapine, Open-label clinical trial, Risperidone, Treatment-refractory schizophrenia",
author = "Takefumi Suzuki and Hiroyuki Uchida and Koichiro Watanabe and Shinichiro Nakajima and Kensuke Nomura and Hiroyoshi Takeuchi and Akira Tanabe and Gohei Yagi and Haruo Kashima",
year = "2008",
month = "8",
doi = "10.1002/hup.959",
language = "English",
volume = "23",
pages = "455--463",
journal = "Human Psychopharmacology",
issn = "0885-6222",
publisher = "John Wiley and Sons Ltd",
number = "6",

}

TY - JOUR

T1 - Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia

T2 - An open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidone

AU - Suzuki, Takefumi

AU - Uchida, Hiroyuki

AU - Watanabe, Koichiro

AU - Nakajima, Shinichiro

AU - Nomura, Kensuke

AU - Takeuchi, Hiroyoshi

AU - Tanabe, Akira

AU - Yagi, Gohei

AU - Kashima, Haruo

PY - 2008/8

Y1 - 2008/8

N2 - Objective: To evaluate the effectiveness of antipsychotic polypharmacy in a methodologically sound manner. Methods: In this open-label study, 17 patients with treatment-refractory schizophrenia, who failed to respond to a sequential monotherapy with olanzapine, quetiapine and risperidone, were subsequently treated with a combination therapy with olanzapine plus risperidone for at least 8 weeks. Results: Seven responded according to the primary endpoint defined as the post-treatment Brief Psychiatric Rating Scale being less than 70% of the pretreatment values, and they were classified as such an average of 10 weeks after the initiation of polypharmacy. Two of them were successful in a later conversion to monotherapy. None dropped out prematurely. Four (out of 13 inpatients) got better enough to be discharged from the hospital, while six patients did not show any response. The Global Assessment of Functioning score improved from 37.1 to 53.0 in responders (mean maximum dose: olanzapine 12.9 mg; risperidone 3.14 mg), while it showed non-significant changes among others (mean maximum dose: olanzapine 14.5 mg; risperidone 5.50 mg). Body weight, prolactin, and total cholesterol increased significantly. Conclusions: Antipsychotic polypharmacy might be sometimes helpful for difficult populations but at the cost of adverse effects. More studies of antipsychotic combination therapy versus clozapine, augmentation strategies or tenacious longer-term monotherapy are warranted for refractory schizophrenia.

AB - Objective: To evaluate the effectiveness of antipsychotic polypharmacy in a methodologically sound manner. Methods: In this open-label study, 17 patients with treatment-refractory schizophrenia, who failed to respond to a sequential monotherapy with olanzapine, quetiapine and risperidone, were subsequently treated with a combination therapy with olanzapine plus risperidone for at least 8 weeks. Results: Seven responded according to the primary endpoint defined as the post-treatment Brief Psychiatric Rating Scale being less than 70% of the pretreatment values, and they were classified as such an average of 10 weeks after the initiation of polypharmacy. Two of them were successful in a later conversion to monotherapy. None dropped out prematurely. Four (out of 13 inpatients) got better enough to be discharged from the hospital, while six patients did not show any response. The Global Assessment of Functioning score improved from 37.1 to 53.0 in responders (mean maximum dose: olanzapine 12.9 mg; risperidone 3.14 mg), while it showed non-significant changes among others (mean maximum dose: olanzapine 14.5 mg; risperidone 5.50 mg). Body weight, prolactin, and total cholesterol increased significantly. Conclusions: Antipsychotic polypharmacy might be sometimes helpful for difficult populations but at the cost of adverse effects. More studies of antipsychotic combination therapy versus clozapine, augmentation strategies or tenacious longer-term monotherapy are warranted for refractory schizophrenia.

KW - Antipsychotic polypharmacy

KW - Olanzapine

KW - Open-label clinical trial

KW - Risperidone

KW - Treatment-refractory schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=51049098290&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=51049098290&partnerID=8YFLogxK

U2 - 10.1002/hup.959

DO - 10.1002/hup.959

M3 - Article

C2 - 18537222

AN - SCOPUS:51049098290

VL - 23

SP - 455

EP - 463

JO - Human Psychopharmacology

JF - Human Psychopharmacology

SN - 0885-6222

IS - 6

ER -