Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year

Takefumi Suzuki, Hiroyuki Uchida, Hiroyoshi Takeuchi, Kenichi Tsunoda, Tomomi Ishizuki, Masaru Mimura

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean±S.D. age: 57.5±13.0 y.o., duration of illness and admissions: 30.9±15.2 years and 20.7±14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3±21.8 μg/mL) and nine used lithium (0.61±0.26. mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional.

Original languageEnglish
Pages (from-to)26-30
Number of pages5
JournalPsychiatry Research
Volume228
Issue number1
DOIs
Publication statusPublished - 2015 Jul 30

Fingerprint

Antipsychotic Agents
Schizophrenia
Polypharmacy
Antiparkinson Agents
Lorazepam
Valproic Acid
International Classification of Diseases
Benzodiazepines
Lithium
Psychiatry
Pharmaceutical Preparations

Keywords

  • Antipsychotics
  • Augmentation
  • Mood Stabilizer
  • Optimization
  • Polypharmacy
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year. / Suzuki, Takefumi; Uchida, Hiroyuki; Takeuchi, Hiroyoshi; Tsunoda, Kenichi; Ishizuki, Tomomi; Mimura, Masaru.

In: Psychiatry Research, Vol. 228, No. 1, 30.07.2015, p. 26-30.

Research output: Contribution to journalArticle

@article{c7845d0c5a0c4865a89efdf3a8541c19,
title = "Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year",
abstract = "We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean±S.D. age: 57.5±13.0 y.o., duration of illness and admissions: 30.9±15.2 years and 20.7±14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3±21.8 μg/mL) and nine used lithium (0.61±0.26. mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional.",
keywords = "Antipsychotics, Augmentation, Mood Stabilizer, Optimization, Polypharmacy, Schizophrenia",
author = "Takefumi Suzuki and Hiroyuki Uchida and Hiroyoshi Takeuchi and Kenichi Tsunoda and Tomomi Ishizuki and Masaru Mimura",
year = "2015",
month = "7",
day = "30",
doi = "10.1016/j.psychres.2015.03.019",
language = "English",
volume = "228",
pages = "26--30",
journal = "Psychiatry Research",
issn = "0165-1781",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year

AU - Suzuki, Takefumi

AU - Uchida, Hiroyuki

AU - Takeuchi, Hiroyoshi

AU - Tsunoda, Kenichi

AU - Ishizuki, Tomomi

AU - Mimura, Masaru

PY - 2015/7/30

Y1 - 2015/7/30

N2 - We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean±S.D. age: 57.5±13.0 y.o., duration of illness and admissions: 30.9±15.2 years and 20.7±14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3±21.8 μg/mL) and nine used lithium (0.61±0.26. mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional.

AB - We describe real-world psychopharmacological treatment in a Japanese, male, closed psychiatric unit where clozapie was still unavailable. Fifty-five persistently-ill patients with schizophrenia (ICD-10), mean±S.D. age: 57.5±13.0 y.o., duration of illness and admissions: 30.9±15.2 years and 20.7±14.5 years, respectively) treated longitudinally were evaluated. The rule was to treat with a simplest possible psychotropic regimen without polypharmacy. Compared to the baseline, the number and dose of antipsychotics were reduced from 1.9 to 1.1 and 1012 mg/day to 607 mg/day, respectively. The number of total psychotropics was minimized from 4.7 to 2.1, with a simplified once or twice daily dosing. Overall, the CGI-Severity and FACT-Sz (global functioning) improved slightly from 5.8 to 5.5 and 28.7 to 32.6, respectively. Of note, no patients got worse in comparison with the baseline clinical presentation. Forty-four patients were successfully treated with a single antipsychotic; only seven needed two antipsychotics simultaneously while 36 had been treated with antipsychotic polypharmacy at baseline. Benzodiazepines (mostly lorazepam) and antiparkinsonian drugs were prescribed in 28 and only two, respectively. Nineteen needed adjunctive valproate (average blood levels: 99.3±21.8 μg/mL) and nine used lithium (0.61±0.26. mEq/L). Optimization of psychopharmacotherapy is still possible for difficult-to-treat patients and, while augmentation of an antipsychotic with mood stabilizers is frequently needed, antipsychotic polypharmacy should be exceptional.

KW - Antipsychotics

KW - Augmentation

KW - Mood Stabilizer

KW - Optimization

KW - Polypharmacy

KW - Schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=84930043746&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930043746&partnerID=8YFLogxK

U2 - 10.1016/j.psychres.2015.03.019

DO - 10.1016/j.psychres.2015.03.019

M3 - Article

VL - 228

SP - 26

EP - 30

JO - Psychiatry Research

JF - Psychiatry Research

SN - 0165-1781

IS - 1

ER -