Welcome to the EPA 2021 Interactive Programme

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Displaying One Session

Clinical/Therapeutic
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Session Description
The Live Q&A of this session will take place in the Live Sessions auditorium. Please refer to the interactive programme for the exact time and channel.

The pharmacotherapy of patients with Schizophrenia is challenging for a variety of reasons. For some patients, a poor response to antipsychotic treatment or a high side effect burden raises the question whether to switch antipsychotics, including to clozapine, or whether to combine antipsychotics. Other patients experience persisting positive, negative as well as comorbid anxiety, depressive or obsessive-compulsive disorders that require the addition of medications to manage their residual symptoms or conditions. With the introduction of new pharmaceuticals, polypharmacy is becoming more and more common in real-world clinical settings and clinicians are confronted with an increasing number of complex treatment options. In this symposium, speakers will outline the conceptual basis for a rational, safe, and evidence-based polypharmacy for Schizophrenia. Four different scenarios for combining medications rationally will be presented. First, we will review combining antipsychotics for non-refractory psychotic patients, including combining olanzapine with amisulpride. Second, we will discuss clozapine augmentation strategies for refractory patients. Third, we will examine the value of adding antidepressants for depression, negative symptoms and obsessive-compulsive symptoms in the management of psychotic disorders. Finally, a talk will address medication strategies to manage antipsychotic-associated weight gain.

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Pre-Recorded with Live Q&A
Symposium: Rational Approaches to Polypharmacy in the Treatment of Schizophrenia (ID 187) No Topic Needed

S0097 - Combination Treatment with Second Generation Antipsychotics Other than Clozapine

Session Icon
Pre-Recorded with Live Q&A
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Lecture Time
15:30 - 15:47

ABSTRACT

Abstract Body

BACKGROUND: Antipsychotic combination treatment without clozapine is common in the treatment of schizophrenia patients worldwide, despite clinical guidelines generally do not recommend such practice. This is potentially due to a high rate of non-response to monotherapies and a low-frequent adoption of Clozapine.

AIM: This presentation briefly summarizes rational combination strategies without second generation antipsychotics other than clozapine and presents new results of a multi-center randomized, double-blind controlled trial comparing monotherapy of oral amisulpride (400-800 mg/day), or olanzapine (10-20 mg/day) with amisulpride-olanzapine combination treatment.

CONCLUSIONS: Positive findings with small to medium effect sizes in favor of combination treatment with amisulpride and olanzapin have to be weight against a higher propensity to side effects since reduced sexual functions, weight gain and gain in waist circumference are higher in patients with combination treatment and olanzapine monotherapy than in patients with amisulpride monotherapy. Overall evidence in favor of combination treatment without clozapine is not strong when regarding its highly-frequent adoption in clinically practice. The strategy of combination treatment with amisulpride and olanzapine may be an alternative in certain clinical situations but should be carefully monitored and justified according to guideline recommendations for resistance to pharmacotherapy.

COMMENTS: The adoption of clozapine should be considered, before other antipsychotic combination treatment is indicated in clinical non-response to various monotherapies. Other factors that may lead to non-response or therapy resistance such as non-adherence, substance-abuse or high metabolization have to be excluded, before such strategy is appropiate.

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Symposium: Rational Approaches to Polypharmacy in the Treatment of Schizophrenia (ID 187) No Topic Needed

S0098 - Augmentation Strategies for Treatment-refractory Clozapine Patients

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Pre-Recorded with Live Q&A
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Lecture Time
15:47 - 16:04

ABSTRACT

Abstract Body

BACKGROUND: Clozapine can be a life-saving and course-altering treatment for patients with psychosis, particularly treatment-resistant schizophrenia. Unfortunately, clozapine monotherapy rarely leads to a full symptomatic remission.

AIMS: This talk outlines key decision points in the use of clozapine: how to select patients for clozapine treatment and how to optimize clozapine’s efficacy in patients with a poor response to an adequate clozapine monotherapy trial.

CONCLUSIONS: Clozapine’s main indication is for treatment-resistant schizophrenia. Therapeutic drug monitoring (TDM) should be used to optimize clozapine dosing during a clozapine trial and to rule-out pseudo-resistance. Up to 50% of patients do not respond to clozapine monotherapy and augmentation strategies can be utilized in such cases. Pharmacological add-on treatments are selected based on the most prominent symptom cluster (refractory psychosis, negative symptoms, depression and suicidality, aggression). Electroconvulsive therapy is the most effective augmentation strategy for refractory psychosis and suicidality. Non-pharmacological interventions and a focus on quality of life become important considerations in clozapine non-responders.

COMMENTS: Clozapine is an important and underutilized tool in the management of treatment-resistant schizophrenia. It should be offered timely, as soon as treatment-resistance becomes apparent. Clinicians can use personalized augmentation strategies as part of a comprehensive treatment plan in order to achieve improvements even in patients with a poor response to clozapine alone. However, polypharmacy should be used judiciously, keeping in mind medical morbidity and quality of life.

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Symposium: Rational Approaches to Polypharmacy in the Treatment of Schizophrenia (ID 187) No Topic Needed

S0099 - Adjunctive Antidepressive Pharmacotherapy in Schizophrenia Patients

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Pre-Recorded with Live Q&A
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Lecture Time
16:04 - 16:21
Presenter

ABSTRACT

Abstract Body

Depressive symptoms during long-term course of schizophrenia constitute an important and frequent clinical problem. They may occur either as stand-alone major depressive episodes (MDEs) or as part of the schizophrenic negative syndrome. Teatment resistant schizophrenia due to affective deficits results in high subjective burden of disease and a marked subgroup of schizophrenia patients die from suicide. International treatment guidelines strongly suggest offering cognitive behavioural therapy to all patients with schizophrenia. Within pharmacological approaches evidence in favour of second generation antipsychotics exist. The application of mood stabilizers lacks evidence from clinical trials, but is often used in clinical practice. Several antidepressive agents have been administered to depressed patients with schizophrenia and were effective in alleviating both affective and negative symptoms. Treatment outcomes, however, were often limited by side effects and pharmacokinetic interactions, which constitutes the necessity of more easily tolerable pharmacological interventions. Data regarding duloxetine, bupropion, vortioxetine and agomelatine are presented in more detail and discussed within the perspective of multimodal treatment of schizophrenia.

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Symposium: Rational Approaches to Polypharmacy in the Treatment of Schizophrenia (ID 187) No Topic Needed

S0100 - Combination Approaches to Reduce Weight-gain Induced by Antipsychotics

Session Icon
Pre-Recorded with Live Q&A
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Lecture Time
16:21 - 16:38
Presenter

ABSTRACT

Abstract Body

Research demonstrates that the prevalence of overweight and obesity in the general population is increasing rapidly worldwide and that the environmental changes that have provoked these increases have also affected people with severe mental illness (SMI). Of note, obesity is two to three times more common among people with SMI and it contributes to a significantly reduced quality of life and to an increased morbidity and mortality rate in this population.

The most important factor related to weight gain in people with SMI is the use of antipsychotic medication. Weight gain often occurs within 6-8 weeks after the initiation of antipsychotic treatment and may continue for at least 4 years. This can lead to non-adherence and risk of relapse.

Next to behavioural interventions several pharmacological approaches have been investigated to deal with antipsychotic-induced weight gain. They target different receptor systems including dopaminergic, glutamatergic, serotonergic, adrenergic, opioid, and glucagon-like peptide 1 receptors. This symposium will provide an overview of the effectiveness of different add-on medications to treat weight gain in patients with SMI.

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Symposium: Rational Approaches to Polypharmacy in the Treatment of Schizophrenia (ID 187) No Topic Needed

Live Q&A

Session Icon
Pre-Recorded with Live Q&A
Date
Mon, 12.04.2021
Session Time
15:30 - 17:00
Room
Channel 3
Lecture Time
16:38 - 16:58