C. Schmidt-Kraepelin, Germany
Kaiserswerther Diakonie and LVR-Clinic Düsseldorf, Medical Faculty Heinrich-Heine-University Düsseldorf Department of Psychiatry and PsychotherapyModerator of 1 Session
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.
Presenter of 2 Presentations
Live Q&A
S0097 - Combination Treatment with Second Generation Antipsychotics Other than Clozapine
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.