title: Adjunct divalproex or lithium to clozapine in treatment-resistant schizophrenia.
abstract: This retrospective study examined adjunct divalproex (N = 15) or lithium (N = 9) in treatment-resistant schizophrenia patients added to clozapine and compared to clozapine monotherapy (N = 25). Six month total BPRS scores were similarly improved in all treatment groups, however significantly greater improvements occurred in the first month for those on divalproex (-9) or lithium (-8) vs. clozapine alone (-4.5) (F = 3.32, df = 10.43, p = 0.0003). Rates of sedation, tachycardia, orthostasis, GI disturbances, confusion and dizziness were similar among groups. Mean weight gain was 8.7 pounds for clozapine monotherapy, 3.0 pounds in the adjunct divalproex group and 13.3 pounds in the adjunct lithium group (P = NS). A trend was noted for greater increases in blood glucose levels for those treated with adjunct lithium (F = 2.62, df = 2.28, p = 0.09). The addition of divalproex was significantly more effective in reducing global symptoms (driven by hostility and anxiety) in the first month of adjunct treatment as compared to clozapine monotherapy and to previous clozapine treatment.
authors.affiliation: Maryland Psychiatric Research Center, University of Maryland, Box 21247, Baltimore, MD 21228, USA. dkelly@mprc.umaryland.edu
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kelly
authors.forename: Robert R
authors.initials: RR
authors.lastname: Conley
authors.forename: Stephanie
authors.initials: S
authors.lastname: Feldman
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Robert P
authors.initials: RP
authors.lastname: McMahon
authors.forename: Charles M
authors.initials: CM
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D001786:Blood Glucose / Q000378:metabolism; D010054:Brief Psychiatric Rating Scale; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006791:Hostility; D006801:Humans; D016651:Lithium Carbonate / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D015430:Weight Gain / Q000187:drug effects
chemical_list: D000927:Anticonvulsants; D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001786:Blood Glucose; D016651:Lithium Carbonate; D014635:Valproic Acid; D003024:Clozapine