Optimization of psychopharmacotherapy for schizophrenia in a male, locked, non-acute unit serving for persistently ill patients over one year.
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.
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, Tokyo, Japan. Electronic address: takefumi@oak.dti.ne.jp.
Takefumi
T
Suzuki
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Centre for Addiction and Mental Health, Geriatric Mental Health Program, Toronto, Ontario, Canada.
Hiroyuki
H
Uchida
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Centre for Addiction and Mental Health, Schizophrenia Division, Toronto, Ontario, Canada.
Hiroyoshi
H
Takeuchi
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Minami Hannou Hospital, Saitama, Japan.
Kenichi
K
Tsunoda
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan; Department of Psychiatry, Kawasaki City Rehabilitation Medical Center, Kanagawa, Japan.
Tomomi
T
Ishizuki
Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.
Masaru
M
Mimura
D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D014635:Valproic Acid
Antipsychotics; Augmentation; Mood Stabilizer; Optimization; Polypharmacy; Schizophrenia