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Combination Treatments for Schizophrenia

Published online by Cambridge University Press:  07 November 2014

Alexander L. Miller
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Abstract

Combination treatments, especially combinations of antipsychotics, are used frequently for schizophrenia, despite a paucity of evidence regarding their safety and efficacy. Because the literature basis is weak and expert recommendations are largely lacking, providers should be vigilant in documenting improved outcomes for patients thought to benefit from combination treatments. Target symptoms that have been studied include psychosis, cognitive deficits, and negative symptoms. The strongest evidence is for augmentation of clozapine with another antipsychotic or with electroconvulsive therapy for persistent positive symptoms. Combination treatments for cognitive deficits and negative symptoms are being actively investigated, but current evidence is insufficient to recommend available agents for these components of schizophrenia. It is important that appropriate monotherapies be given adequate trials before resorting to combination therapies.

Type
Academic Supplement
Information
CNS Spectrums , Volume 9 , Issue S9 , September 2004 , pp. 19 - 23
Copyright
Copyright © Cambridge University Press 2004

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References

REFERENCES

1.Centorrino, F, Goren, JL, Hennen, J, Salvatore, P, Kelleher, JP, Baldessarini, RJ. Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry. 2004;161(4):700–706.CrossRefGoogle ScholarPubMed
2.Miller, AL, Craig, CS. Combination antipsychotics: pros, cons, and questions. Schizophrenia Bull. 2002;28(1):105–109.CrossRefGoogle ScholarPubMed
3.Botts, S, Hines, H, Littrell, R. Antipsychotic polypharmacy in the ambulatory care setting, 1993–2000. Psychiatr Serv. 2003;54(8):1086.CrossRefGoogle ScholarPubMed
4.Stahl, S. Fiscal pharmacology of the atypical antipsychotics: getting the biggest bang out of the bucks: an interactive CD-ROM program [computer program]. Version, CA: Neuroscience Education Institute; 2002.Google Scholar
5.Shiloh, R, Zemishlany, Z, Aizenberg, D et al. , Sulpiride augmentation in people with schizophrenia partially responsive to clozapine. A double-blind, placebo-controlled study. Br J Psychiatry. 1997;171:569–573.CrossRefGoogle ScholarPubMed
6.Henderson, DC, Goff, DC. Risperidone as an adjunct to clozapine therapy in chronic schizophrenics. J Clin Psychiatry. 1996;57(9):395–397.Google ScholarPubMed
7.Mowerman, S, Siris, SG. Adjunctive loxapine in a clozapine-resistant cohort of schizophrenic patients. Ann Clin Psychiatry. 1996;8(4):193–197.CrossRefGoogle Scholar
8.Friedman, JH, Ault, K, Powchik, P. Pimozide augmentation for the treatment of schizophrenic patients who are partial responders to clozapine. Biol Psychiatry. 1997;42(6):522–523.CrossRefGoogle ScholarPubMed
9.Perry, PJ. Therapeutic drug monitoring of antipsychotics. Psychopharmacology Bull. 2001;35(3):19–20.Google ScholarPubMed
10.Masiar, SJ, Johns, CA. ECT following clozapine. Br J Psychiatry. 1991;158:133–134.CrossRefGoogle ScholarPubMed
11.Frankenberg, FR, Suppes, T, McLean, PE. Combined clozapine and electro-convulsive therapy. Conculsive Therapy. 1993;9:176–180.Google Scholar
12.Benatov, R, Sirota, P, Megged, S. Neuroleptic-resistant schizophrenia treated with clozapine and ECT. Convulsive Therapy. 1996;12(2):117–121.Google ScholarPubMed
13.Bhatia, SC, Bhatia, SK, Gupta, S. Concurrent administration of clozapine and ECT: a successful therapeutic strategy for a patient with treatment-resistant schizophrenia. Journal of ECT 1998;14(4):280–283.CrossRefGoogle ScholarPubMed
14.James, DV, Gray, NS. Elective combined electroconvulsive and clozapine therapy. Int Clin Psychopharmacol. 1999;14(2):69–72.CrossRefGoogle ScholarPubMed
15.Kales, HD, Dequardo, JR, Tandon, R. Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry. 1999;23(3):547–556.CrossRefGoogle ScholarPubMed
16.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia, Second Edition. Am J Psychiatry. 2004;161(Suppl 2):S1–S56.Google Scholar
17.Wassef, AA, Hafiz, NG, Hampton, D, Molloy, M. Divalproex sodium augmentation of haloperidol in hospitalized patients with schizophrenia: clinical and economic implications. J Clin Psychopharmacol. 2001;21(1):21–26.CrossRefGoogle ScholarPubMed
18.Casey, DE, Daniel, DG, Wassef, AA, Tracy, KA, Wozniak, P, Sommerville, KW. Effect of divalproex combined with olanzapine or risperidone in patients with an acute exacerbation of schizophrenia. Neuropsychophannacology. 2003;28:182–192.CrossRefGoogle ScholarPubMed
19.Dursun, SM, Deakin, JFW. Augmenting antipsychotic treatment with lamotrigine or topiramate in patients with treatment-resistant schizphrenia: A naturalistic case-series outcome study. J Psychopharmacol. 2001;15:297–301.CrossRefGoogle ScholarPubMed
20.Tuhonen, J, Hallikainen, T, Ryynanen, OP et al. , Lamotrigine in treatment-resistant schizophrenia: a randomized placebo-controlled crossover trial. Biol Psychiatry. 2003;54(11):1241–1243.CrossRefGoogle Scholar
21.Peet, M, Brind, J, Ramchand, CN, Shah, S, Vankar, GK. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophrenia Res. 2001;49:243–251.CrossRefGoogle ScholarPubMed
22.Fenton, WS, Dickerson, FB, Boronow, JJ, Hibbeln, JR, Knable, M. A placebo-controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158:2071–2074.CrossRefGoogle ScholarPubMed
23.Emsley, R, Myburgh, C, Oosthuizen, P, van Rensburg, SJ. Randomized, placebo-controlled study of ethyl-eicosapentaenoic acid as supplemental treatment in schizophrenia. Am J Psychiatry. 2002;159:1596–1593.CrossRefGoogle ScholarPubMed
24.Kulkarni, J, Riedel, A, de Castella, AR et al. , A clinical trial of adjunctive oestrogen treatment in women with schizophrenia. Arch Women Ment Health. 2002;5(3):99–104.CrossRefGoogle ScholarPubMed
25.Harvey, PD, Keefe, RS. Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. Am J Psychiatry. 2001;158(2):176–184.CrossRefGoogle ScholarPubMed
26.Nahas, Z, George, MS, Homer, MD et al. , Augmenting atypical antipsychotics with a cognitive enhancer (donepezil) improves regional brain activity in schizophrenia patients: a pilot double-blind placebo-controlled fMRI study. Neurocase. 2003;9(3):274–282.CrossRefGoogle Scholar
27.MacEwan, GW, Ehmann, TS, Khanbhai, I, Wrixon, C. Donepezil in schizophrenia: is it helpful? An experimental design case study. Acta Psychiatr Scand. 2001;104(6):469–472.CrossRefGoogle ScholarPubMed
28.Friedman, JI, Adler, DN, Howanitz, E et al. , A double-blind placebo-controlled trial of donepezil adjunctive treatment to risperidone for the cognitive impairment of schizophrenia. Biol Psychiatry. 2002;51(5):349–357.CrossRefGoogle ScholarPubMed
29.Allen, TB, McEvoy, JP. Galantamine for treatment-resistant schizophrenia. Am J Psychiatry. 2002;159(7):1244–1245.CrossRefGoogle ScholarPubMed
30.Javitt, DC, Zylberman, I, Zukin, SR, Heresco-Levy, U, Lindenmayer, JP. Amelioration of negative symptoms in schizophrenia by glycine. Am J Psychiatry. 1994;151(8):1234–1236.Google ScholarPubMed
31.Hercsco-Levy, U, Javitt, DC, Ermilov, M, Mordel, C, Horowitz, A, Kelly, D. Double-blind, placebo-controlled, crossover trial of glycine adjuvant therapy for treatment-resistant schizophrenia. Br J Psychiatry. 1996;169(5):610–617.CrossRefGoogle Scholar
32.Heresco-Levy, U, Ermilov, M, Shimoni, J, Shapira, B, Silipo, G, Javitt, DCPlacebo-controlled trial of D-cycloserine added to conventional neuroleptics, olanzapine, or risperidone in schizophrenia. Am J Psychiatry. 2002;159(3):480–482.CrossRefGoogle ScholarPubMed
33.Tsai, G, Yang, P, Chung, L, Lange, N, Coyle, JT. D-serine added to antipsychotics for the trearment of schizophrenia. Biol Psychiatry. 1998;44(11):1081–1089.CrossRefGoogle Scholar
34.Goff, DC, Tsai, GA, Levitt, J et al. , A placebo-controlled trial of D-cycloserine added to conventional neuroleptics in patients with schizophrenia. Arch Gen Psychiatry. 1999a;56(1):21–27.CrossRefGoogle ScholarPubMed
35.Evins, AE, Amico, E, Posever, TA, Toker, R, Goff, DC. D-Cycloserine added to risperidone in patients with primary negative symptoms of schizophrenia. Schizophrenia Res. 2002;56(1–2):19–23.CrossRefGoogle ScholarPubMed
36.Heresco-Levy, U, Javitt, DC. Comparative effects of glycine and D-cycloserine on persistent negative symptoms in schizophrenia: a retrospective analysis. Schizophrenia Res. 2004;66(2–3):89–96.CrossRefGoogle ScholarPubMed
37.Goff, D, Henderson, D, Evins, AE, Amico, E. A placebo-controlled crossover trial of D-cycloserine added to clozapine in patients with schizophrenia. Biol Psychiatry. 1999b;45(4):512–514.CrossRefGoogle ScholarPubMed
38.van Berckel, BN, Evenblij, CN, van Loon, BJ et al. , D-cycloserine increases positive symptoms in chronic schizophrenic patients when administered in addition to antipsychotics: a double-blind, parallel, placebo-controlled study. Neuropsychopharmacology. 1999;21(2):203–210.CrossRefGoogle ScholarPubMed
39.Rosse, RB, Deutsch, SI. Adjuvant galantamine administration improves negative symptoms in a patient with treatment-refractory schizophrenia. Clin Neuropharmacol. 2002;25(5):272–275.CrossRefGoogle Scholar
40.Goff, DC, Midha, KK, Sarid-Segal, O, Hubbard, JW, Amico, E. A placebo-controlled trial of fluoxetine added to neuroleptic in patients with schizophrenia. Psychopharmacology. 1995;117(4):417–423.CrossRefGoogle ScholarPubMed
41.Buchanan, RW, Kirkpatrick, B, Bryant, N, Ball, P, Breier, A. Fluoxetine augmentation of clozapine treatment in patients with schizophrenia. Am J Psychiatry. 1996;153(12):1625–1627.Google ScholarPubMed
42.Salokangas, RK, Saarijèarvi, S, Taiminen, T et al. , Citalopram as an adjuvant in chronic schizophrenia: a double-blind placebo-controlled study. Acta Psychiatr Scand. 1996;94(3):175–180.CrossRefGoogle ScholarPubMed
43.Lee, MS, Kim, YK, Lee, SK, Suh, KY. A double-blind study of adjunctive sertraline in haloperidol-stabilized patients with chronic schizophrenia. J Clin Psychopharmacol. 1998;18(5):399–403.CrossRefGoogle ScholarPubMed
44.Arango, C, Kirkpatrick, B, Buchanan, RW. Fluoxetine as an adjunct to conventional antipsychotic treatment of schizophrenia patients with residual symptoms. J Nerv Ment Dis. 2000;183(1):50–53.CrossRefGoogle Scholar
45.Kapur, S, McClelland, RA, VanderSpek, SC et al. , Increasing D2 affinity results in the loss of clozapine's atypical antipsychotic action. Neuroreport. 2002;13(6):831–835.CrossRefGoogle ScholarPubMed
46.Lieberman, JA, Safferman, AZ, Pollack, S et al. , Clinical effects of clozapine in chronic schizophrenia: response to treatment and predictors of outcome. Am J Psychiatry. 1994;151:1744–1752.Google ScholarPubMed
47.Miller, AL, Chiles, JA, Chiles, JK, Crismon, ML, Shon, SP, Rush, AJ. The Texas Medication Algorithm Project (TMAP) Schizophrenia Algorithms. J Clin Psychiatry. 1999;60(10):649–657.CrossRefGoogle ScholarPubMed
48.McEvoy, JP, Scheifler, PI, Frances, A. The Expert Consensus Guideline Series: treatment of schizophrenia 1999. J Clin Psychiatry. 1999;60(suppl 11):1–80.Google Scholar
49.Miller, AL, Hall, CS, Buchanan, RW et al. , The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry. 2004;65(4):500–503.CrossRefGoogle ScholarPubMed
50.Lehman, AF, Steinwachs, DM. Translating research into practice: The schizophrenia PORT treatment recommendations. Schizophrenia Bull. 1998;24:1–10.CrossRefGoogle Scholar
51.Lehman, AF, Kreyenbuhl, J, Buchanan, RW et al. , The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophrenia Bull. 2004;30(2):193–217.CrossRefGoogle ScholarPubMed