Pharmacotherapy of schizophrenia: clinical and some age-related aspects

Ivanov S.V.; Goryunov A.V.

doi:https://doi.org/10.17116/jnevro202412407141

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Abstract:

The article discusses modern approaches to the rational choice of therapy for schizophrenia in accordance with the principles of personalized medicine. Clinical markers for determining the optimal treatment tactics are considered depending on the syndromic features and stereotype of the course of the disease, and the possibility of justified combination therapy with drugs of different pharmacological classes. The specifics of the treatment of schizophrenia in childhood/adolescence and adult are discussed, including the basic principles of choosing drug classes, daily doses and drug therapy tactics.

Keywords:

schizophrenia

pharmacotherapy

antipsychotics

childhood

adult

Authors:

Ivanov S.V.

Mental Health Research Center

ORCID: 0000-0001-9532-7150

Goryunov A.V.

Mental Health Research Center

SPIN RSCI: 6932-3880
Scopus AuthorID: 35773220700
ResearcherID: B-9476-2017
ORCID: 0000-0002-2851-8843

Received:

01.05.2024

Accepted:

08.05.2024

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References:

The Russian Society of Psychiatrists (ROP). Schizophrenia. Clinical recommendations (approved by the Ministry of Health of the Russian Federation), 2021—2023. (In Russ.). https://library.mededtech.ru/rest/documents/KP451/?ysclid=lpxv8f7son618037748#3
Mosolov SN. Biologicheskie metody terapii psihicheskih rasstrojstv (dokazatel’naya medicina — klinicheskoj praktike). Pod red. S.N. Mosolova. M.: Izdatel’stvo «Social’no-politicheskaya mysl’». 2012;1080. (In Russ.).
Neznanov NG, Aleksandrovskij YuA. Racional’naya farmakoterapiya v psihiatricheskoj praktike: rukovodstvo dlya praktikuyushchih vrachej. Pod obshch. red. Yu.A. Aleksandrovskogo, N.G. Neznanova. M.: Litterra. 2014;1080. (In Russ.).
Shmukler A.B. Shizofreniya. M.: GEOTAR-Media. 2021;176. (In Russ.).
Fusar-Poli P. The Clinical High-Risk State for Psychosis (CHR-P), Version II. Schizophr Bull. 2017;43(1):44-47. https://doi.org/10.1093/schbul/sbw158
Bora E, Binnur Akdede B, Alptekin K. Neurocognitive impairment in deficit and non-deficit schizophrenia: a meta-analysis. Psychol Med. 2017;47(14):2401-2413. https://doi.org/10.1017/S0033291717000952
O’Keeffe D, Kinsella A, Waddington JL, et al. Clarke M. 20-Year Prospective, Sequential Follow-Up Study of Heterogeneity in Associations of Duration of Untreated Psychosis With Symptoms, Functioning, and Quality of Life Following First-Episode Psychosis. Am J Psychiatry. 2022;179(4):288-297. https://doi.org/10.1176/appi.ajp.2021.20111658
Kaleda VG, Omelchenko MA, Rumyantsev AO. Psychotic risk in adolescence. Psychiatry and psychopharmacotherapy. 2017;19(2):27-33. (In Russ.).
Fusar-Poli P, Salazar de Pablo G, Correll CU, et al. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry. 2020;77(7):755-765. https://doi.org/10.1001/jamapsychiatry.2019.4779
Sommer IE, Bearden CE, van Dellen E, et al. Early interventions in risk groups for schizophrenia: what are we waiting for? NPJ Schizophr. 2016;2:16003. https://doi.org/10.1038/npjschz.2016.3
Murru A, Carpiniello B. Duration of untreated illness as a key to early intervention in schizophrenia: A review. Neurosci Lett. 2018;669:59-67. https://doi.org/10.1016/j.neulet.2016.10.003
The National Institute for Health and Care Excellence. NICE guidance, Psychosis and schizophrenia in adults: prevention and management. 2014. https://www.nice.org.uk/guidance/cg178/chapter/1-Recommendations#preventing-psychosis-2.
Schmidt SJ, Schultze-Lutter F, Schimmelmann BG, et al. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry. 2015;30(3):388-404. https://doi.org/10.1016/j.eurpsy.2015.01.013
Smulevich AB. The new psychopathological paradigm of schizophrenia and schizophrenia spectrum disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(1):7-15. (In Russ.). https://doi.org/10.17116/jnevro20241240117
Pandurangi AK, Buckley PF. Inflammation, Antipsychotic Drugs, and Evidence for Effectiveness of Anti-inflammatory Agents in Schizophrenia. Curr Top Behav Neurosci. 2020;44:227-244. https://doi.org/10.1007/7854_2019_91
de Bartolomeis A, Barone A, Vellucci L, et al. Linking Inflammation, Aberrant Glutamate-Dopamine Interaction, and Post-synaptic Changes: Translational Relevance for Schizophrenia and Antipsychotic Treatment: a Systematic Review. Mol Neurobiol. 2022;59(10):6460-6501. https://doi.org/10.1007/s12035-022-02976-3
van der Gaag M, Smit F, Bechdolf A, et al. Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups. Schizophr Res. 2013;149(1-3):56-62. https://doi.org/10.1016/j.schres.2013.07.004
Mosolov SN, Yaltinskaya PA. Algorithm of therapy of primary negative symptoms in schizophrenia. Modern therapy of mental disorders. 2020;2:2-10. (In Russ.). https://doi.org/10.21265/PSYPH.2020.26.17.001
Leucht S, Leucht C, Huhn M, et al. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. Am J Psychiatry. 2017;174(10):927-942. https://doi.org/10.1176/appi.ajp.2017.16121358
Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al, Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394(10202):939-951. https://doi.org/10.1016/S0140-6736(19)31135-3
Leucht S, Kane JM, Etschel E, et al. Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology. 2006;31(10):2318-2325. https://doi.org/10.1038/sj.npp.1301147
Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group consensus guidelines on diagnosis and terminology. Am J Psychiatry. 2017;174(3):216-229. https://doi.org/10.1176/appi.ajp.2016.16050503
Mosolov SN, Tsukarzi EE, Alfimov PV. Algorithms of biological therapy of schizophrenia. Modern therapy of mental disorders. 2014;1:27-36. (In Russ.).
Seppälä A, Pylvänäinen J, Lehtiniemi H et al. Predictors of response to pharmacological treatments in treatment-resistant schizophrenia — A systematic review and meta-analysis. Schizophr Res. 2021;236:123-134. https://doi.org/10.1016/j.schres.2021.08.005
Siskind D, Orr S, Sinha, et al. Rates of treatment-resistant schizophrenia from first-episode cohorts: systematic review and meta-analysis. Br J Psychiatry. 2022;220(3):115-120. https://doi.org/10.1192/bjp.2021.61
Demjaha A, Lappin JM, Stahl D, et al. Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors. Psychol Med. 2017;47(11):1981-1989. https://doi.org/10.1017/S0033291717000435
Siskind D, McCartney L, Goldschlager R, KiselyS. Clozapine v. first-and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2016;209(5):385-392. https://doi.org/10.1192/bjp.bp.115.177261
Kishimoto T, Robenzadeh A, Leucht C, et al. Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull. 2014;40(1):192-213. https://doi.org/10.1093/schbul/sbs150
Emsley R, Asmal L, Rubio JM, et al. Predictors of psychosis breakthrough during 24 months of long-acting antipsychotic maintenance treatment in first episode schizophrenia. Schizophr Res. 2020;225:55-62. https://doi.org/10.1016/j.schres.2019.11.025
Rubio JM, Taipale H, Correll CU, et al. Psychosis breakthrough on antipsychotic maintenance: results from a nationwide study. Psychol Med. 2020;50(8):1356-1367. https://doi.org/10.1017/S0033291719001296
Land R, Siskind D, Mcardle P, et al. The impact of clozapine on hospital use: a systematic review and meta-analysis. Acta Psychiatr Scand. 2017;135(4):296-309. https://doi.org/10.1111/acps.12700
Vermeulen JM, van Rooijen G, van de Kerkhof, et al. Clozapine and long-term mortality risk in patients with schizophrenia: a systematic review and meta-analysis of studies lasting 1.1-12.5 years. Schizophr Bull. 2019; 45(2):315-329. https://doi.org/10.1093/schbul/sby052
McEvoy JP, Lieberman JA, Stroup TS, et al. CATIE Investigators. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163(4):600-610. https://doi.org/10.1176/appi.ajp.163.4.600
Samara MT, Dold M, Gianatsi M, et al. Efficacy, Acceptability, and Tolerability of Antipsychotics in Treatment-Resistant Schizophrenia: A Network Meta-analysis. JAMA Psychiatry. 2016;73(3):199-210. https://doi.org/10.1001/jamapsychiatry.2015.2955
Rancans E, Dombi ZB, Mátrai P, et al. The effectiveness and safety of cariprazine in schizophrenia patients with negative symptoms and insufficient effectiveness of previous antipsychotic therapy: an observational study. Int Clin Psychopharmacol. 2021;36(3):154-161. https://doi.org/10.1097/YIC.0000000000000351
Mosolov SN. Primenenie transkranial’noj magnitnoj stimulyacii v psihiatrii. Ivanovo: Nejrosoft. 2023;576. (In Russ.).
Bighelli I, Rodolico A, Siafis S, et al. Antipsychotic polypharmacy reduction versus polypharmacy continuation for people with schizophrenia. Cochrane Database Syst Rev. 2022;8(8):CD014383. https://doi.org/10.1002/14651858.CD014383.pub2
Tiihonen J, Taipale H, Mehtala, J, et al. Association of Antipsychotic Polypharmacy vs Monotherapy With Psychiatric Rehospitalization Among Adults With Schizophrenia. JAMA psychiatry. 2019;76:499-507. https://doi.org/10.1001/jamapsychiatry.2018.4320
Kaar SJ, Natesan S, McCutcheon R, et al. Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology. Neuropharmacology. 2020;172:107704. https://doi.org/10.1016/j.neuropharm.2019.107704
Galling B, Roldan A, Hagi K, et al. Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry. 2017;16(1):77-89. https://doi.org/10.1002/wps.20387
Ivanov SV, Smulevich AB, Borisova PO, et al. Therapy of catatonia in the clinical space of schizophrenia and schizophrenic spectrum disorders. Psychiatry. 2022;20(3):112-123. (In Russ.). https://doi.org/10.30629/2618-6667-2022-20-3-112-123
Rasmussen S, Mazurek M, Rosebush P. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World J Psychiatry. 2016;6(4):391. https://doi.org/10.5498/wjp.v6.i4.391
Zaman H, Gibson RC, Walcott G. Benzodiazepines for catatonia in people with schizophrenia or other serious mental illnesses. Cochrane Database Syst Rev. 2019;8(8):CD006570. https://doi.org/10.1002/14651858.CD006570.pub3
Ungvari GS, Chiu HF, Chow LY, et al. Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study. Psychopharmacology (Berl). 1999;142(4):393-398. https://doi.org/10.1007/s002130050904
Avruckij GYa, Neduva AA. Lechenie psihicheski bol’nyh. M.: Medicina. 1988;496. (In Russ.).
Tiganov AS. Febril’naya shizofreniya. M: Medicina. 1982;128. (In Russ.).
Cygankov BD, Ovsyannikov SA. Psihiatriya. M.: GEOTAR-Media. 2012;384. (In Russ.).
Woodbury MM, Woodbury MA. Neuroleptic-induced catatonia as a stage in the progression toward neuroleptic malignant syndrome. J Am Acad Child Adolesc Psychiatry. 1992;31(6):1161-1164. https://doi.org/10.1097/00004583-199211000-00028
Lee JW. Neuroleptic-induced catatonia: clinical presentation, response to benzodiazepines, and relationship to neuroleptic malignant syndrome. J Clin Psychopharmacol. 2010;30(1):3-10. https://doi.org/10.1097/JCP.0b013e3181c9bfe6
Muneoka K, Kanahara N, Kimura S. Switching to aripiprazole for the treatment of residual mutism resulted in distinct clinical courses in two catatonic schizophrenia cases. SAGE Open Med Case Rep. 2017;5:2050313X17692936. https://doi.org/10.1177/2050313X17692936
Bush G, Fink M, Petrides G, et al. Rating scale and standardized examination. Acta Psychiat Scand. 1996;93(2):129-136. https://doi.org/10.1111/j.1600-0447.1996.tb09814.x
Suzuki K, Awata S, Matsuoka H. One-year outcome after response to ECT in middle-aged and elderly patients with intractable catatonic schizophrenia. J ECT. 2004;20(2):99-106. https://doi.org/10.1097/00124509-200406000-00005
Hatta K, Miyakawa K, Ota T, et al. Maximal Response to Electroconvulsive Therapy for the Treatment of Catatonic Symptoms. J ECT. 2007;23(4):233-235. https://doi.org/10.1097/yct.0b013e3181587949
Smulevich AB. Negativnye rasstrojstva v psihopatologicheskom prostranstve shizofrenii. 2-e izd. M.: MEDpress-inform. 2023;248. (In Russ.).
Németh G, Laszlovszky I, Czobor P, et al. Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet. 2017;389(10074):1103-1113. https://doi.org/10.1016/S0140-6736(17)30060-0
Smulevich AB, Ivanov SV, Yakhin KK, et al. Cariprazine in schizophrenia with predominantly negative symptoms: early effects of therapy (observational study). S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(12):67-72. (In Russ.). https://doi.org/10.17116/jnevro202012012167
Werner FM, Coveñas R. New developments in the management of schizophrenia and bipolar disorder: potential use of cariprazine. Ther Clin Risk Manag. 2015;11:1657-1661. https://doi.org/10.2147/TCRM.S64915
Misiak B, Bieńkowski P, Samochowiec J. Cariprazine — a novel antipsychotic drug and its place in the treatment of schizophrenia. Psychiatr Pol. 2018;52(6):971-981. https://doi.org/10.12740/PP/OnlineFirst/80710
Frankel JS, Schwartz TL. Brexpiprazole and cariprazine: Distinguishing two new atypical antipsychotics from the original dopamine stabilizer aripiprazole. Ther Adv Psychopharmacol. 2017;7(1):29-41.
Leucht S, Corves C, Arbter D, et al. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. The Lancet. 2009;373(9657):31-41. https://doi.org/10.1016/s0140-6736(08)61764-x
Davis MC, Horan WP, Marder SR. Psychopharmacology of the negative symptoms: current status and prospects for progress. Eur Neuropsychopharmacol. 2014;24(5):788-799. https://doi.org/10.1016/j.euroneuro.2013.10.010
Krause M, Zhu Y, Huhn M, et al. Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2018;268(7):625-639. https://doi.org/10.1007/s00406-018-0869-3
Makushkin EV, Simashkova NV, Perezhogin LO, et al. Schizophrenia in childhood and adolescence. Russian Psychiatric Journal. 2016;(6):62-81. (In Russ.).
Goryunov AV. Using Lurasidone in the treatment of mental illness in childhood. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(11-2):77-85. (In Russ.). https://doi.org/10.17116/jnevro202112111277
Shtal S. Rukovodstvo dlya praktikuyushchih vrachej: deti i podrostki. S. Shtal; per. s angl. M.: MEDprecs-inform. 2022;742. (In Russ.).
Correll CU, Findling RL, Tocco M, et al. Safety and effectiveness of lurasidone in adolescents with schizophrenia: results of a 2-year, open-label extension study. CNS Spectr. 2022;27(1):118-128. https://doi.org/10.1017/S1092852920001893