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Augmentation Strategies (augmentation + strategy)
Selected AbstractsAugmentation of clozapine with a second antipsychotic , a meta-analysis of randomized, placebo-controlled studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009D. M. Taylor Objective:, Inadequate response to clozapine treatment is frequently encountered in practice and augmentation strategies have been developed in an attempt to improve response. Aims of the study were to evaluate the therapeutic effect of adding an antipsychotic drug to clozapine treatment. Method:, Meta-analysis of randomized, placebo-controlled studies of antipsychotic augmentation of clozapine treatment. Results:, Ten studies (including 522 subjects) met inclusion criteria. Antipsychotic augmentation showed significant benefit over the addition of placebo on only one outcome measure examined [mean effect size for rating scale score (BPRS/PANSS) ,0.180, 95% CI ,0.356 to ,0.004]. Antipsychotic augmentation showed no advantage on withdrawals from trials (risk ratio 1.261, 95% CI 0.679,2.345) or on CGI scores (effect size ,0.661, 95% CI ,1.475 to 0.151). Duration of study was not associated with outcome (P = 0.95). There was no evidence of publication bias. Conclusion:, In studies lasting up to 16 weeks, the addition of an antipsychotic to clozapine treatment has marginal therapeutic benefit. Longer and larger trials are necessary to demonstrate the precise therapeutic utility of antipsychotic co-therapy with clozapine. [source] Antipsychotic combination therapy in schizophrenia.ACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2002A review of efficacy, risks of current combinations Objective:, To review the literature on efficacy and risks of combining antipsychotics (atypical with atypical or conventional) and suggest a rationale and strategies for future clinical trials. Method:, A computerized Medline search supplemented by an examination of cross-references and reviews was performed. Results:, Empirical evidence for the efficacy of combining antipsychotics is too limited to draw firm conclusions. The practice of augmenting clozapine with more ,tightly bound' D2 receptor antagonists as exemplified by risperidone augmentation of clozapine has some empirical and theoretical support. The risks of augmentation strategies have not been studied systematically. No study has examined the economic impact of combination treatment. Conclusion:, Further trials of antipsychotic combination therapies are needed before this currently unsupported practice can be recommended. Rationales for combination treatment include a broadening of the range of receptor activity or an increase in D2 receptor occupancy with certain atypical agents. Trial methodology needs to take into account subject characteristics, duration of treatment, optimization of monotherapy comparators, and appropriate outcome measures. [source] Augmentation with sulpiride for a schizophrenic patient partially responsiveto clozapineACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2000Jean H. Stubbs Objective:,Schizophrenic patients who are only partially responsive to clozapine pose a therapeutic challenge. In these circumstances some clinicians would consider adding in a second antipsychotic. We present a case report and review evidence for the efficacy of such augmentation strategies. Method:,Single case report and literature review. Results:,The total number of patients in studies and case reports of combining clozapine with other antipsychotics is small. There has been only one randomized controlled trial. This found the addition of sulpiride to clozapine resulted in clinical improvement in some patients. Conclusion:,Further randomized controlled studies of augmentation of clozapine therapy are needed to provide scientific justification for this clinical practice. [source] Effectiveness of antipsychotic polypharmacy for patients with treatment refractory schizophrenia: an open-label trial of olanzapine plus risperidone for those who failed to respond to a sequential treatment with olanzapine, quetiapine and risperidoneHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2008Takefumi Suzuki Abstract Objective To evaluate the effectiveness of antipsychotic polypharmacy in a methodologically sound manner. Methods In this open-label study, 17 patients with treatment-refractory schizophrenia, who failed to respond to a sequential monotherapy with olanzapine, quetiapine and risperidone, were subsequently treated with a combination therapy with olanzapine plus risperidone for at least 8 weeks. Results Seven responded according to the primary endpoint defined as the post-treatment Brief Psychiatric Rating Scale being less than 70% of the pretreatment values, and they were classified as such an average of 10 weeks after the initiation of polypharmacy. Two of them were successful in a later conversion to monotherapy. None dropped out prematurely. Four (out of 13 inpatients) got better enough to be discharged from the hospital, while six patients did not show any response. The Global Assessment of Functioning score improved from 37.1 to 53.0 in responders (mean maximum dose: olanzapine 12.9,mg; risperidone 3.14,mg), while it showed non-significant changes among others (mean maximum dose: olanzapine 14.5,mg; risperidone 5.50,mg). Body weight, prolactin, and total cholesterol increased significantly. Conclusions Antipsychotic polypharmacy might be sometimes helpful for difficult populations but at the cost of adverse effects. More studies of antipsychotic combination therapy versus clozapine, augmentation strategies or tenacious longer- term monotherapy are warranted for refractory schizophrenia. Copyright © 2008 John Wiley & Sons, Ltd. [source] Efficacy of treatments for patients with obsessive-compulsive disorder: A systematic reviewJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2009PMHNP (Lecturer)Article first published online: 2 APR 200, Yun-Jung Choi PhD Abstract Purpose: This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder (OCD), addressing two major issues: which treatment is most effective in treating the patient's symptoms and which is beneficial for maintaining remission. Data sources: Seven databases were used to acquire articles. The key words used to search for the relative topics published from 1996 to 2007 were "obsessive-compulsive disorder" and "Yale-Brown obsession-compulsion scale." Based on the inclusion and exclusion criteria, 25 studies were selected from 57 potentially relevant studies. Conclusions: The effects of treatment with clomipramine and selective serotonin reuptake inhibitors (SSRIs: fluvoxamine, sertraline, fluoxetine, citalopram, and escitalopram) proved to be similar, except for the lower adherence rate in case of clomipramine because of its side effects. An adequate drug trial involves administering an effective daily dose for a minimum of 8 weeks. An augmentation strategy proven effective for individuals refractory to monotherapy with SSRI treatment alone is the use of atypical antipsychotics (risperidone, olanzapine, and quetiapine). Implications for practice: Administration of fluvoxamine or sertraline to patients for an adequate duration is recommended as the first-line prescription for OCD, and augmentation therapy with risperidone, olanzapine, or quetiapine is recommended for refractory OCD. [source] | ||||||||||