Antipsychotic Polypharmacy in Clozapine Resistent Schizophrenia

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Antipsychotic polypharmacy in clozapine resistent schizophrenia: a randomized controlled trial of tapering antipsychotic co- treatment Presented by : dr. I Putu Diatmika Mentored by : dr. Ni Ketut Putri A Sp.KJ Bagian/SMF Psikiatri Fakultas Kedokteran Universitas Udayana RSUP Sanglah Denpasar

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Transcript of Antipsychotic Polypharmacy in Clozapine Resistent Schizophrenia

  • Antipsychotic polypharmacy in clozapine resistent schizophrenia: a randomized controlled trial of tapering antipsychotic co-treatmentPresented by : dr. I Putu Diatmika Mentored by : dr. Ni Ketut Putri A Sp.KJBagian/SMF Psikiatri Fakultas Kedokteran Universitas Udayana RSUP Sanglah Denpasar

  • Introduction

    Treatment resistance and inadequate response to antipsychotic (AP) medication are significant clinical problems.Treatment resistant patients represent 20-30 % of people with schizophrenia.

  • IntroductionPatients are comonly trated with clozapineAtypical Antipsychotic Monotherapies at therapeutic doses have been suggested to be the best pharmacological treatmant of schizophrenia.In spite of recommendations, these patients often have added on polypharmacy with several APs. This augmentation has been questioned in several studies.

  • introductionFrom the results of four randomized con-trolled trials (RCTs), Paton et al. 6 suggested that augmentation of clozapine with another AP cannot be recommended but it is worth of a long enough clinical trial.After reviewing 19 RCTs, Correll et al.7 suggested that antipsychotic co-treatment may be superior to monotherapy in certain clinical situations. However, it was not possible to derive firm clinical recommendations from these results

  • Introduction

  • AIMThe aim of the present study was to determine if clozapine monotherapy is as effective as clozapine-olanzapine therapy for treatment resistant schizophrenia in a randomized double-blind setting.

  • MATERIALS AND METHODSPATIENTS

    In 2009, 30 schizophrenic patients in the Niuvanniemi State Mental Hospital received clozapine-olanzapine therapy for severe psychotic symptoms after only partially responding to clozapine alone.

  • Patient flowchart.

  • MethodsThe criteria inclusion; An age of at least 18 years, compe-tence to understand the meaning of the study and give informed consent, Insufficient response to clozapine-olanzapine therapy,Unchanged psychotropic medication during the last two months andNo concurrent pregnancy

  • Ethical considerationsEvery pastien in this study signed the informed consent.

  • Primary outcome measures

  • Methods

  • Results

  • Conclusions

    The clinical state of seriously ill schizophrenic patients who were on olanzapine-clozapine therapy was not affected by discontinuation of olanzapine. The natural fluctuating course of schizophrenia is often represented by worsening of psychotic symptoms which may lead to longlasting and unnecessary AP polypharmacy

  • KAJIAN KRITIS KEDOKTERAN BERBASIS BUKTI

  • APAKAH BUKTI TENTANG PROGNOSIS INI PENTING ?Seberapa besar kemungkinan kesudahan ini terjadi untuk jangka waktu yang lebih panjang ? Peneliti tidak menjelaskan tentang kemungkinan jangka panjangnya.Seberapa persisi estimasi prognosis ? Tidak dijelaskan detail---- PENELITIAN INI PERLU DI TINJAU ULANG

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  • Supporting Journal

  • Supporting journal

  • THANK YOUTERIMA KASIH

  • CGI

  • PREVALENSI PREVALESI RESISTENSI 20%-45% DARI ORANG DENGAN SKIZOFRENIA DENGAN DURASI LEBIH DARI DUA TAHUN HANYA SEBAGIAN YANG RESPONSIF TERHADAP ANTIPSIKOTIK DAN 5%-10% TIDAK MENDAPATKAN MANFAAT SAMA SEKALI. PADA PENGOBATAN TIPIKAL AP (FGA)Pantelis C, lambert TJ. Managing patients with treatmant resistant schoziphrenia Med J Aust 2003

  • IPAP (international psychopharmacology algorithm project) CRITERIA OF TREATMENT RESISTANT SCHIZOPHRENIANo period of good functioning in previous 5 years.Prior non response to at least 2 antipsychotic drugs of 2 different chemical classes for at least 4-6 weeks each at dosages equivalent to >400 mg/d of chlorpromazine or 5 mg/d of risperidoneModerate to severe psychopathology, especially positive symptoms: conceptual disorganization, suspiciousness, delutions, or hallucinatory behaviors

  • Kane creteria for treatment-resistant schizophrenia (BPRS brief psychiatric rating scale, CGI clinical global impression)

    Treatment resistant (TR)creteriaHistory of TRAt lest 3 treatments with typical antipsychotic from at least 2 defferent chemical classes with dosages equivalent to 1000mg/d of chlorpromazine for a period of 6 weeks without significant relief of symptoms, no period of good function within the preceding 5 yearsSeverity of symptomsA score of at least 45 in the BPRS (1-7 severity degree) with scores of at least 4 in 2 of the following items : conceptual disorgenization, suspiciousness, hallucinatory behavior, or unusual thought contentCurrent TRNo improvemeny after 6 weeks of treatment with haloperidol (60mg/d or higher) : improvement is defined as a 20 % reduction in BPRS score as compared with the level of severity defined by the actual creteria and/ or a posttretment CGI of < 3 or a BPRS of