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2 - Evidence-based pharmacotherapy of schizophrenia

Published online by Cambridge University Press:  05 August 2012

Dan Stein
Affiliation:
University of Cape Town
Bernard Lerer
Affiliation:
Hadassah-Hebrew Medical Centre
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

This chapter presents the authors' interpretation of the core evidence about the pharmacological treatment of schizophrenia. It summarizes the interpretation of the discussion about second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs), and which is the best SGA, mainly based on recent systematic reviews and effectiveness studies CATIE. The author interprets the meta-analyses such that overall clozapine, amisulpride, olanzapine and risperidonemay be somewhat more efficacious than FGAs and other SGAs. Depressive symptoms are frequently present in acutely ill patients with schizophrenia and may first improve with antipsychotics alone. Neuroleptic-induced depressive symptoms might be ruled out by anti-parkinson medication or switching to a drug with fewer extrapyramidal side-effects (EPS). Post-psychotic depression may be treated with an antidepressant. Electroconvulsive therapy (ECT) is recommended only as a last resort, but advantageously compared with the other augmentation strategies, it is effective as monotherapy and has a different mechanism of action than antipsychotics.
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Publisher: Cambridge University Press
Print publication year: 2012

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