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CC BY-NC-ND 4.0 · Pharmacopsychiatry 2021; 54(02): 60-67
DOI: 10.1055/a-1324-3517
Original Paper

Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus

Hitoshi Sakurai
1   Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
,
Norio Yasui-Furukori
3   Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
,
Takefumi Suzuki
4   Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
,
Hiroyuki Uchida
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
,
Hajime Baba
5   Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
,
Koichiro Watanabe
6   Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
,
Ken Inada
7   Department of Psychiatry, Tokyo Women’s Medical University School of Medicine, Tokyo Japan
,
Yuka Sugawara Kikuchi
8   Department of Psychiatry, Akita University School of Medicine, Akita, Japan
,
Toshiaki Kikuchi
2   Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
,
Asuka Katsuki
9   Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
,
Ikuko Kishida
10   Fujisawa Hospital, Kanagawa, Japan
11   Department of Psychiatry, Yokohama City University School of Medicine, Kanagawa, Japan
,
Masaki Kato
12   Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
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Abstract

Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues.

Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=“disagree” and 9=“agree”).

Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1).

Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.

Key words

antipsychotics - expert consensus - pharmacotherapy - schizophrenia

Supplementary Material



Publication History

Received: 19 November 2020
Received: 16 July 2020

Accepted: 22 November 2020

Article published online:
12 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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