RSS-Feed abonnieren
DOI: 10.1055/s-0031-1279728
© Georg Thieme Verlag KG Stuttgart · New York
Augmentation Treatment with Amisulpride in Schizophrenic Patients Partially Responsive to Olanzapine
Publikationsverlauf
received 21.12.2010
revised 20.03.2011
accepted 21.03.2011
Publikationsdatum:
27. Juni 2011 (online)
![](https://www.thieme-connect.de/media/pharmaco/201104/lookinside/thumbnails/10.1055-s-0031-1279728-1.jpg)
Abstract
Objective: The association of antipsychotics is a widespread therapeutic resource in clinical practice. The purpose of the present work was to evaluate the efficacy and safety of amisulpride augmentation in patients responding at least partially to olanzapine.
Methods: In this observational 3-months open-label investigation, we evaluated the effectiveness of the addition of amisulpride to 49 subjects, after having scored at least 25 on the brief psychiatric rating scale (BPRS) following olanzapine monotherapy for 6 weeks. Patients were assessed at baseline, 1 and 3 months using the BPRS, the clinical global impression severity of illness (CGI-S) scale and the Udvalg for Kliniske Undersogelser side effect rating scale (UKU).
Results: In subjects who were at least partially responsive to monotherapy with olanzapine, coadjuvant treatment with amisulpride achieved a statistically significant improvement in mental status over a 3 month period as measured by the BPRS, CGI and UKU scales. The response rate (>20% reduction in BPRS score) was 75.51%.
Conclusions: Amisulpride augmentation, in a group of patients partially or non-responsive to olanzapine, may lead to an improvement in schizoprenic symptoms. However, these results are subject to several limitations making it difficult to derive firm clinical recommendations, and underscoring the need for future research into the value of these therapeutic alternatives in poor responders.
Key words
olanzapine - amisulpride - augmentation - schizophrenia - treatment resistance
References
- 1 Heresco-Levy U, Greenberg D, Wittman L. et al . Prescribing patterns of neuroactive drugs in 98 schizophrenic patients. Isr J Psychiatry Relat Sci. 1989; 26 157-163
- 2 Kiivet RA, Llerena A, Dahl ML. et al . Patterns of drug treatment of schizophrenic patients in Estonia, Spain and Sweden. Br J Clin Pharmacol. 1995; 40 467-476
- 3 Ungvari GS, Pang AH, Chiu HF. et al . Psychotropic drug prescription in rehabilitation. A survey in Hong Kong. Soc Psychiatry Psychiatr Epidemiol. 1996; 31 288-291
- 4 Ito C, Kubota Y, Sato M. A prospective survey on drug choice for prescriptions for admitted patients with schizophrenia. Psychiatry Clin Neurosci. 1999; 53 (Suppl) S35-S40
- 5 Rittmannsberger H, Meise U, Schauflinger K. et al . Polypharmacy in psychiatric treatment. Patterns of psychotropic drug use in Austrian psychiatric clinics. Eur Psychiatry. 1999; 14 33-40
- 6 Wang PS, West JC, Tanielian T. et al . Recent patterns and predictors of antipsychotic medication regimens used to treat schizophrenia and other psychotic disorders. Schizophr Bull. 2000; 26 451-457
- 7 Fourrier A, Gasquet I, Allicar MP. et al . Patterns of neuroleptic drug prescription: a national cross-sectional survey of a random sample of French psychiatrists. Br J Clin Pharmacol. 2000; 49 80-86
- 8 Procyshyn RM, Kennedy NB, Tse G. et al . Antipsychotic polypharmacy: a survey of discharge prescriptions from a tertiary care psychiatric institution. Can J Psychiatry. 2001; 46 334-339
- 9 Weissman EM. Antipsychotic prescribing practices in the Veterans Healthcare Administration – New York metropolitan region. Schizophr Bull. 2002; 28 31-42
- 10 Covell NH, Jackson CT, Evans AC. et al . Antipsychotic prescribing practices in Connecticutâs public mental health system: rates of changing medications and prescribing styles. Schizophr Bull. 2002; 28 17-29
- 11 Clark RE, Bartels SJ, Mellman TA. et al . Recent trends in antipsychotic combination therapy of schizophrenia and schizoaffective disorder: implications for state mental health policy. Schizophr Bull. 2002; 28 75-84
- 12 McCue RE, Waheed R, Urcuyo L. Polypharmacy in patients with schizophrenia. J Clin Psychiatry. 2003; 64 984-989
- 13 Flórez Menéndez G, Blanco Ramos M, Gómez-Reino Rodríguez I. et al . Polypharmacy in the antipsychotic prescribing practices in psychiatric out-patient clinic. Actas Esp Psiquiatr. 2004; 32 333-339
- 14 Ganguly R, Kotzan JA, Miller LS. et al . Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients, 1998–2000. J Clin Psychiatry. 2004; 65 1377-1388
- 15 Sim K, Su A, Fujii S. et al . Antipsychotic polypharmacy in patients with schizophrenia: a multicentre comparative study in East Asia. Br J Clin Pharmacol. 2004; 58 178-183
- 16 Janssen B, Weinmann S, Berger M. et al . Validation of polypharmacy process measures in inpatient schizophrenia care. Schizophr Bull. 2004; 30 1023-1033
- 17 Faries D, Ascher-Svanum H, Zhu B. et al . Antipsychotic monotherapy and polypharmacy in the naturalistic treatment of schizophrenia with atypical antipsychotics. BMC Psychiatry. 2005; 5 26
- 18 Ito H, Koyama A, Higuchi T. Polypharmacy and excessive dosing: psychiatrists’ perceptions of antipsychotic drug prescription. Br J Psychiatry. 2005; 187 243-247
- 19 Ghaemi SN. Polypharmacy in psychiatry.. New York: Marcel Dekker; 2002
- 20 Kane JM, Leucht S, Carpenter D. et al . Treatment of schizophrenia 1999. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003; 64 (Suppl. 12) 5-19
- 21 Lehman AF, Lieberman JA, Dixon LB. et al . American Psychiatric Association; Steering Committee on Practice Guidelines. Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004; 161 (Suppl. 2) 1-56
- 22 Miller AL, Crismon ML, Rush AJ. et al . The Texas medication algorithm project: clinical results for schizophrenia. Schizophr Bull. 2004; 30 627-647
- 23 Lehman AF, Kreyenbuhl J, Buchanan RW. et al . The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004; 30 193-217
- 24 National Institute for Mental Health in England . Implementing NICE Guidance. Available at http://www.schizophreniaguidelines.co.uk/
- 25 Zink M, Englisch S, Meyer-Lindenberg A. Polypharmacy in psychiatry. Current Op Psych. 2010; 23 103-111
- 26 Wang J, Omori IM, Fenton M. et al . Sulpiride augmentation for schizophrenia. Cochrane Database Syst Rev. 2010 Jan 20; (1) CD008125
- 27 Cipriani A, Boso M, Barbui C. Clozapine combined with different antipsychotic drugs for treatment resistant schizophrenia. Cochrane Database Syst Rev. 2009 Jul 8; (3) CD006324
- 28 Tylor DM, Smith L. Augmentation of clozapine with a second antipsycchotic. A meta-analysis of randomized, placebo controlled studies. Acta psychiatr Scand. 2009; 119 419-425
- 29 Paton C, Whittington C, Barnes TR. Augmentation with a second antipsychotic in patients with schizophrenia who partially respond to clozapine: a meta-analysis. J Clin Psychopharmacol. 2007; 27 198-204
- 30 National Association of State Mental Health Program Directors, Medical Directors Council and State Medicaid Directors .NASMHPD Medical Directors Technical Report on Psychiatric Polypharmacy.. Alexandria: NASMHPD Research Institute, Inc.; 2001
- 31 Lerma-Carrillo I, de Pablo Brühlmann S, del Pozo ML. et al . Antipsychotic polypharmacy in patients with schizophrenia in a brief hospitalization unit. Clin Neuropharmacol. 2008; 31 319-332
- 32 Molina JD, Lerma-Carrillo I, Leonor M. et al . Combined treatment with amisulpride in patients with schizophrenia discharged from a short-term hospitalization unit: a one-year retrospective study. Clin Neuropharmacol. 2009; 32 10-15
- 33 Lerma-Carrillo I, Molina JD, Gonzalez-Parra S. et al . Rational antipsychotic polypharmacy. Can J Clin Pharmacol. 2008; 15 e420-e421
- 34 Leucht S. Amisulpride a selective dopamine antagonist and atypical antipsychotic: results of a meta-analysis of randomized controlled trials. Int J Neuropsychopharmacol. 2004; 7 (Suppl. 1) S15-S20
- 35 Kissling W. Compliance, quality management and standards in the treatment of schizophrenia. Neuropsychobiology. 1997; 35 70-72
- 36 Zink M, Henn FA, Thome J. Combination of amisulpride and olanzapine in treatment-resistant schizophrenic psychoses. Eur Psychiatry. 2004; 19 56-58
- 37 Zink M. Augmentation of olanzapine in treatment-resistant schizophrenia. J Psychiatr Neurosci. 2005; 30 409-415
- 38 Zink M. Optimizing the antipsychotic potency of olanzapine by augmentation- a critical review. Psychiatr Prax. 2006; 33 261-268
- 39 Pedrosa Gil F, Schneider C, Grohmann R. Incompatibility of olanzapine and amisulpride in multisystemic myotonic myopathy. Nervenartz. 2001; 72 729-733
- 40 Munro J, Matthiasson P, Osborne S. et al . Amisulpride augmentation of clozapine: an open non-randomized study in patients with schizophrenia partially responsive to clozapine. Acta Psychiatr Scand. 2004; 110 292-298
- 41 Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962; 10 799-812
- 42 Guy W. ECDEU Assessment Manual for Psychopharmacology – Revised (DHEW Publ No ADM 76-338).. Rockville: Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976: 218-222
- 43 Lingjaerde O, Ahlfors UG, Bech P. et al . The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs, and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl. 1987; 76 1-100
- 44 Tapp A, Wood AE, Secrest L. et al . Combination antipsychotic therapy in clinical practice. Psychiatric Serv. 2003; 54 55-59
- 45 Correll CU, Rummel-Kluge C, Cirves C. et al . Antipsychotic combinations vs. monotherapy in schizophrenia: a meta-analysis of randomized controlled trials. Schizophr Bull. 2009; 35 443-457
- 46 Correll CU, Malhotra AK, Kaushik S. et al . Early prediction of antipsychotic response in schizophrenia. Am J Psychiatry. 2003; 160 2063-2065 Erratum in: Am J Psychiatry 2005; 162: 1774
- 47 Leucht S, Bush R, Kissling W. et al . Early prediction of antipsychotic nonresponse among patients with schizophrenia. J Clin Psychiatry. 2007; 68 352-360
- 48 Lieberman JA, Stroup S, McEvoy JP. et al . Effectiveness of antipsychotic drugs in patients with chronic schizophrrenia. N Engl J Med. 2005; 353 1209-1223
- 49 Johnsen E, Jorgensen HA. Effectiveness of second generation antipsychotics: a systematic review of randomized trials. BMC Psychiatry. 2008; 8 1-14
Correspondence
Dr. J. D. Molina
Acute Inpatient Unit
Coordinator
Doctor R. Lafora Psychiatric
Hospital
Carretera de Colmenar Viejo,
Km. 13800
28049 Madrid
Spain
Telefon: +34/91/586 7633
eMail: candrader@medynet.com