Pergolide as Adjuvant Therapy to Amisulpride in the Treatment of Negative and Depressive Symptoms in Schizophrenia

Negative and cognitive symptoms of schizophrenia are associated with a hypodopaminergic state in the frontal cortex and do not respond to neuroleptics equally well as positive symptoms. Therefore pharmacological strategies, which increase dopamine metabolism in the mesocortical pathways, may prove beneficial to ameliorate these symptoms.

We report on a case of a patient with paranoid schizophrenia, who still presented negative and depressive symptoms during treatment with amisulpride for more than 6 weeks. We prescribed pergolide (a mixed D1/D2 agonist) as adjuvant therapy to treat these symptoms.

The patient showed an improvement of global psychopathology, decrease of negative and depressive symptoms, while no changes in positive symptoms nor EPS were present.

For this patient, the adjuvant therapy of pergolide to amisulpride constituted a valid pharmacological approach to treat negative and depressive symptoms of schizophrenia, without increasing positive symptoms.

References

• 1 Davis K L, Kahn R S, Ko G, Davidson M. Dopamine in schizophrenia: a review and reconceptualization.  Am J Psychiatry. 1991;  148 1474-1486
• 2 Hall H, Sedvall G, Magnusson O, Kopp J, Halldin C, Farde L. Distribution of D1- and D2-dopamine receptors, and dopamine and its metabolites in the human brain.  Neuropsychopharmacology. 1994;  11 245-256
• 3 Izumi T, Inoue T, Kitagawa N, Nishi N, Shimanaka S, Takahashi Y, Kusumi I, Odagaki Y, Denda K, Ohmori T, Koyama T. Open pergolide treatment of tricyclic and heterocyclic antidepressant-resistant depression.  J Affect Disord. 2000;  61 127-132
• 4 Kampf P, Agelink M W, Naber D. Augmentation of clozapine with amisulpride: a promising therapeutic approach to refractory schizophrenic symptoms.  Pharmacopsychiatry. 2005;  38 39-40
• 5 Kay S. The positive and negative syndrome scale (PANSS): rationale and standardisation.  Br J Psychiatry Suppl.. 1989;  7 59-67
• 6 Keefe R S, Silva S G, Perkins D O, Lieberman J A. The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis.  Schizophr Bull. 1999;  25 201-222
• 7 Levi-Minzi S, Bermanzohn P C, Siris S G. Bromocriptine for ”Negative Schizophrenia”.  Compr Psychiatry. 1991;  32 210-216
• 8 Moller H. Management of the negative symptoms of schizophrenia: new treatment options.  CNS Drugs. 2003;  17 793-823
• 9 Müller M. Calgary Depressions Rating Skala. 2000 University Mainz
• 10 Naber D. A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables.  Int Clin Psychopharmacol. 1995;  10 (Suppl 3) 133-138
• 11 Ohmori T, Koyama T, Inoue T, Matsubara S, Yamashita I. B-HT 920, a dopamine D2 agonist, in the treatment of negative symptoms of chronic schizophrenia.  Biol Psychiatry. 1993;  33 687-693
• 12 Powell J H, al-Adawi S, Morgan J, Greenwood R J. Motivational deficits after brain injury: effects of bromocriptine in 11 patients.  J Neurol Neurosurg Psychiatry. 1996;  60 416-421
• 13 Sawaguchi T, Goldman-Rakic P S. D1 dopamine receptors in prefrontal cortex: involvement in working memory.  Science. 1991;  251 947-950
• 14 Sekine Y, Takei N, Suzuki K, Nakamura K, Tsuchiya K J, Takebayashi K, Toulopoulou , Mori N. Effective adjunctive use of pergolide with quetiapine for cognitive impairment and negative symptoms in schizophrenia.  J Clin Psychopharmacol. 2005;  25 281-283
• 15 Simpson G M, Angus J W. A rating scale for extrapyramidal side effects.  Acta Psychiatr Scand Suppl. 1970;  212 11-19

1 Percent values calculated from change from baseline T0:  (-) = improvement; (+) = worsening of scores.