Antipsychotics

Meet the patient

A 22-year-old apprentice, nine months into a first episode of psychosis, is back on the ward. He has now had risperidone and then olanzapine, both stopped early — the first for stiffness he called "feeling like a robot", the second because he gained fourteen kilos and could not face it. The plan on the whiteboard reads: "add amisulpride."^[1][4]

Two questions are hiding in that sentence, and examiners ask both. Were those trials ever adequate? And if they were, why is the next word not "clozapine"?^[4][6][12]

This topic is the drug-class spine that schizophrenia, bipolar mania, agitation and clozapine all plug into. Examiners want pathway maps, occupancy concepts, agent-level doses, monitoring schedules and the TRRIP door — never brand slogans.^[1][4][6]

References16ShowHide

1. [1]Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia N Engl J Med, 2005.PMID 16172203
2. [2]Jones PB, Barnes TR, Davies L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1) Arch Gen Psychiatry, 2006.PMID 17015810
3. [3]Kahn RS, Fleischhacker WW, Boter H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial Lancet, 2008.PMID 18374841
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11. [11]Leucht S, Leucht C, Huhn M, et al. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors Am J Psychiatry, 2017.PMID 28541090
12. [12]Siskind D, Siskind V, Kisely S Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis Can J Psychiatry, 2017.PMID 28655284
13. [13]Davis JM, Chen N, Glick ID A meta-analysis of the efficacy of second-generation antipsychotics Arch Gen Psychiatry, 2003.PMID 12796218
14. [14]Bertelsen M, Jeppesen P, Petersen L, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial Arch Gen Psychiatry, 2008.PMID 18606949
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