Switching Antipsychotic Medications / 대한정신약물학회지

Switch to another newer antipsychotic is indicated when current treatment is insufficiently effective or is associated with drug related adverse events that impair quality of life. There are two main switching strategies. The first `clean method' is to discontinue the previous treatment and then to start the new one. The second, more preferable method is cross-tapering where the previous and the new antipsychotic treatment are overlapped. Abrupt switching is usually indicated when severe side effects are present, but it may produce withdrawal problems or higher risk of relapse. When overlapping the previous and new treatments in cross-tapering, the daily dose of the former is tapered down progressively (by approximately 30-50% every 3 to 7 days) and the latter is started and titrated up progressively to achieve a therapeutic response. In relation to the speed of cross-tapering, it is important to maintain adequate therapeutic level of overlapping drugs to avoid relapse or adverse events associated with subtherapeutic or too high level of overlapping drugs. Caution is advised in patients who have suffered recent relapse, a severe psychotic episode or who are being treated as outpatients. Anticholinergic medication, if needed, should be continued for 2-4 weeks after the switch has been made. Treatment should be individualized. At least three months of full-dose treatment is required for the decision of successful drug switch. Patient education and frequent monitoring is essential in switching medications. Switch from clozapine need more caution and clozapine should be tapered slowly for 2-6 weeks except in inevitable cases. In this review, the advantages of switching to a newer antipsychotic drug in the management of patients with schizophrenia have been demonstrated while successful switching strategies being presented.

Long-term Efficacy and Safety of Risperidone in Patients with Schizophrenia / 대한정신약물학회지

Most informations on the efficacy and safety of new antipsychotic durgs are based on short-term clinical trials. Short-term studies are usually conducted as well-controlled, randomized, comparative studies. However, they do not provide any informations about delayed efficacy or late-onset adverse events such as tardive dyskinesia, functional recovery, relapse or recur rates and maintenance treatment. This is why there is growing interest in long-term clinical studies of antipsychotic drugs. The number of well designed long-term studies, however, are limited compared to that of short-term studies because of practical reasons as well as some methodological issues. In this article, the authors reviewed original research papers on the long-term treatment outcomes of risperidone while discussing the methodological considerations.

Tretment Effect of Bromocriptine on Antipsychotics-induced Amenorrhea / 대한정신약물학회지

Amenorrhea is one of the well-known side effects of antipsychotics in women. It is associated with hyperprolactinemia induced by dopamine blocking effect of antipsychotics. Administration of bromocriptine which belongs to dopamine agonist may reverse amenorrhea and hyperprolactinemia. However dopamine agonist has been reserved in the treatment of antipsychotics-induced amenorrhea because of concern about exacerbation of psychotic symptoms. This case series study was designed to determine whether bromocriptine can be used safely in schizophrenic patients with amenorrhea. We administered bromocriptine to 5 stable schizophrenic outpatients who experienced amenorrhea over 6 months. Bromocrptine dosage was titrated upward from 2.5 mg/day to 7.5 mg/day until menstrual recovery. Patients' menstrual state and side effects of bromocriptine was monitored prospectively for 22 weeks, and clinical symptom were assessed using brief psychiatric rating scale (BPRS) and clinical global impression scale-severity (CGI-S). These were assessed biweekly until 12th week and then every 4weeks thereafter. All five patients resumed menstruation without deterioration of clinical symptoms measured by BPRS and CGI-S. No serious side effect of bromocriptine was reported. Patients with lower baseline prolactin level showed faster recovery and needed lower dose of bromocriptine. These findings suggest bromocriptine may be used safely in the treatment of antipsychotics-induced amenorrhea.