This review surveys the therapeutic efficacy of tricyclic antidepressants and monoamine oxidase inhibitors in schizophrenic patients. In general, the use of these drugs alone was found not to be warranted in schizophrenia, except perhaps in the so-called pseudoneurotic subgroup. In most cases, combinations of antidepressants and phenothiazines were not more beneficial than phenothiazines alone. In particular, the conditions of agitated patients and patients with histories of social deviance dating back to childhood were often made worse by the addition of an antidepressant. However, when the patients who demonstrated symptoms of clinical depression other than anergia were isolated from several of these studies, it was found that they constituted a subgroup that was often benefited by use of these combinations. Favorable and unfavorable clinical response patterns are discussed, and recommendations for future research are outlined.
"Multiple studies and clinical trials have verified the effect of these drugs in weight gain as large as 30–50 pounds after short-term use of Olanzapine . The weight gain adds to the risk of diabetes mellitus and hyperlipidemia  . In order to prevent or diminish the induced weight gain caused by Olanzapine, several types of drugs have been investigated including H2-receptor antagonists such as Nizatidine and Ranitidine   as well as selective serotonin reuptake inhibitors such as Fluoxetine, topiramate, reboxetine-betahistine, aripiprazole, and Amantadine  . "
[Show abstract][Hide abstract] ABSTRACT: Induced weight gain is a disturbing side effect of Olanzapine that affects the quality of life in psychotic patients. The aim of this study was to assess the efficacy of Ranitidine in attenuating or preventing Olanzapine-induced weight gain. A parallel 2-arm clinical trial was done on 52 patients with schizophrenia, schizoaffective and schizophreniform disorders who received Olanzapine for the first time. All these were first-episode admitted patients. They were randomly allocated to receive either Ranitidine or placebo. The trend of body mass index (BMI) was compared between groups over 16-week course of treatment. Mean weight was 62.3 (SD: 9.6) kg at baseline. Thirty-three subjects (63.5%) had positive family history of obesity. The average BMI increment was 1.1 for Ranitidine group and 2.4 for the placebo group. The multivariate analysis showed this effect to be independent of sex, family history of obesity, and baseline BMI value. The longitudinal modeling after controlling for baseline values failed to show the whole trend slope to be different. Although the slight change in trend's slope puts forward a hypothesis that combined use of Ranitidine and Olanzapine may attenuate the weight gain long run, this needs to be retested in future larger scale long-term studies. This trial is registered with IRCT.ir 201009112181N5.
Available from: schizophreniabulletin.oxfordjournals.org
"No review provides data on demographic or other subgroups of patients who might benefit from adjunctive antidepressant treatment. In an individual study, Siris et al. (1978) explore whether paranoia influences outcome in adjunctive antidepressant use; finding conflicting evidence , they came to no conclusion. ECT. "
[Show abstract][Hide abstract] ABSTRACT: Substantial proportions of patients with schizophrenia do not achieve acceptable levels of response with antipsychotic therapy alone, which commonly leads clinicians to use additional somatic interventions. This article reviews the literature on the use of adjunctive pharmacological treatments and electroconvulsive therapy (ECT) in schizophrenia. The authors find that, despite a large volume of literature, it is difficult to draw conclusions or treatment recommendations from available data because of small sample sizes and widely divergent study designs. At present, there is little firm evidence that adding adjunctive agents to standard neuroleptics will dramatically change the somatic treatment of schizophrenia. The most promising adjunctive agents are benzodiazepines, lithium, and carbamazepine, as well as antidepressants and ECT for affective symptoms. Future inpatient research on adjunctive treatments should be multicenter studies, followed by long-term outpatient trials that assess quality-of-life issues as well as symptom relief.
"The difficulty of differentiating akinesia from postpsychotic depression, demoralization, or residual schizophrenic defects has been recognized by several authors (Rifkin et al., 1978; Siris et al., 1978; Van Putten and May, 1978). The most important impetus, however, for establishing minimum effective dosage is tardive dyskinesia. "
[Show abstract][Hide abstract] ABSTRACT: To test the clinical efficacy of low dose fluphenazine decanoate (1.25 mg to 5.0 mg biweekly), we carried out two separate experiments: (1) an open trial in 57 schizophrenic outpatients, lasting 6 months; (2) a double-blind, placebo-controlled discontinuation study in a subgroup of patients who maintained good remission throughout the entire 6-month open trial. The results suggest that lower doses of fluphenazine decanoate than those usually used may be effective in preventing psychotic relapse while keeping total cumulative dosage to a minimum.
Psychiatry Research 12/1979; 1(3-1):341-348. DOI:10.1016/0165-1781(79)90016-7 · 2.47 Impact Factor
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