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Pharmacological Treatment of Schizophrenia: Japanese Expert Consensus
Introduction Conventional treatment guidelines of schizophrenia do not necessarily provide solutions on clinically important issues.
Methods A total of 141 certified psychiatrists of the Japanese Society of Clinical Neuropsychopharmacology evaluated treatment options regarding 19 clinically relevant situations in the treatment of schizophrenia with a 9-point scale (1=“disagree” and 9=“agree”).
Results First-line antipsychotics varied depending on predominant symptoms: risperidone (mean±standard deviation score, 7.9±1.4), olanzapine (7.5±1.6), and aripiprazole (6.9±1.9) were more likely selected for positive symptoms; aripiprazole (7.6±1.6) for negative symptoms; aripiprazole (7.3±1.9), olanzapine (7.2±1.9), and quetiapine (6.9±1.9) for depression and anxiety; and olanzapine (7.9±1.5) and risperidone (7.5±1.5) for excitement and aggression. While only aripiprazole was categorized as a first-line treatment for relapse prevention (7.6±1.0) in patients without noticeable symptoms, aripiprazole (8.0±1.6) and brexpiprazole (6.9±2.3) were categorized as such for social integration. First-line treatments in patients who are vulnerable to extrapyramidal symptoms include quetiapine (7.5±2.0) and aripiprazole (6.9±2.1).
Discussion These clinical recommendations represent the expert consensus on the use of a particular antipsychotic medication for a particular situation, filling a current gap in the literature.
Received: 19 November 2020
Received: 16 July 2020
Accepted: 22 November 2020
Article published online:
12 January 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Hasan A, Falkai P, Wobrock T. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry 2012; 13: 318-378
- 2 Hasan A, Falkai P, Wobrock T. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World J Biol Psychiatry 2013; 14: 2-44
- 3 Hasan A, Falkai P, Wobrock T. et al. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 3: update 2015 management of special circumstances: depression, suicidality, substance use disorders and pregnancy and lactation. World J Biol Psychiatry 2015; 16: 142-170
- 4 Galletly C, Castle D, Dark F. et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZ J Psychiatry 2016; 50: 410-472
- 5 Buchanan RW, Kreyenbuhl J, Kelly DL. et al. The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010: 71-93
- 6 Barnes TR, Drake R, Paton C. et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol Oxf Engl 2020; 34: 3-78
- 7 Osser DN, Roudsari MJ, Manschreck T. The psychopharmacology algorithm project at the Harvard South Shore Program: An update on schizophrenia. Harv Rev Psychiatry 2013; 21: 18-40
- 8 National Collaborating Centre for Mental Health (UK). Psychosis and Schizophrenia in Adults: Treatment and Management: Updated Edition 2014. 2014; http://www.ncbi.nlm.nih.gov/books/NBK248060/
- 9 Scottish Intercollegiate Guidelines Network. Management of schizophrenia. 2013; SIGN 131: https://www.sign.ac.uk
- 10 Sakurai H, Uchida H, Kato M. et al. Pharmacological management of depression: Japanese expert consensus. J Affect Disord 2020; 266: 626-632
- 11 Sakurai H, Kato M, Yasui-Furukori N. et al. Pharmacological management of bipolar disorder: Japanese expert consensus. Bipolar Disord 2020; DOI: 10.1111/bdi.12959.
- 12 Allen MH, Currier GW, Hughes DH. et al. Treatment of behavioral emergencies: a summary of the expert consensus guidelines. J Psychiatr Pract 2003; 9: 16-38
- 13 Crossley NA, Constante M, McGuire P. et al. Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: Meta-analysis. Br J Psychiatry. J Ment Sci 2010; 196: 434-439
- 14 Zhang J-P, Gallego JA, Robinson DG. et al. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: A systematic review and meta-analysis. Int J Neuropsychopharmacol 2013; 16: 1205-1218
- 15 Stone JM, Roux S, Taylor D. et al. First-generation versus second-generation long-acting injectable antipsychotic drugs and time to relapse. Ther Adv Psychopharmacol 2018; 8: 333-336
- 16 Zhao YJ, Lin L, Teng M. et al. Long-term antipsychotic treatment in schizophrenia: Systematic review and network meta-analysis of randomised controlled trials. BJPsych Open 2016; 2: 59-66
- 17 Naber D, Hansen K, Forray C. et al. Qualify: A randomized head-to-head study of aripiprazole once-monthly and paliperidone palmitate in the treatment of schizophrenia. Schizophr Res 2015; 168: 498-504
- 18 Suzuki T. A further consideration on long-acting injectable versus oral antipsychotics in the treatment of schizophrenia: A narrative review and critical appraisal. Expert Opin Drug Deliv 2016; 13: 253-264
- 19 Huhn M, Nikolakopoulou A, Schneider-Thoma J. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis. Lancet Lond Engl 2019; 394: 939-951
- 20 Wang S-M, Han C, Lee S-J. et al. Second generation antipsychotics in the treatment of major depressive disorder: an update. Chonnam Med J. 2016; 52: 159-172
- 21 Krause M, Huhn M, Schneider-Thoma J. et al. Antipsychotic drugs for elderly patients with schizophrenia: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2018; 28: 1360-1370
- 22 Khanna P, Suo T, Komossa K. et al. Aripiprazole versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2014; 1: CD006569
- 23 Solmi M, Murru A, Pacchiarotti I. et al. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: A state-of-the-art clinical review. Ther Clin Risk Manag 2017; 13: 757-777
- 24 Sackett DL, Straus SE, Richardson WS. et al. Evidence-based medicine: How to practice and teach EBM. 2nd ed.. Edinburgh: Churchill Livingstone; 2000
- 25 Johnsen E, Kroken RA, Løberg E. et al. Amisulpride, aripiprazole, and olanzapine in patients with schizophrenia-spectrum disorders (BeSt InTro): A pragmatic, rater-blind, semi-randomised trial. Lancet. Psychiatry 2020; 7: 945-954
- 26 Schneider-Thoma J, Efthimiou O, Huhn M. et al. Second-generation antipsychotic drugs and short-term mortality: A systematic review and meta-analysis of placebo-controlled randomised controlled trials. Lancet Psychiatry 2018; 5: 653-663
- 27 Kelleher JP, Centorrino F, Albert MJ. et al. Advances in atypical antipsychotics for the treatment of schizophrenia: New formulations and new agents. CNS Drugs 2002; 16: 249-261
- 28 Yoshida K, Suzuki T, Uchida H. et al. Absence of evidence that the pro re nata regimen confers benefit: a review of the studies. Int Clin Psychopharmacol 2013; 28: 228-237
- 29 Fonseka TM, Richter MA, Müller DJ. Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature. Curr Psychiatry Rep 2014; 16: 510
- 30 Panes A, Pariente A, Bénard-Laribière A. et al. Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: A population-based study. Eur Arch Psychiatry Clin Neurosci 2020; 270: 3-10
- 31 Nielsen J, Young C, Ifteni P. et al. Worldwide differences in regulations of clozapine use. CNS Drugs 2016; 30: 149-161
- 32 Yoshida K, Suzuki T, Uchida H. Psychopharmacology in Japan: An overview and recent topics. J Clin Psychopharmacol 2018; 38: 415-419