Concomitant Medications May Not Improve Outcome of Antipsychotic Monotherapy for Stabilized Patients With Nonacute Schizophrenia. [CME]
J Clin Psychiatry 2006;67(8):1261-1265
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Background: There are virtually no controlled
data suggesting that concomitant psychotropic medications (CPMs)
improve outcome in schizophrenia after the acute phase. Despite
that, polypharmacy (with all of its disadvantages) is far more
common than monotherapy. To our knowledge, there have been no
published reports of prospective systematic investigations of the
efficacy of unrestricted CPM use in nonacute schizophrenia.
Method: This was a naturalistic, systematic
study using a sample of 53 stabilized patients with DSM-IV-TR
schizophrenia from 1 clinical practice setting including both
private patients and patients from controlled research studies of
the effectiveness of antipsychotics. Since there are meager
controlled or systematic data on the effectiveness of CPM use
with antipsychotics in nonacute schizophrenia, we tested the
clinical strategy of CPM use by gradually tapering all CPMs
(except antianxiety agents). The aim was to determine if the CPM
improved outcome, had no effect, or worsened outcome using the
Clinical Global Impressions-Improvement scale before and after
taper, over at least 3 months and in some cases up to 18 months
after discontinuation. Data were gathered from July 2002 to June
Results: For 21 patients undergoing 22
antidepressant tapers, no change was noted in 18 of 22 tapers,
while in 3 improvement was noted and in 1 worsening was noted.
For the 12 patients on treatment with mood stabilizers, no change
was noted in 10 of 13 discontinuations, while in 3 mild worsening
was noted. One patient was on treatment with both modafinil and
trazodone and reported no change after tapering each in separate
discontinuation trials, while another 3 patients were taking
sleeping medications and also noted no change after
Conclusion: For most stabilized, chronic
patients with schizophrenia, tapering adjunctive medications did
not change outcome. This naturalistic study further defines the
limits of efficacy of some concomitant classes of medications in
patients with chronic schizophrenia who are already receiving
adequate antipsychotic therapy.