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Treatments for specific symptoms and populations

This category includes treatments for specific symptoms and specific populations, including treatments for aggressive symptoms, for people with schizophrenia and co-occurring substance abuse problems, and treatments for children and pregnant women with schizophrenia.

Treatments during pregnancy and breastfeeding

What are the issues regarding antipsychotic treatment during pregnancy and motherhood?  Antipsychotic use during pregnancy requires careful consideration of the mother’s risk of illness relapse, against the risk of harm or complications for the developing infant if medication is to be continued. What is the evidence for the use of antipsychotics during pregnancy and breastfeeding? Moderate quality evidence suggests a small increased risk of heart defect or lower birth weight in infants, and a small increased risk of preterm delivery, but not stillbirth, with exposure to antipsychotics (first or second generation). Lower quality evidence is unsure about the risk of…

Treatments for aggression and agitation

How is aggression and agitation relevant to schizophrenia? Agitation and/or aggression are sometimes observed during a psychiatric emergency such as in onset of acute psychosis. Agitation typically includes irritability and restlessness, motor or verbal hyperactivity, uncooperativeness, and occasionally aggressive gestures or behaviour. This can pose a risk both to the individual, as well as the attending health care professionals, and so is important to manage this behaviour and prevent potential harm. What is the evidence for treatments for aggression and agitation? Moderate quality evidence found a small to medium-sized effect of less hostility with second-generation antipsychotics compared to first-generation antipsychotics,…

Treatments for childhood and early-onset schizophrenia

What is childhood and early-onset schizophrenia? Childhood-onset schizophrenia is defined as schizophrenia with onset prior to the age of 13 years, and early-onset schizophrenia describes schizophrenia onset between the ages of 13 and 17 years. What is the evidence for pharmaceutical treatments for childhood and early-onset schizophrenia? Compared to first-generation antipsychotics, moderate quality evidence finds a small to medium-sized benefit of second-generation antipsychotics for global and mental state in children and adolescents with schizophrenia. There was greater improvement with standard dose than low-dose antipsychotics, although there are more side effects with standard doses. Moderate quality evidence finds clozapine was the…

Treatments for cognitive symptoms

What are cognitive symptoms? Cognitive symptoms of schizophrenia have been found in all cognitive domains, including executive function, memory, and attention, and often develop prior to the other symptoms of schizophrenia. They are highly disabling and predict poor functional outcomes. What is the evidence for treatments for cognitive symptoms? Overall, moderate to high quality evidence suggests second-generation antipsychotics are associated with small improvements in processing speed, verbal fluency, learning, motor skills, long-term memory, and global cognition when compared to first generation antipsychotics, but have no benefit over first generation antipsychotics for improving attention, cognitive flexibility, working memory, delayed recall, or…

Treatments for constipation

What is constipation? Constipation is a common side effect of antipsychotic medications, particularly clozapine, and occurs when bowel movements are infrequent and difficult to pass. Adjunct medications prescribed to treat side effects such as constipation may contribute to increasing adherence to antipsychotics which can reduce the risk of psychotic relapse. What is the evidence for treatments for antipsychotic-induced constipation? Moderate to low quality evidence suggests tuina massage or acupuncture are more effective than glycerol laxative suppository, and mannitol is more effective than rhubarb soda or phenolphthalein for relief of constipation caused by antipsychotics. There were no other randomised controlled trials…

Treatments for dual diagnosis

What is dual diagnosis? Dual diagnosis is the term used for people with both mental health and substance use disorders. Studies targeting this population often investigate outcomes relating to both diagnoses, such as symptoms, substance use, social function, quality of life, and cognitive outcomes. What is the evidence for treatments for dual diagnosis? Moderate to low quality evidence suggests olanzapine was superior to perphenazine, quetiapine, risperidone, and ziprasidone for overall symptoms in people with a dual diagnosis. Olanzapine was superior to perphenazine, quetiapine, and ziprasidone for positive symptoms, and olanzapine was superior to perphenazine, risperidone, and ziprasidone for negative symptoms….

Treatments for elderly people and people with late-onset schizophrenia

What is late-onset schizophrenia? Studies of the life course of schizophrenia suggest that positive symptoms tend to reduce with time, while negative symptoms, such as social withdrawal and emotional apathy, increase with time. In contrast, people with late-onset schizophrenia (onset after 40 years of age) and very late-onset schizophrenia (onset after 60 years of age) tend to have predominant positive symptoms and fewer negative symptoms. This summary table includes both elderly people with chronic schizophrenia, and people who have been diagnosed with late-onset or very late-onset schizophrenia. What is the evidence for treatments for older people with  schizophrenia? Moderate to…

Treatments for first-episode psychosis

What are the treatments for first-episode psychosis? People with a first episode of psychosis experience distressing symptoms such as unusual beliefs or abnormal behaviour (positive symptoms) and/or withdrawal or loss of interest in work or school (negative symptoms). Early intervention programs for schizophrenia and psychosis often combine many elements comprising both pharmaceutical and psychosocial therapies, and may involve enriched therapies that are tailored to an individual’s needs. The conclusions presented here are based on group data, and as such individual treatment programs need to be tailored by trained clinicians. Individual response to treatment can vary in terms of both symptoms…

Treatments for high-risk groups

What are high-risk groups? The primary aims of early intervention are to prevent or delay future transition to psychosis in high-risk individuals with early symptoms, and to reduce symptom severity in individuals following a first episode of psychosis. A key target of early intervention is “indicated prevention”, for individuals at high risk of psychosis who have been identified with detectable signs of possible disorder, but do not meet any diagnostic criteria for disorder. There are two key approaches for identifying patients with early signs that may suggest an ultra-high risk (UHR) of developing psychosis. The first approach is based on…

Treatments for high-risk groups

What are high-risk groups? A key target of early intervention is “indicated prevention” for individuals at high risk of psychosis who have been identified with early signs of the disorder, but do not meet any diagnostic criteria. There are two key approaches for identifying people with early signs. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances in the domains of perception, cognition, language, motor function, will, initiative and level of energy, and stress tolerance. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect…

Treatments for hyperprolactinaemia

What is hyperprolactinemia? One potential side effect of antipsychotic use is hyperprolactinaemia, which can disrupt sex hormones and the production and flow of breast milk, and can cause infertility and erectile dysfunction in men. Hyperprolactinaemia is caused by blocking of the D2 dopamine receptor at the anterior lobe of the pituitary gland, resulting in high prolactin levels. As different antipsychotics have different actions, they also differ in the degree to which they affect prolactin levels. What is the evidence for treatments for hyperprolactinaemia? Moderate quality evidence shows a benefit of adjunctive metaformin for reducing serum prolactin levels in people with…

Treatments for hypersalivation

What is hypersalivation?  Antipsychotic medications such as clozapine and olanzapine, among others, may induce excessive (hyper) salivation, which can be uncomfortable and embarrassing as well as increasing the risk of aspiration pneumonia. Various pharmacological approaches have been used to try and alleviate this problem. Adjunctive medications prescribed to treat such side effects may contribute to increasing adherence to antipsychotic medications, which reduces the risk of psychotic relapse. What is the evidence for adjunctive therapies to relieve hypersalivation? Moderate to low quality evidence suggests antimuscarinic may be more effective than placebo for reducing clozapine-induced hypersalivation. Traditional Chinese medicine (SuoQuan Wan) and…

Treatments for medication non-adherence

What is the importance of medication adherence? One-quarter to one-half of people with schizophrenia do not adhere to their medication. Non-adherence to maintenance treatments, including antipsychotics, is a widespread issue that plagues clinical management for schizophrenia. It reduces the success of the treatment regimen and the ability to achieve remission from illness, but it also increases the burden for psychotic relapse treatments, emergency admissions and hospitalisation. Greater adherence to treatment can contribute not only to more successful disease management and better quality of life, but also to improved attitudes towards treatment and medication, as well as increasing insight and confidence. In…

Treatments for medication-resistant schizophrenia

What is medication resistance?  Antipsychotic medications provide symptom respite and improvement in quality of life for many people with schizophrenia. However, for a subset of people with schizophrenia, antipsychotic medications do not provide adequate relief from symptoms. Treatment-resistant schizophrenia has many definitions that vary depending on the individual study, but a broad definition includes those patients whose symptoms have not responded to antipsychotic medications, or only partially responded. What is the evidence for medication resistance? Moderate to high quality evidence finds a general pattern of superiority of clozapine, olanzapine or risperidone over other antipsychotics for improving symptoms in people with…

Treatments for movement disorders

What are movement disorders? Movement disorders such as extrapyramidal symptoms are common side effects of many antipsychotic medications. Extrapyramidal symptoms include tardive dyskinesia, a severe and chronic condition involving repetitive, involuntary movements, most commonly occurring around the mouth and face. Akathisia is characterised by a feeling of restlessness and movements such as shuffling of the legs, pacing, rocking from foot to foot, or the inability to sit down or stand still. Dystonia involves muscular spasms and abnormal postures. Medications prescribed to treat the side effects of antipsychotic drugs increase adherence to antipsychotics, which reduces the risk of psychotic relapse. What…

Treatments for negative symptoms

What are negative symptoms?  Negative symptoms are referring to an absence of normal functions. This may include (but is not limited to) blunted affect, which is a scarcity of facial expressions of emotion, reduced frequency and range of gestures and voice modulation, and restricted eye contact; alogia (poverty of speech); asociality (reduced social interaction); avolition (reduced motivation and often poor hygiene) and anhedonia, which is reduced experience of pleasure. What is the evidence on treatments for negative symptoms? Moderate quality evidence finds some benefit for improving negative symptoms from second-generation, but not first-generation antipsychotics compared to placebo. Moderate to low…

Treatments for relapse prevention

What is relapse prevention? Studies have shown that about 80% of patients relapse to psychosis within 5 years of initial diagnosis. Antipsychotic drugs have played a central role in the treatment of schizophrenia for more than 50 years and antipsychotic use significantly reduces the risk of relapse. What is the evidence for relapse prevention? High quality evidence shows a small benefit of specialist first-episode psychosis programs (involving both psychosocial and pharmaceutical treatments) for reducing the risk of relapse and less all-cause discontinuation of treatment compared to treatment as usual. These programs may also reduce the length of hospital stay should…

Treatments for schizoaffective disorder

We have not found any systematic reviews specifically targeting treatments for schizoaffective disorder, as most studies on schizophrenia also include people with schizoaffective disorder. Please see the schizoaffective disorder diagnosis topic for related information. Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library. March 2019

Treatments for sexual dysfunction

How is sexual dysfunction relevant to schizophrenia?  One side effect of some antipsychotic medications is sexual dysfunction. Sexual dysfunction can take many forms, affecting both men and women, and can have far-reaching implications on self-esteem, quality of life, and relationships. It also considerably reduces medication compliance. Adjunct medications prescribed to treat such side effects increases adherence to antipsychotic medications, which can reduce the risk of psychotic relapse. What is the evidence on adjunctive therapies for sexual dysfunction?  Moderate to low quality evidence suggests sildenafil may improve sexual functioning in males with schizophrenia August 2019

Treatments for sleep disturbance

What is sleep disturbance? Typically, sleep follows a characteristic pattern of four stages, where stage 1 is a state of drowsiness and early sleep, stage 2 comprises the largest component of the sleep cycle and is the first complete loss of awareness of the external environment, stage 3 is a deep slow-wave sleep, and the fourth stage is rapid eye movement (REM) sleep where muscle paralysis and memorable dreaming occurs. Sleep disturbances include changes in sleep time, sleep latency (the length of time it takes from full wakefulness to sleep) and sleep efficiency (the amount of time spent asleep while…

Treatments for smoking cessation

How is smoking related to schizophrenia? Tobacco smoking is very common among people with schizophrenia, who often show particularly heavy usage. This poses considerable health risks, may interfere with antipsychotic medications and may place a financial burden on the individual. Heavy cigarette use may contribute to the increased mortality and reduced life expectancy reported within the schizophrenia population. What is the evidence for interventions for smoking? Moderate quality evidence finds a medium-sized effect of more smoking cessation with bupropion than with placebo, which was maintained at six months follow-up. Moderate quality evidence finds varenicline can reduce the number of cigarettes…

Treatments for weight gain

How is weight gain relevant for people with schizophrenia?  Many antipsychotic medications are associated with weight gain, and various pharmacological approaches have been investigated for this problem. Effective adjunctive pharmaceutical treatments for side effects such as weight gain increase adherence to antipsychotic medications and reduces the risk of psychotic relapse. What is the evidence for adjunctive pharmaceutical therapies for weight reduction? Moderate quality evidence finds a benefit of adjunctive metformin for reducing weight in adults and children with schizophrenia. Moderate to low quality evidence finds more weight reduction with metformin plus lifestyle intervention than placebo (less 5.05kg), metaformin alone (less…

NeuRA Libraries

Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.