1 de diciembre de 2011

The 2009 Schizophrenia PORT Psychopharmacological Treatment Recommendations and Summary Statements

Robert W. Buchanan,1,2 Julie Kreyenbuhl,3,4 Deanna L. Kelly,2 Jason M. Noel,5 Douglas L. Boggs,2 Bernard A. Fischer,2 Seth Himelhoch,3 Beverly Fang,6 Eunice Peterson,6 Patrick R. Aquino,6 and William Keller6
2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228
3Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
4VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD
5Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
6Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
1To whom correspondence should be addressed; tel: 410-402-7876, fax: 410-402-7198, e-mail: rwbuchanan@mprc.umaryland.edu .
In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.
Keywords: acute treatment, antipsychotic medications, clozapine, first-episode schizophrenia, maintenance treatment, side effects