CLINICAL HANDBOOK OF SCHIZOPHRENIA

16. Antipsychotics 167• Therapeutic dosages of antipsychotics can take 4–6 weeks to provide clinical improvements;time must be given for a medication to be effective.• Antipsychotic polypharmacy is not considered standard practice unless a patient cannot utilizeclozapine or has failed clozapine therapy.• Complete resolution of the symptoms of schizophrenia with antipsychotics is uncommon;oftentimes the symptoms are reduced to tolerable levels.• Single daily dosages of antipsychotics should be used, if possible, to improve medicationadherence.• Drug interactions are possible with all antipsychotics and must be monitored.• Following published treatment guidelines and using the STEPS process of medication selectionhelps to improve patient outcomes.REFERENCES AND RECOMMENDED READINGSAlam, D. A., & Janicak, P. G. (2005). The role of psychopharmacotherapy in improving the long-termoutcome of schizophrenia. Essential Psychopharmacology, 6(3), 127–140.American Psychiatric Association. (2004). American Psychiatric Association Practice Guidelines forthe Treatment of Psychiatric Disorders Compendium 2004. American Journal of Psychiatry,161(Suppl. 2), 1–56.Davis, J. M., & Chen, N. (2005). Old versus new: Weighing the evidence between the first- and second-generationantipsychotics. European Psychiatry, 20(1), 7–14.Davis, J. M., Chen, N., & Glick, I. D. (2003). A meta-analysis of the efficacy of second-generationantipsychotics. Archives of General Psychiatry, 60(6), 553–564.Dolder, C. R., Lacro, J. P., Leckband, S., & Jeste, D. V. (2003). Interventions to improve antipsychoticmedication adherence: Review of recent literature. Journal of Clinical Psychopharmacology,23(4), 389–399.Janssen Pharmaceutica. (2007). Product Information for Invega. Mountain View, CA: Author.Lehman, A. F., Kreyenbuhl, J., Buchanan, R. W.. Dickerson, F., Dixon, L. B., Goldberg, R., et al.(2004). The Schizophrenia Patient Outcomes Research Team (PORT): Updated treatment recommendations2003. Schizophrenia Bulletin, 30(2), 193–217.Leucht, S. L., Barnes, T. R., Kissling, W., Engel, R. R., Correll, C., & Kane, J. M. (2003). Relapse preventionin schizophrenia with new-generation antipsychotics: A systematic review and exploratorymeta-analysis of randomized, controlled trials. American Journal of Psychiatry, 160,1209–1222.Leucht, S., Wahlbeck, K., Hamann, J., & Kissling, W. (2003) New generation antipsychotics versuslow-potency conventional antipsychotics: A systematic review and meta-analysis. Lancet, 361,1581–1589.Lieberman, J. A., Tollefson, G., Tohen, M., Green, A. I., Gur, R. E., Kahn, R., et al. (2003). Comparativeefficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis:A randomized, double-blind trial of olanzapine versus haloperidol. American Journal of Psychiatry,160(8), 1396–1404.Miller, A. L., Chiles, J. A., Chiles, J. K., Crismon, M. D., Shon, S. P., & Rush, A. J. (1999). The TMAPschizophrenia algorithms. Journal of Clinical Psychiatry, 60, 649–657. (Electronic updatesavailable at www.dshs.state.tx.us/mhprograms/tmaptoc.shtm.)Moncrieff, J. (2003). Clozapine v. conventional antipsychotic drugs for treatment-resistant schizophrenia:A re-examination. British Journal of Psychiatry, 183, 161–166.Perry, P. J. (2007). Psychotropic drug handbook (8th ed.). Philadelphia: Lippincott Williams &Wilkins.Rummel, C., Hamann, J., Kissling, W., Leucht, S., et al. (2003). New generation antipsychotics forfirst episode schizophrenia. Cochrane Database of Systematic Reviews, 4, CD004410.Stahl, S. M. (2005). Essential psychopharmacology: Neuroscientific basis and practical applications(2nd ed.). Cambridge, UK: Cambridge University Press.