CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 19OTHER MEDICATIONSBRITTON ASHLEY AREYSTEPHEN R. MARDERAlthough antipsychotics are the first-line agents for the treatment of schizophrenia,large areas of need are still unmet. First, many patients with schizophrenia demonstrateonly partial responses to antipsychotics. Second, as the Clinical Antipsychotic Trials ofIntervention Effectiveness (CATIE) revealed, a large proportion of patients discontinuetheir antipsychotic due to lack of efficacy or tolerability issues. Last, neither the first- norsecond-generation antipsychotics adequately address symptom domains such as cognitionand negative symptoms. Both of these domains have been shown to have significant impacton functional outcomes in schizophrenia.In this chapter, we discuss alternative and adjunctive medication strategies for thetreatment of schizophrenia, including mood stabilizers, benzodiazepines, and antidepressants.Furthermore, we present the evidence supporting treatments for co-occurring disorderssuch as depression, mania, anxiety, and obsessive–compulsive disorder. Finally, wemention new medications and mechanisms in development for the treatment of schizophrenia.We do not discuss treatment strategies for the side effects of antipsychotics, suchas extrapyramidal symptoms, tardive dyskinesia, weight gain, or metabolic issues (for adiscussion of these side effects, see Dolder, Chapter 17, this volume).MOOD STABILIZERSMood stabilizers or antiepileptic agents have been widely used in the treatment of schizophrenia.Citrome, Jaffe, Levine, and Allingham (2002) showed that the use of mood stabilizersin the New York State mental health system nearly doubled from 1994 to 2001,with 47.1% of inpatients diagnosed as having schizophrenia in 2001 receiving a moodstabilizer.We discuss the evidence for the use of mood stabilizers as monotherapy and as augmentationagents to address the core symptoms of schizophrenia. We also discuss datathat support using these medications as adjunctive treatment for affective symptoms and186