Korean J Schizophr Res.  2019 Oct;22(2):21-33. 10.16946/kjsr.2019.22.2.21.

Korean Treatment Guideline on Pharmacotherapy of Co-existing Symptoms and Antipsychotics-related Side Effects in Patients with Schizophrenia

• Yun JY
• Lee JS
• Kang SH
• Nam B
• Lee SJ
• Lee SH
• Choi J
• Kim CH
• Chung YC

• KMID: 2462049
• DOI: http://doi.org/10.16946/kjsr.2019.22.2.21

Abstract

OBJECTIVES
The current study covers a secondary revision of the guidelines for the pharmacotherapy of schizophrenia issued by the Korean Medication Algorithm for Schizophrenia (KMAP-SCZ) 2001, specifically for co-existing symptoms and antipsychotics-related side-effects in schizophrenia patients.
METHODS
An expert consensus regarding the strategies of pharmacotherapy for positive symptoms of schizophrenia, co-existing symptoms of schizophrenia, and side-effect of antipsychotics in patients with schizophrenia was retrieved by responses obtained using a 30-item questionnaire.
RESULTS
For the co-existing symptoms, agitation could be treated with oral or intramuscular injection of benzodiazepine or antipsychotics; depressive symptoms with atypical antipsychotics and adjunctive use of antidepressant; obsessive-compulsive symptoms with selective serotonin reuptake inhibitors and antipsychotics other than clozapine and olanzapine; negative symptoms with atypical antipsychotics or antidepressants; higher risk of suicide with clozapine; comorbid substance abuse with use of naltrexone or bupropion/ varenicline, respectively. For the antipsychotics-related side effects, anticholinergics (extrapyramidal symptom), propranolol and benzodiazepine (akathisia), topiramate or metformin (weight gain), change of antipsychotics to aripiprazole (hyperprolactinemia and prolonged QTc) or clozapine (tardive dyskinesia) could be used.
CONCLUSION
Updated pharmacotherapy strategies for co-existing symptoms and antipsychotics-related side effects in schizophrenia patients as presented in KMAP-SCZ 2019 could help effective clinical decision making of psychiatrists as a preferable option.

Keyword

Antipsychotics-related Side effects; Co-existing symptoms; Schizophrenia; 2019 Korean Medication Algorithm for Schizophrenia

MeSH Terms

Antidepressive Agents
Antipsychotic Agents
Aripiprazole
Benzodiazepines
Cholinergic Antagonists
Clinical Decision-Making
Clozapine
Consensus
Depression
Dihydroergotamine
Drug Therapy*
Humans
Injections, Intramuscular
Metformin
Naltrexone
Propranolol
Psychiatry
Schizophrenia*
Serotonin Uptake Inhibitors
Substance-Related Disorders
Suicide
Varenicline
Antidepressive Agents
Antipsychotic Agents
Aripiprazole
Benzodiazepines
Cholinergic Antagonists
Clozapine
Dihydroergotamine
Metformin
Naltrexone
Propranolol
Serotonin Uptake Inhibitors
Varenicline

Figure

• 

  Fig. 1 Flowchart of treatment guideline for co-existing symptoms in schizophrenia.

• 

  Fig. 2 Flowchart of management for antipsychotics use-related side effects in schizophrenia.

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