Schizoaffective disorder treatment

Typical (classical) antipsychotics have been proposed for a wide range of disorders. In the context of EOS the following indications exist acute treatment, maintenance treatment, and relapse prevention of schizophrenic disorders acute treatment and maintenance treatment of schizoaffective disorders treatment of organic mental disorders with psychotic features and... 

The molten carbonate fuel ceU uses eutectic blends of Hthium and potassium carbonates as the electrolyte. A special grade of Hthium carbonate is used in treatment of affective mental (mood) disorders, including clinical depression and bipolar disorders. Lithium has also been evaluated in treatment of schizophrenia, schizoaffective disorders, alcoholism, and periodic aggressive behavior (56). 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Opolka etal. (2003) examined Texas Medicaid claims for patients with schizophrenia or schizoaffective disorder during the period of January 1996 to August 1998. These patients had been initiated to treatment with either haloperi-dol or olanzapine and had no previous use of these medications in the year prior (total, n = 2601 haloperidol, n = 726 olanzapine, n = 1875). 

McEhoy SL, Keck PE, Strakowski SM. An overview of the treatment of schizoaffective disorder. J Clin Psychiatry 1999 60(Snpplement 5) 16-21. 

Recurrent suicidal behavior (except orally disintegrating tablets) - For reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for reexperiencing suicidal behavior, based on history and recent clinical state. Continue clozapine treatment to reduce the risk of suicidal behavior for at least 2 years. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Cabrera JE, Muhlbauer HD, Schley J, et al Long-term randomized clinical trial on oxcarbazepine vs lithium in bipolar and schizoaffective disorders preliminary results. Pharmacopsychiatry 19 282-283, 1986 Cade JFJ Lithium salts in the treatment of psychotic excitement. Med J Aust 36 349-352, 1949... 

Keck PE Jr, McElroy SL, Tugrul KC, et al Valproate oral loading in the treatment of acute mania. J Clin Psychiatry 54 305-308, 1993 Keck PE Jr, McElroy SL, Strakowski SM, et al Pharmacologic treatment of schizoaffective disorder. Psychopharmacology 114 529-538, 1994 Keller MB Chronic and recurrent affective disorders Incidence, course, and influencing factors, in Chronic Treatments in Neuropsychiatry. Edited by Kemah D, Recagni G. New York, Raven, 1985... 

McElroy SL, Keck PE Jr, Pope EIG Jr, et al Valproate in primary psychiatric disorders literature review and clinical experience in a private psychiatric hospital, in Use of Anticonvulsants in Psychiatry Recent Advances. Edited by McElroy SL, Pope HG Jr. Clifton, NJ, Oxford Health Care, 1988b McElroy SL, Keck PE Jr, Pope HG Jr, et al Valproate in the treatment of rapid-cycling bipolar disorder. J Clin Psychopharmacol 8 275-279, 1988c McElroy SL, Sessain EC, Pope HG Jr, et al Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder and schizophrenia. J Clin Psychiatry 52 411-414, 1991a... 

Volavka, J., Czobor, P., Sheitman, B., et ah Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am. J. Psychiatry 159, 255-262, 2002. 

Janicak et al. (87) studied the relative efficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder. Sixty-two patients (29 depressed type, 33 bipolar type) entered a randomized, double-blind, 6-week trial of risperidone (up to 10 mg/day) or haloperidol (up to 20 mg/day). They found no difference between risperidone and haloperidol in the amelioration of psychotic and manic symptoms nor any significant worsening of mania with either agent. For the total PANSS, risperidone produced a mean decrease of 16 points from baseline, compared with a 14-point decrease with haloperidol. For the total CARS-M scale, risperidone and haloperidol produced mean change scores of 5 and 8 points, respectively and for the CARS-M mania factor, 3 and 7 points, respectively. 

A limited body of evidence indicates that lithium helps atypical mania, schizoaffective disorder, or schizophreniform disorder, both as an acute treatment and for prevention of recurrence. There are younger patients who demonstrate both schizophrenic and manic features early in the course of their illness. When in doubt about the diagnosis, lithium may be preferable for an acute episode because, if successful, it will most likely be an effective prophylaxis as well. Clearly, some patients are so disturbed that the clinician cannot wait until lithium becomes fully effective, and an antipsychotic must be added, but often it can be discontinued after a brief period to determine whether lithium alone is sufficient. 

Janicak PG, Keck PE Jr, Davis J, et al. A double-blind, randomized, prospective evaluation of the effficacy and safety of risperidone versus haloperidol in the treatment of schizoaffective disorder. J din Psychopharmacoi (in press). 

Dwight MM, Keck PE, Stanton SP, et al. Antidepressant activity and mania associated with risperidone treatment of schizoaffective disorder. Lancet 1994 344 554-555. 

Keck PE, McElroy SL, Strakowski SM, et al. Pharmacologic treatment of schizoaffective disorder. Psychopharmacology 1994 114 529-538. 

Madhusoodanan S, Brenner R, Araujo L, et al. Efficacy of risperidone treatment for psychoses associated with schizophrenia, schizoaffective disorder, bipolar disorder, or senile dementia in 11 geriatric patients a case series. J din Psychiatry 1995 56 514-518. 

Tran P, Lu Y, Sanger T, et al. Olanzapine in the treatment of schizoaffective disorder. Presented at the 36th Annual NCDEU Meeting. Boca Raton, FL, May 1996. 

Harrigan E, Morrissey M, and the Ziprasidone Working Group. The efficacy and safety of 28-day treatment with ziprasidone in schizophrenia/schizoaffective disorder. Presented at the XXth Collegium Internationale Neuropsychopharmacologicum, Melbourne, Australia, June 1996. 

Thus, although lithium therapy of sufficient duration may be the treatment of choice in classic milder presentations of mania, the adjunctive antipsychotics (especially the novel agents) may be preferable in conditions such as mania with psychosis and schizoaffective disorder, given their faster onset of effect and broader spectrum of activity (see the section Alternatiye Treat later in this chapter). 

Dwight et al. (291) reported their experience with risperidone in eight patients with schizoaffective disorder (six bipolar type two depressive type). All six bipolar type patients showed the onset of or an increase in mania shortly after starting risperidone (mean number of treatment days = 7 3 mean dose = 7 1 mg/day). In this context, O Croinin et al. (292) reported on a chronic paranoid schizophrenic patient who was admitted in an acute psychotic state unresponsive to thioridazine or CPZ. Risperidone was started (6mg/day by day 3), but by the end of the first week she was displaying hypomanic symptoms. When risperidone was discontinued and haloperidol introduced, her hypomanic symptoms resolved. 

McElroy SL, Dessain EC, Pope HG, et al. Clozapine in the treatment of psychotic mood disorders, schizoaffective disorder, and schizophrenia. J Clin Psychiatry 1991 52 411-414. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

FIGURE 10—6. Depressive and anxious symptoms are not only a hallmark of major depressive disorder but are frequently associated with other psychiatric disorders, including bipolar disorder, schizophrenia, and schizoaffective disorder with organic causes of depression, such as substance abuse with childhood mood disorders (child) with psychotic forms of depression and with mood and psychotic disorders resistant to treatment with drugs (treatment-resistant), among others. 

Although the usefulness of the atypical antipsychotics is best documented for the positive symptoms of schizophrenia, numerous studies are documenting the utility of these agents for the treatment of positive symptoms associated with several other disorders (discussed in Chapter 10 see Fig. 10—2). Atypical antipsychotics have become first-line acute and maintenance treatments for positive symptoms of psychosis, not only in schizophrenia but also in the acute manic and mixed manic-depressed phases of bipolar disorder in depressive psychosis and schizoaffective disorder in psychosis associated with behavioral disturbances in cognitive disorders such as Alzheimer s disease, Parkinson s disease, and other organic psychoses and in psychotic disorders in children and adolescents (Fig. 11—52, first-line treatments). In fact, current treatment standards have evolved in many countries so that atypical antipsychotics have largely replaced conventional antipsychotics for the treatment of positive psychotic symptoms except in a few specific clinical situations. 

Mood symptoms of depression are associated with many conditions in addition to major depressive disorder, including mood and anxiety symptoms in schizophrenia, schizoaffective disorder, bipolar manic/depressed/mixed/rapid cycling states, organic mood disorders, psychotic depression, childhood and adolescent mood disorders, treatment-resistant mood disorders, and many more (see Chapter 10, Fig. 10-6). Atypical antipsychotics are enjoying expanded use for the treatment of symptoms of depression and anxiety in schizophrenia that are troublesome but not severe enough to reach the diagnostic threshold for a major depressive episode or anxiety disorder in these cases the antipsychotics are used not only to reduce such symptoms but hopefully also to reduce suicide rates, which are so high in schizophrenia (Fig. 11 — 53). Atypical antipsychotics may also be useful adjunctive treatments to anti-... 

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