Schizophrenia valproate

The evidence base for clinical decisions based on cost-effectiveness for the affective disorders is less clear than for schizophrenia. In bipolar disorder the primary effectiveness of the mainstay treatments, lithium and anticonvulsant pharmacotherapy, is undergoing considerable revision (Bowden et al, 2000). Until this is clarified, cost-effectiveness studies are probably premature. Nevertheless the cost burden in bipolar disorder is qualitatively similar to that in schizophrenia, with in-patient costs being the primary burden and associated social costs in treated patients. The drug costs are even less than those for schizophrenia. In Chapter 5 John Cookson suggests there is little economic evidence to drive prescribing decisions. The in-patient burden does not seem to have altered with the introduction of lithium. The only drug-related study (Keck et al, 1996) showed an obvious difference in treatment costs only when lithium was compared with sodium valproate. Since these are both cheap drugs this is unlikely to influence clinical decisions. The main question is what impact... 

Bowden C and Muller-Oerlinghausen B (2000). Carbamazepine and valproate Use in mood disorders. In PF Buckley and JL Waddington (eds), Schizophrenia and Mood Disorders (pp. 179-189). Butterworth-Heinemann, Oxford, UK. 

Another serious side effect of clozapine is a risk of seizures. This mainly occurs at higher doses of the drug, and having a seizure is not necessarily a sufficient reason to stop clozapine permanently. If the clozapine has been especially helpful, an anticonvulsant can be added to protect against further seizures. Valproate (Depakote) may be best in this regard because it not only provides protection from seizures but also may help to relieve some of the symptoms of schizophrenia. Recently, it has become clear that two atypical antipsychotic drugs, clozapine and olanzapine, are associated with an increased risk for the development of type II diabetes. 

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... 

Lautin A, Angrist B, Stanley M, et al. Sodium valproate in schizophrenia some biochemical correlates. Br J Psychiatry 1980 137 240-244. 

Schwarz C, Volz Al, Li C, Leucht S Valproate for schizophrenia. Cochrane Database Syst Rev 2008 (3) CD004028. 

Valproate (+olanzapine or risperidone) II Schizophrenia Abbott Laboratories... 

Hofer A, Fleischhacker WW, Hummer M. 2003. Worsening of psychosis after replacement of adjunctive valproate with topiramate in a schizophrenia patient. J Clin Psychiatry... 

Addition of a mood stabilizing anticonvulsant such as valproate, carbamazepine, or lamotrigine may be helpful in both schizophrenia and bipolar mania... 

Olanzapine is an antipsychotic that controls psychotic symptoms throngh antagonism of selected dopamine and serotonin receptors in the central nervons system (CNS). It is indicated in the treatment of schizophrenia (oral) shortterm treatment of acnte mixed or manic episodes with bipolar I disorder (oral) in combination with lithium or valproate, for short-term treatment of acnte episodes associated with bipolar 1 disorder (oral) and treatment of agitation associated with schizophrenia and bipolar I mania (IM). 

Click ID, Bosch J, Casey DE. A doubleblind randomized trial of mood stabilizer augmentation using lamotrigine and valproate for patients with schizophrenia who are stabilized and partially responsive. J Clin Psychopharmacol 2009 29(3) 267-71. 

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