Schizophrenia and mood disorders : the new drug therapies in clinical practice

368 Pages·2000·23.992 MB·English

by  Peter Buckley, John L Waddington

Schizophrenia and Mood Disorders
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Schizophrenia and
Mood Disorders:
the new drug therapies in clinical practice
Edited by
Peter F. Buckley MD
Professor of Psychiatry
Case Western Reserve University, Cleveland, Ohio, USA
and
John L. Waddington PHD DSC
Professor of Neuroscience, Department of Clinical Pharmacology
Royal College of Surgeons in Ireland, Dublin, Ireland
With a Foreword by
Ross J. Baldessarini MD DSC
A member of the Hodder Headline Group
LONDON
This edition first published in Great Britain in 2000 by Butterworth Heinemann.
This impression published in 2001 by
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Contents
Foreword vii
Preface ix
Contributors x
Section I: Schizophrenia 1
Chapter 1. Comparative pharmacology of classical and novel
(second-generation) antipsychotics 3
John Waddington and Daniel Casey
Chapter 2. Traditional antipsychotic medications: contemporary
clinical use 14
Charles Schulz and Patrick McGorry
Chapter 3. Clozapine: clinical use and experience 21
Robert Buchanan and Peter McKenna
Chapter 4. Risperidone and olanzapine: clinical use and experience 32
Wolfgang Fleischhacker and Stephen Marder
Chapter 5. Quetiapine and sertindole: clinical use and experience 42
Peter Buckley and Dieter Naber
Chapter 6. Ziprasidone and zotepine: clinical use and experience 49
Steven Potkin and Stephen Cooper
Chapter 7. Future directions in novel antipsychotics 59
Robert Conley
Section II: Depression and Mania 65
Chapter 8. Synaptic effects of antidepressants: relationships to
their therapeutic and adverse effects 67
Brian Leonard and Elliott Richelson
Chapter 9. Tricyclic antidepressants and classical monoamine
oxidase inhibitors: contemporary clinical use 85
Michael Thase and Willem Nolen
Chapter 10. Selective serotonin reuptake inhibitors: clinical use
and experience 100
Ted Dinan, Jeffrey Kelsey and Charles Nemeroff
Chapter 11. Nefazodone, mirtazapine and venlafaxine: clinical
use and experience 109
Madhukar Trivedi and Trisha Suppes
Chapter 12. Psychopharmacology of mood stabilizers 127
Robert Post
Chapter 13. Lithium: clinical use in mania and prophylaxis of
affective disorders 155
John Cookson and Gary Sachs
vi Contents
Chapter 14. Carbamazepine and valproate: use in mood disorders 179
Charles Bowden and Bruno Muller-Oerlinghausen
Chapter 15. Lamotrigine, gabapentin and the new anticonvulsants:
efficacy in mood disorders 190
Nicol Ferrier and Joseph Calabrese
Chapter 16. Antipsychotic medications in the treatment of mood
disorders 199
Paul Keck and Rasmus Licht
Chapter 17. Future directions in novel antidepressants and mood
stabilizing agents 212
Siegfried Kasper and Alan Schatzberg
Section III: Key Issues in Clinical Psychopharmacology 221
Chapter 18. Drug interactions 223
David King
Chapter 19. Psycho tropic drugs during pregnancy 234
Sheila Marcus and Rajiv Tandon
Chapter 20. Psychopharmacology in the young 253
Sophia Frangou and Sanjiv Kumra
Chapter 21. Drug treatment of schizophrenia and mood disorders
in older people 273
Ruth Allen, Barbara Richardson, Tim Stevens and
Cornelius Katona
Chapter 22. Treatment of substance misuse in schizophrenia 286
Kim Mueser and Shon Lewis
Chapter 23. Treating violence in the context of psychosis 297
Pamela Taylor and Peter Buckley
Chapter 24. Poor compliance with treatment in people with
schizophrenia: causes and management 317
Thomas Barnes, Daniel Andrews and A. George Awad
Chapter 25. Pharmacoeconomics and resource allocation:
lessons from North America 330
William Glazer and Ruth Dickson
Index 345
Foreword
This new, multiauthored, international textbook on the pharmacological
treatment of major mental illnesses, edited by Peter Buckley of Cleveland,
Ohio, and John Waddington, of Dublin, Republic of Ireland, includes 25
chapters organized into sections on schizophrenia, major mood disorders,
and special problems. Individual chapters on specific topics were prepared
by experts representing academic centres in nine nations. These include
Australia (Melbourne), Austria (Innsbruck, Vienna), Canada (Calgary,
Toronto), Denmark (Arrhus), Germany (Berlin, Hamburg), Irish Republic
(Dublin, Galway), Netherlands (Utrecht), United Kingdom (Belfast,
Cambridge, Crowthorne, London, Newcastle), and United States (Ann
Arbor, Atlanta, Baltimore, Bethesda, Boston, Cincinnati, Cleveland,
Dallas, Hanover, Irvine, Jacksonville, Los Angeles, New York, Palo Alto,
Pittsburgh, Portland, San Antonio).
The initial sections open with the preclinical pharmacology of each major
class of psychotropic drugs used to treat psychotic and major affective
disorders, respectively, and consider the relevance of pharmacology to clin-
ical decision-making. The first section on psychotic disorders provides sepa-
rate chapters on the clinical use of traditional international neuroleptics
(benzamides, butyrophenones, phenothiazenes, thioxanthenes, and others)
and on each of the established and emerging modern antipsychotics (includ-
ing clozapine, risperidone, clanzapine, quetiapine, sertindole, ziprasidone,
zotepine), with a concluding look into the future of antipsychotic drug
development.
The second section on mood-altering treatments, similarly, summarizes
use of older antidepressants (tricyclics, monoamine oxidase inhibitors), with
separate chapters covering modern antidepressants (serotonin reuptake inhi-
bitors, nefazodone, mirtazapine, venlafaxine), as well as on lithium and
alternative or proposed mood stabilizers (antipsychotics, carbamezepine,
valproate, gabapentin, lamotrigine), again with a look into the future devel-
opment of mood-altering agents.
The third, special section covers important topics that are often insuffi-
ciently addressed in textbooks on psychopharmacology. These include drug
interactions, management of pregnant women as well as paediatric and
geriatric patients, comorbid substance-use disorders, violence, treatment-
compliance, and pharmacoeconomics.
The chapters are well organized and edited for stylistic consistency. Each
chapter includes a brief summary, specific topics divided by subheadings,
and an adequate, alphabetically organized bibliography of full reference
citations. Some preclinical chapters provide highly detailed reviews of emer-
ging scientific understanding of the neuropharmacology of antipsychotic
and mood-altering agents. Most clinical chapters are brief but authoritative
and reliable, usually without providing detailed summaries of research data
viii Foreword
to back up conclusions and therapeutic advice offered. The level of detail is
appropriate both as a textbook for general readers new to the field, and as a
reference for clinicians and other professionals.
The disorders addressed in this book represent leading problems for con-
temporary world health since, together, the psychotic and severe mood
disorders afflict at least 1/20 citizens of all countries at any time, and
more than 1/10, if less severe forms of the disorders are included. These
disorders, with their commonly associated comorbidities and high fatality
rates, account for very high proportions of morbidity, disability, and pre-
mature mortality, as well as enormous social and economic costs worldwide.
Indeed, their overall societal impact compares well with that of cancer, all
forms of cardiovascular disease, and many infectious diseases. Ironically,
the impact of these major mental disorders on international health and
global economics stands in gross disproportion to the limited resources
available for their study and treatment, in that way still comparing very
unfavorably with other leading health problems
Arguably, more than any other single factor, modern drug treatments for
psychotic disorders, mania, and severe depression have had the greatest
impact on their improved clinical management and increasingly favorable
long-term prospects for their victims. Too, the modern treatments have had
an enormous stimulating and heuristic effect on academic psychiatry and
psychiatric research. They have challenged traditional nosologies and had a
major impact on both the DSM-IV and ICD-10 international diagnostic
systems followed in this book. Moreover, most biological theories concern-
ing the causes or pathophysiology of the disorders discussed in the book owe
much to our understanding of the actions of drugs that have proved effec-
tive in their treatment and led to more, essentially similar agents.
Psychopharmacology has developed and expanded enormously in the
half-century since the introduction of lithium into modern psychiatry in
1949, to become a truly international field with an increasingly refined,
restless, rapidly expanding and changing basic and scientific knowledge-
base. Although most of the material in this book has emerged from aca-
demic departments of psychiatry or pharmacology, it is important to point
out that the bulk of modern drug discovery and both preclinical and very
costly and formidable clinical development have become largely the pro-
vince of the multinational pharmaceutical industry.
The content, authorship, and organization of this new volume reflect well
the current state of psychopharmacology for the common major mental
disorders. The scientific, clinical and regional complexity of this field calls
for the kind of expert, international collaborative effort represented in this
volume. The editors and authors have efficiently and readably compiled
information derived from extraordinarily high levels of scientific and clinical
knowledge and experience, to provide essential, useful and reliable informa-
tion on specific topics pertinent to the informed treatment of psychiatrically
ill persons with psychotic and major affective disorders.
Ross J. Baldessarini, M.D., D.Sc.
Professor of Psychiatry and Neuroscience
Harvard Medical School, Boston, Massachusetts
October 25, 1999
Preface
Technological advances in computing and telecommunications now provide
an unprecedented volume of educational information, derived from all cor-
ners of the world. This global perspective is particularly advantageous for
psychiatry given historical precedents for continent-specific variations in
diagnosis and treatment. Differences in the diagnosis of mood disorders
and schizophrenia between European and American psychiatrists in the
US-UK project exemplified this fundamental difficulty. Subsequent work
to devise DSM-IV and ICD-10 diagnostic systems testifies to greater con-
gruence now between continents. This book draws upon this heightened
appreciation of global information on diagnosis and treatment to examine
current knowledge, 'best practices' and clinical pearls from each continent,
as well as overall future directions in the psychopharmacology of the major
mental illnesses of schizophrenia and mood disorders. Most chapters are
coauthored by American and European/Australasian experts in an effort to
assimilate the breadth of clinical wisdom on each topic. The editors are
particularly grateful to the Stanley Foundation, who provide support to
both of them and to fellow researchers into schizophrenia and mood dis-
orders across the continents.
In recognition that most clinicians treat patients with either condition in
their practice, this book has a combined focus on schizophrenia and mood
disorders. The organization of the book reflects this perspective. The first
section covers the clinical use and experience with a variety of antipsychotic
medications for the treatment of schizophrenia, including those most
recently available as well as those under development. The second section
covers the clinical use and experience with the range of antidepressant med-
ications and mood stabilizers, including those under regulatory considera-
tion or in advanced clinical development. The third section covers broader
topics of drug interactions, psychopharmacology during pregnancy, psycho-
pharmacology of the young and the old, pharmacoeconomics, medication
compliance, and the management of difficult-to-treat patients with sub-
stance abuse and with violence.
We are most grateful to the contributors, each of whom provided a
scholarly synthesis of clinical information from America and Europe/
Australasia.
Peter F. Buckley
John L. Waddington