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

Je-Yeon Yun; Jung Suk Lee; Shi Hyun Kang; Beomwoo Nam; Seung Jae Lee; Seung-Hwan Lee; Joonho Choi; Chan-Hyung Kim; Young-Chul Chung

doi:10.16946/kjsr.2019.22.2.21

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Yun, Lee, Kang, Nam, Lee, Lee, Choi, Kim, and Chung: Korean Treatment Guideline on Pharmacotherapy of Co-existing Symptoms and Antipsychotics-related Side Effects in Patients with Schizophrenia

Original Article

Korean Journal of Schizophrenia Research 2019; 22(2): 21-33.

Published online: 31 October 2019

DOI: https://doi.org/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

Je-Yeon Yun, MD, PhD^1,², Jung Suk Lee, MD, PhD³, Shi Hyun Kang, MD, PhD⁴, Beomwoo Nam, MD, PhD⁵, Seung Jae Lee, MD, PhD⁶, Seung-Hwan Lee, MD, PhD⁷, Joonho Choi, MD, PhD⁸, Chan-Hyung Kim, MD, PhD⁹, Young-Chul Chung, MD, PhD¹⁰

¹Seoul National University Hospital, Seoul, Korea.

²Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Korea.

³Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

⁴Adult Psychiatry, Division of Medical Services, National Center for Mental Health, Seoul, Korea.

⁵Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.

⁶Department of Psychiatry, School of Medicine, Kyoungpook National University, Daegu, Korea.

⁷Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Korea.

⁸Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea.

⁹Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

¹⁰Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.

Address for correspondence: Young-Chul Chung, Department of Psychiatry, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeongu 54907. Korea. Tel: 063-250-2185, Fax: 063-275-3157, chungyc@jbnu.ac.kr

Received 4 August 2019 Revised 3 September 2019 Accepted 3 September 2019

Korean Society for Schizophrenia Research

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.

Keywords: Antipsychotics-related Side effects, Co-existing symptoms, Schizophrenia, 2019 Korean Medication Algorithm for Schizophrenia

Figures and Tables

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.

Table 1

Assessment schedule for antipsychotics use-related side effects*

^*: Referred from Hasan, Falkai, Wobrock, Lieberman, Glenthoj, Gattaz, et al.21)

Table 2

Medications used for management of extrapyramidal symptoms (EPS)

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