Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-29T06:50:23.969Z Has data issue: false hasContentIssue false

Sulpiride augmentation in people with schizophrenia partially responsive to clozapine

A double-blind, placebo-controlled study

Published online by Cambridge University Press:  02 January 2018

Roni Shiloh
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Zvi Zemishlany
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Dov Aizenberg
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Marguerite Radwan
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Bruria Schwartz
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Pnina Dorfman-Etrog
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Ilan Modai
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Marina Khaikin
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University
Abraham Weizman*
Affiliation:
Geha Psychiatric Hospital, Rabin Medical Center, and Felsenstein Medical Research Center, Beilinson Campus, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Israel
*
Professor A. Weizman, Geha Psychiatric Hospital, P.O.B. 102; Petah Tiqva, 49100, Israel; Fax: 972-3-9241041

Abstract

Background

We hypothesised that a combined regimen of clozapine, a relatively weak D2-dopaminergic antagonist, and sulpiride, a selective D2 blocker, would demonstrate a greater antipsychotic efficacy by enhancing the D2 blockade of clozapine.

Method

Twenty-eight people with schizophrenia, previously unresponsive to typical antipsychotics and only partially responsive to current treatment with clozapine, received, double-blind, 600 mg/day sulpiride or placebo, in addition to an ongoing clozapine treatment. The clinical status was evaluated before, during, and at the end of 10 weeks of sulpiride addition using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, and Hamilton Rating Scale for Depression.

Results

The clozapine–sulpiride group exhibited substantially greater and significant improvements in positive and negative psychotic symptoms. About half of them, characterised by a younger age and lower baseline SAPS scores, had a mean reduction of 42.4 and 50.4% in their BPRS and SAPS scores, respectively.

Conclusions

A subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.

Type
Papers
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, N. C. (1983) Scale for the Assessment of Negative Symptoms (SANS). Iowa City: The University of Iowa.Google Scholar
Andreasen, N. C. (1984) Scale for the Assessment of Positive Symptoms (SANS). Iowa City: The University of Iowa.Google Scholar
Braftos, O. & Haug, J. O. (1979) Comparison of sulpiride and chlorpromazine in psychoses. A double-blind multicenter study. Acta Psychiatrica Scandinavica, 60, 19.Google Scholar
Casey, D. E., Gerlach, J. & Simelsgaard, I. I. (1979) Sulpiride in tardive dyskinesia. Psychopharmacology, 66, 7377.CrossRefGoogle ScholarPubMed
Cassano, G. B., Castrogiovanni, P. & Conti, L. (1975) Sulpiride versus haloperidol in schizophrenia: A double-blind comparative trial. Current Therapeutic Research, 17, 189201.Google Scholar
Elizur, A. & Davidson, S. (1975) The evaluation of the anti-autistic activity of sulpiride. Current Therapeutic Research, 18, 578584.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.CrossRefGoogle ScholarPubMed
Harnryd, C., Bjerkenstedt, L., Gullberg, B., et al (1984a) Time course for effects of sulpiride and chlorpromazine on monoamine metabolites and prolactin levels in cerebrospinal fluid from schizophrenic patients. Acta Psychiatrica Scandinavica Supplementum, 311, 7592.CrossRefGoogle ScholarPubMed
Harnryd, C., Bjerkenstedt, L., Bjork, K., et al (1984b) Clinical evaluation of sulpiride in schizophrenic patients – a double-blind comparison with chlorpromazine. Acta Psychiatrica Scandinavica Supplementum, 311, 730.CrossRefGoogle ScholarPubMed
Jenner, P. & Marsden, D. D. (1981) Substituted benzamide drugs as selective neuroleptic agents. Neuropharmacology, 20, 12851293.Google Scholar
Kane, J. (1992) Clinical efficacy of clozapine in treatment of refractory schizophrenia: an overview. British Journal of Psychiatry, 18 (suppl. 17), 4154.Google Scholar
Kane, J., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment of resistant schizophrenia. Archives of General Psychiatry, 45, 789796.Google Scholar
Kapur, S. & Remington, G. (1996) Serotonin–dopamine interaction and its relevance to schizophrenia. American Journal of Psychiatry, 153, 466476.Google ScholarPubMed
Leopola, U., Koskinen, T., Rimon, R., et al (1989) Sulpiride and perphenazine in schizophrenia. A double-blind clinical trial. Acta Psychiatrica Scandinavica, 80, 9296.CrossRefGoogle Scholar
Meltzer, H. Y. (1992) The importance of serotonin–dopamine interactions in the action of clozapine. British Journal of Psychiatry, 160 (suppl. 17), 2229.CrossRefGoogle Scholar
Mielke, D. H., Gallant, D. M., Roninger, J. J., et al (1977) Sulpiride: evaluation of antipsychotic activity in schizophrenic patients. Journal of Nervous and Mental Diseases, 38, 569571.Google Scholar
Nishiura, M. (1976) Clinico-pharmacological studies of sulpiride. Current Therapeutic Research, 20, 164172.Google ScholarPubMed
Overall, J. E. & Gorham, D. E. (1961) The Brief Psychiatric Rating Scale. Psychology Reports, 10, 799812.Google Scholar
Shiloh, R., Zemishlany, Z., Alzenberg, D., et al (1997) Sulpiride adjunction to clozapine in treatment-resistant schizophrenic patients: a preliminary case series study. European Psychiatry, 12, 152155.Google Scholar
Tagliamonte, A., De Montis, G., Olianas, M., et al (1975) Selective increase of brain dopamine synthesis by sulpiride. Journal of Neurochemistry, 24, 707710.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.