Switching approach in the management of schizophrenia patients

Atypical neuroleptics combine efficacy with good tolerability. As a result, prognosis and quality of life may improve when patients receiving treatment with traditional agents are switched to an atypical compound. Major indications for switching are lack of or incomplete response to classical neuroleptic treatment, and/or the occurrence of extrapyramidal symptoms. The previous treatment should be discontinued, preferably progressively, and the new one started, overlapping the previous treatment. Caution is advised in patients who have suffered a recent relapse, a severe psychotic episode or who are being treated as outpatients. Anticholinergic medication, if needed, should be continued for 2-4 weeks after the switch has been made. The physician should be aware of the potential drug interactions leading to increased sedation or hypotension. Patient education is vital when switching medications. Treatment should be individualized. Patients who have gained weight on previous therapy, or who have negative symptoms of schizophrenia and depressive symptoms, are particularly likely to benefit from amisulpride. Furthermore, the highly selective affinity of amisulpride for dopaminergic receptors with its lack of interference with other neurotransmitter systems facilitates the change in treatment.