There were 18 studies of schizoaffective disorder (n=1171) and 15 of schizophrenia with mood symptoms (n=2983).
Lithium for schizoaffective disorder, manic type.
Three double-blind, parallel-group studies of schizoaffective mania were included. One found chlorpromazine plus placebo was as effective as chlorpromazine plus lithium; one found haloperidol plus lithium was superior to haloperidol plus placebo in schizophrenic disorder effective subtype, however lithium did not benefit patients with schizoaffective disorder by APA DSM-III-R or DSM-IV criteria; and the final study found fluphenazine was statistically superior to lithium. One other controlled crossover study was identified but proved difficult to interpret. Lithium showed an improvement over placebo in only two of a large number of rating scales. There were no controlled studies (or large uncontrolled studies) of lithium in studies using modern criteria to define schizoaffective disorder, depressed type.
Antidepressants for schizoaffective disorder, depressed type.
Two controlled studies were identified. In one study chlorpromazine plus placebo was as effective as chlorpromazine plus amitriptyline or amitriptyline alone. The other double-blind controlled study found that a neuroleptic alone was more effective than a neuroleptic with an antidepressant.
Atypical antipsychotics for schizoaffective disorder.
Three open or retrospective studies of relatively large groups examined the effect of clozapine in patients with schizoaffective disorder and schizophrenia. All three studies found patients with schizoaffective disorder improved more than patients with schizophrenia, and one study that looked at schizoaffective disorder, bipolar type found patients improved more than those with schizoaffective disorder, depressed type. One other retrospective study found those with schizoaffective disorder, depressed type improved more than those with schizoaffective disorder, bipolar type when treated with risperidone (versus haloperidol). In a double-blind trial in schizoaffective disorder (ICD-9) patients, haloperidol and risperidone were found to be comparable. Another trial found no advantage of risperidone over haloperidol plus amitriptyline in patients with schizoaffective disorder, depressed type, but the latter combination was more effective than risperidone in patients with major depression with psychotic features. Overall the studies suggest atypical antipsychotics could be more effective than typical neuroleptics for schizoaffective disorders, but the results are inconsistent and additional controlled trials are required.
Anticonvulsants for schizoaffective disorder.
One study (design not stated) found similar outcomes for those treated with neuroleptics plus carbamazepine and those treated with neuroleptics plus placebo. Four small open mainly retrospective studies (n=5 to n=14) of sodium valporate, but these were largely descriptive and no comparison treatments within schizoaffective disorder were reported. The relevance of these data to patients with schizoaffective disorder defined by APA DSM-IV criteria were unclear.
Neuroleptics for schizophrenia with depressive symptoms.
Five studies including four double-blind controlled studies showed neuroleptics to produce an improvement in depressive symptoms in patients with exacerbations of schizophrenia or schizoaffective depression.
Atypical antipsychotics for schizophrenia with depressive symptoms.
Two double-blind controlled studies were identified. One found significantly greater improvement in depressive symptoms with olanzapine as opposed to haloperidol. The other found risperidone was more effective than haloperidol in improving all symptom factors including depression-anxiety. One other open study reported that patients with neuroleptic-resistant illness who had a history of suicidal ideation experienced a significant decrease in suicidal and depressive ideation during treatment with clozapine.
Antidepressants for schizophrenia with depressive symptoms.
No controlled studies were identified which demonstrated an advantage of combinations of antidepressants and neuroleptics over neuroleptics alone. Most other studies (number not stated) showed no difference between these two groups of drugs, but one found haloperidol plus placebo produced greater improvement in psychotic symptoms than haloperidol plus either amitriptyline or desipramine. Results of out-patient studies were more mixed with several demonstrating that addition of antidepressants to a neuroleptic regimen improved depressive symptoms (3 double-blind controlled trials) or depressive syndromes (2 double-blind controlled studies) compared with addition of placebo. Three double-blind controlled studies showed no advantage to addition of antidepressants for depressive symptoms.
Lithium for schizophrenia with depressive symptoms.
One double-blind controlled study was identified and this reported a greater overall improvement in the BPRS for patients (RDC-defined schizophrenia or schizoaffective disorder and high depression ratings) given haloperidol plus lithium versus haloperidol plus placebo.
Treatments for schizophrenia with manic symptoms.
No controlled studies were identified, although one double-blind controlled study reported a positive effect of adjunctive lithium in schizophrenic outpatients with 'anxiety' (some features of which might be described as hypomanic by some observers).