SS01.01 - The art and science of switching in patients with schizophrenia: Strategies for achieving a smooth transition

Abstract

Many patients with schizophrenia experience persistent symptoms or side effects on their current antipsychotic regimen. Such patients, particularly those treated with conventional antipsychotic agents may benefit from switching to atypical agents, which offer broader efficacy and improved tolerability compared with earlier counterparts. In addition, patients already receiving treatment with an atypical agent may benefit from switching to an alternative atypical, given that there is great variation in (1) individuals’ response to different atypical antipsychotics, and (2) the side-effect profile of the atypicals. With switching from one antipsychotic to another becoming increasingly common, there is an urgent need to define optimal switching strategies. The main goal when switching antipsychotics is to improve or (in stable patients) maintain the symptomatic and functional level, while improving (or not worsening) tolerability. It is important to identify patients who would be likely to benefit from switching and to discuss with them and their carers the advantages and potential problems of the switching process. To date, four strategies have been effective in controlled studies of switching to atypical antipsychotics: therapeutic dose initiation of the new antipsychotic and abrupt discontinuation of the first (‘abrupt switch’); gradual dose escalation of the new antipsychotic and abrupt discontinuation of the first (‘ascending switch’); therapeutic dose initiation of the new antipsychotic and gradual discontinuation of the first (‘descending switch’), and; gradual dose escalation of the new antipsychotic and gradual discontinuation of the first (‘cross-titration’). An individualized approach is key to the success of switching, as are patient co-operation and carer support.