Psychiatria pre prax 1/2013

Optimization of psychopharmacotherapy in schizophrenia

The development of psychotropics has behind six decades and represents a significant contribution for psychiatry. Psychosis is associated with dopamine and antipsychotics strongly influence availability of dopamine. Because we have no drugs based on other mechanisms of action, we should optimize the treatment of available antipsychotics. Undoubtedly the therapeutic drug monitoring is an important tool. In the Czech Republic it is not currently used in spite of the fact, that optimal therapeutic plasma levels of antipsychotics are known and the assessment is available. Clozapine is the gold standard in the treatment of pharmacoresistant schizophrenia, other antipsychotics are less effective. In non-reactors to clozapine, plasma level monitoring is important for the choice of further treatment strategy. Our preliminary results as well as published findings support the utility of drug therapy monitoring in these patients.

Keywords: antipsychotics, therapeutic drug monitoring, optimization, clozapine, pharmacoresistancy.