Schizophrenia Treatment Trial Demonstrates the Benefits of Antipsychotics

T. Scott Stroup, M.D., MPH, of the University of North Carolina at Chapel Hill, and colleagues compared the effectiveness of the medications by determining how long patients stayed on their assigned medication. Those taking quetiapine stayed on the longest — averaging about ten months before discontinuing. Those taking olanzapine discontinued after an average of about seven months, and those taking risperidone discontinued after an average of four months.

Although the discontinuation results suggest that olanzapine was generally on par with quetiapine, patients taking olanzapine experienced more side effects. While none of those taking quetiapine discontinued use due to weight gain or metabolic side effects, 13 percent of those assigned to olanzapine discontinued it due to weight gain or metabolic problems, and 5 percent of those on risperidone did so.

“These results reinforce the fact that finding the most effective medication for each patient sometimes means trying multiple medications,” said Dr. Stroup. “They remind us of the considerable variability in clinical circumstances and of our need to be responsive to an individual’s needs and preferences.”

In addition, patients with schizophrenia taking antipsychotic medications experience modest improvements in social, interpersonal and community living (psychosocial) skills, regardless of what antipsychotic medication they are taking.

Improvements in psychosocial skills among patients with schizophrenia have been notoriously difficult to achieve, even when the more disruptive symptoms of the disease can be controlled. “Helping patients with schizophrenia restore their psychosocial functioning remains a challenge,” said NIMH Director Thomas R. Insel, M.D. “These CATIE results reinforce the growing understanding that we must do a better job of helping patients get their life skills back on track.”

Marvin Swartz, M.D., of Duke University and colleagues evaluated the social and vocational functioning, interpersonal relationships, and psychological well-being of 455 participants — about one-third of all patients in the CATIE study — who completed an initial evaluation before the study began and were available to provide data after 12 months of treatment. In the first phase of the CATIE study, patients were randomly assigned to take either perphenazine — an older, first-generation antipsychotic medication — or one of several newer, second-generation medications (olanzapine, quetiapine, risperidone, or ziprasidone).

The researchers found that those patients who stuck with their initial treatment showed some improvement in their psychosocial functioning, and there were no differences among the medications in making these gains. The results are consistent with previously reported CATIE results ( http://www.nimh.nih.gov/healthinformation/catie.cfm ) in which few differences were seen among perphenazine and the newer, second-generation antipsychotic medications in effectively reducing symptoms.

The studies are:

Stroup TS, et al.Effectiveness of Olanzapine, Quetiapine and Risperidone in Patients with Chronic Schizophrenia After Discontinuing Perphenazine: A CATIE Study. American Journal of Psychiatry 2007; 164:3.

Swartz MS, et al. Effects of Antipsychotic Medications on Psychosocial Functioning in Patients with Chronic Schizophrenia: Findings From the NIMH CATIE Study. American Journal of Psychiatry 2007; 164:3.

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