Mid-Term and Long-Term Efficacy and Effectiveness of Antipsychotic Medications for Schizophrenia

Glick, Ira D.; Correll, Christoph U.; Altamura, A.C.; Marder, Stephen R.; Csernansky, John G.; Weiden, Peter J.; Leucht, Stefan; Davis, John M.

doi:10.4088/jcp.11r06927

Cited by 45 publications

(29 citation statements)

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“…The highly publicized primary endpoint finding was difference in time to discontinuation, which favored olanzapine, with improvement in psychopathology a secondary endpoint, which also slightly favored olanzapine (9). However, subsequent independent scrutiny of the design and data analysis of this study revealed serious flaws, leading to the conclusion that it was impossible to draw conclusions about the relative merits of the drugs from CATIE's findings (1,(68)(69)(70)(71). These flaws included allowing patients to remain on the same drug they had been receiving prior to randomization, which affected many of those randomized to risperidone or olanzapine (9), and olanzapine dosage up to 30 mg/day (9), three times the dose found to be effective for non-TRS (72).…”

Section: Use Of Atypical Apds In Non-treatment-resistant Schizophreniamentioning

confidence: 88%

Update on Typical and Atypical Antipsychotic Drugs

2013

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Antipsychotic drugs (APDs) are best classified as typical or atypical. The distinction is based solely on their ability to cause extrapyramidal side effects (EPS), including tardive dyskinesia (TD). The two classes differ in mechanism of action, with atypical APDs providing important modulation of serotonergic neurotransmission. TD increases the death rate and can be minimized by limiting use of typical APDs. Clozapine is unique among the atypical APDs in its efficacy for ameliorating psychosis in patients with treatment-resistant schizophrenia (TRS), for reduction of suicide, and for improving longevity. The typical and atypical APDs do not differ in improving psychopathology in non-TRS. The atypicals vary in metabolic side effects: some have little burden. Cognitive benefits of the atypical APDs may be superior for some domains of cognition and require less use of anticholinergic drugs, which impair memory, for treatment of EPS. Overall, choosing among the atypical APDs as first-line treatment represents the best course for schizophrenia and most likely other disorders for which APDs are used.

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Section: Use Of Atypical Apds In Non-treatment-resistant Schizophreniamentioning

confidence: 88%

Update on Typical and Atypical Antipsychotic Drugs

2013

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“…Time to treatment failure offers an integrated measure of efficacy and tolerability that is clinically relevant and is perhaps more meaningful than using as a primary outcome measure a rating scale that measures psychopathology. 26 Time to treatment failure has been proposed to more accurately reflect drug effects, compared with all-cause discontinuation, because the latter outcome can include discontinuations that are not necessarily related to failure of the intervention. For example, it has been argued that in the context of the CATIE schizophrenia study, discontinuations "owing to patient's decision" (a component of all-cause discontinuation) may have reflected effects that were unrelated to drug treatment, such as subject dissatisfaction with study participation.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Lurasidone in Patients with Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics

McEvoy¹,

Citrome²,

Hernández³

et al. 2013

J. Clin. Psychiatry

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“…Olanzapine might lead to longer treatment maintenance than haloperidol or ziprasidone in treatment-naïve people with a FEP [40]. Accordingly, Glick et al have reported in a metanalysis of medium and long-term effectiveness that olanzapine and risperidone appear to be the most effective antipsychotics in the treatment of schizophrenia and FEP [42]. …”

Section: Aiming For Efficacy and Effectivenessmentioning

confidence: 99%

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Crespo‐Facorro

Pelayo-Terán²,

Son³

2016

Neurol Ther

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Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.

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Mid-Term and Long-Term Efficacy and Effectiveness of Antipsychotic Medications for Schizophrenia

Abstract: Despite intraclass differences and the complexities of antipsychotic choice, the second-generation antipsychotics are important contributions not only to the acute phase but, more importantly, to the maintenance treatment of schizophrenia.

Cited by 45 publications

References 0 publications

Update on Typical and Atypical Antipsychotic Drugs

Update on Typical and Atypical Antipsychotic Drugs

Effectiveness of Lurasidone in Patients with Schizophrenia or Schizoaffective Disorder Switched From Other Antipsychotics

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

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