Trajectories of Treatment Response in Hallucinations

Abstract

ObjectiveHallucinations are highly prevalent in schizophrenia and related disorders. Antipsychotics are generally effective in treating hallucinations, but major inter-individual differences in treatment response exist. Previous studies have identified heterogeneity of over-all antipsychotic response patterns in schizophrenia. The aim of this study was to explore the heterogeneity in the response of hallucinations to antipsychotic drug treatment in a representative sample of patients acutely admitted for psychosis. Methods226 adult patients with symptoms of active psychosis were included in a randomized pragmatic trial of second-generation antipsychotics and followed for 27 weeks. Latent-mixture and latent growth curve models were conducted to analyze heterogeneity of treatment response for hallucinations to second-generation antipsychotics. ResultsWe found five different trajectories of treatment response for patients with hallucinations at baseline. These included two groups of "dramatic responders" who had rapid reduction followed by extinction of hallucinations during the first four weeks of treatment, then groups of "gradual responders", "temporal responders" and "non-responders". Most responders, 80% of those with hallucinations at baseline, were dramatic responders. Patients who showed no response in the early weeks remained non-responders also after longer follow-up. ConclusionsThe study suggests the existence of differential response patterns of hallucinations to antipsychotic treatment, and that a significant subgroup are dramatic responders. Hallucinations generally respond quickly to antipsychotic treatment. With no improvement in the very first weeks an early change of treatment should be considered.

Differential Effectiveness of Atypical Antipsychotics on Hallucinations

“…For participants with clinically significant hallucinations, the symptom had decreased to “mild” according to PANSS P3 after 3 weeks and continued to decrease throughout the follow-up period. This finding is consistent with our previous findings, where 80% of patients with clinically significant hallucinations at baseline were found to be “dramatic” responders, with extinction of hallucinations during the first 4 weeks of treatment 11 . The present results are also in line with findings from Sommer et al 10 where first-episode schizophrenia patients showed a mean reduction of hallucinations from 4.4 at baseline to 2.5 after 4 weeks of treatment measured by the PANSS P3 item.…”

“…Hallucinations in general and auditory verbal hallucinations in particular are important treatment targets, being not only a major burden to patients but might also lead to self-harm, suicide, violence or homicide 8,9 . Hallucinations respond well to antipsychotics, and the response is likely to appear rapidly 10,11 . In our previous study, we demonstrated that more than three-quarters of patients with clinically significant hallucinations at baseline reported vanishing of hallucinations during the first 4 weeks of treatment 11 .…”

“…10,11 In our previous study, we demonstrated that more than three-quarters of patients with clinically significant hallucinations at baseline reported vanishing of hallucinations during the first 4 weeks of treatment. 11 In a study with 362 patients with first-episode (FEP) schizophrenia, Sommer et al 10 found that hallucinations were reduced to a level of minimal-mild already after 4 weeks of treatment. After treatment with antipsychotics for 1 year, only 8% still had mild to moderate hallucinations.…”

“… 8 , 9 Hallucinations respond well to antipsychotics, and the response is likely to appear rapidly. 10 , 11 In our previous study, we demonstrated that more than three-quarters of patients with clinically significant hallucinations at baseline reported vanishing of hallucinations during the first 4 weeks of treatment. 11 In a study with 362 patients with first-episode (FEP) schizophrenia, Sommer et al 10 found that hallucinations were reduced to a level of minimal-mild already after 4 weeks of treatment.…”