Disorders - psychosis disorders
Anderson, Kathryn H., Ford, Stephanie, Robson, Deborah, Cassis, Jimmy, Rodrigues, Cristina, Gray, Richard
Poor adherence limits the effectiveness of
antipsychotic treatment in people with psychosis. The aim of the pragmatic, exploratory, single-masked trial conducted in the USA was to explore the
efficacy, acceptability, and satisfaction with adherence therapy (AT) in a sample of people with schizophrenia. Twenty-six patients (12 experimental
and 14 controls) were randomly allocated to receive eight weekly sessions of AT or continue with their treatment as usual (TAU). Patients were
assessed at baseline and follow up (after therapy completion). The primary outcome was psychiatric symptoms, assessed using the Positive and Negative
Syndrome Scale (PANSS). The secondary outcome, medication adherence, was measured by The Personal Evaluation of Transitions in Treatment. Patients
receiving AT did not significantly improve in overall psychiatric symptomatology (change in PANSS total scores: AT: -10.2, TAU: -8.6; mean
difference, -1.6; P = ns) or with medication adherence (AT: -2.8, TAU 1.5; P = ns) compared with the TAU group at follow up. Using the Adherence
Therapy Patient Satisfaction Questionnaire, a high degree of satisfaction with AT was reported. Although AT did not result in a statistically-
significant improvement in symptoms or medication adherence, evidence of active clinical engagement in treatment occurred.
International Journal of Mental Health
Nursing, 19(5) : 340-349
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Arango, Celso, Robles, Olalla, Parellada, Mara, Fraguas, David, Ruiz-
Sancho, Ana, Medina, Oscar, Zabala, Arantzazu, Bombín,
Igor, Moreno, Dolores
Objective: Method: Results: Conclusion: To
compare the efficacy, safety, and tolerability of olanzapine and quetiapine in adolescents with first episode psychosis.Fifty adolescents (age 16 +/-
1.25) with a first episode of psychosis were randomized to quetiapine or olanzapine in a 6-month open label study. Efficacy and side effect scales,
as well as vital signs and laboratory data were recorded at baseline, 7, 15, 30, 90, and 180 days (end of study).Out of the total sample included in
the study, 32 patients completed the trial (quetiapine n = 16, olanzapine n = 16). Patients in both treatment groups had a significant reduction in
all clinical scales with the exception of the negative scale of the Positive and Negative Symptom Scale (PANSS) for olanzapine and the general
psychopathology scale of the PANSS for quetiapine. The only difference between treatment arms on the clinical scales was observed on the patients'
strength and difficulties questionnaire (SDQ) scale, with greater improvement for olanzapine. Patients on olanzapine gained 15.5 kg and patients on
quetiapine gained 5.5 kg.Olanzapine and quetiapine reduced psychotic symptoms in this adolescent sample. Patients on olanzapine gained significantly
more weight. Side effects with both drugs seemed to be more prevalent than those reported in adult studies.
European Child & Adolescent Psychiatry, 18(7) : 418-
428
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Boter,
Han, Peuskens, Joseph, Libiger, Jan, Fleischhacker, Wolfgang, Davidson, Michael, Galderisi, Silvana, Kahn, Rene
Background: Methods: Results: Conclusions: Predefined
response and remission criteria may hold more clinical relevance than mean scores on rating scales. We compared the effectiveness of low doses of
haloperidol and regular doses of second generation antipsychotics (SGAs) on >or=50% response and remission.In an open randomized clinical trial in 14
countries, 498 unselected first-episode patients with schizophrenia were assigned to haloperidol (1-4 mg/d; n=103), amisulpride (200-800 mg/d;
n=104), olanzapine (5-20mg/d; n=105), quetiapine (200-750 mg/d; n=104), or ziprasidone (40-160 mg/d; n=82). Primary outcomes were >or=50% response
and remission within 12 months, as measured with the Positive and Negative Syndrome Scale. Analysis was by intention-to-treat.Within 12 months, the
proportions of patients with >or=50% response were 37% for haloperidol, 67% for amisulpride, 67% for olanzapine, 46% for quetiapine, and 56% for
ziprasidone. Comparisons with haloperidol showed a higher likelihood for >or=50% response with amisulpride (hazard ratio [HR] 2.27, [95% CI 1.51-
3.42]), olanzapine (HR 2.07 [1.38-3.10]), and ziprasidone (HR 1.62 [1.02-2.56]). Within 12 months, the proportions of patients in remission were 17%
for haloperidol, 40% for amisulpride, 41% for olanzapine, 24% for quetiapine, and 28% for ziprasidone. Comparisons with haloperidol showed a better
chance for remission on amisulpride (HR 2.49, [95% CI 1.43-4.35]), olanzapine (HR 2.58 [1.48-4.48]), quetiapine (HR 1.96 [1.06-3.64]), and
ziprasidone (HR 2.03 [1.07-3.87]).Substantial proportions of first-episode patients with schizophrenia showed clinically meaningful response and
remission rates within 12 months. The proportions of response and remission were higher for most SGAs as compared to haloperidol.
Schizophrenia Research, 115(2-3) : 97-
103
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Eack, Shaun M., Greenwald, Deborah P., Hogarty, Susan S., Cooley, Susan J., DiBarry, Ann
Louise, Montrose,
Debra M., Keshavan, Matcheri S.
Objective: Methods: Results: Conclusions: The early application of cognitive rehabilitation may afford long-term functional benefits to patients
with schizophrenia. This study examined the two-year effects of an integrated neurocognitive and social-cognitive rehabilitation program, cognitive
enhancement therapy (CET), on cognitive and functional outcomes in early-course schizophrenia.Early-course outpatients (mean+/-SD illness
duration=3.19+/-2.24 years) with schizophrenia or schizoaffective disorder were randomly assigned to CET (N=31) or enriched supportive therapy (EST)
(N=27), an illness management intervention utilizing psychoeducation and applied coping strategies, and treated for two years. Multivariate composite
indexes of cognitive, social adjustment, and symptom domains were derived from assessment batteries administered annually by computer-based tests and
raters not blind to treatment assignment.Of the 58 participants who were randomly assigned and treated, 49 and 46 completed one year and two years of
treatment, respectively. Intent-to-treat analyses showed significant differential effects favoring CET on social cognition, cognitive style, social
adjustment, and symptomatology composites during the first year of treatment. After two years, moderate effects (d=.46) were observed favoring CET
for enhancing neurocognitive function. Strong differential effects (d>1.00) on social cognition, cognitive style, and social adjustment composites
remained at year 2 and also extended to measures of symptomatology, particularly negative symptoms.CET appears to be an effective approach to the
remediation of cognitive deficits in early schizophrenia that may help reduce disability in this population. The remediation of such deficits should
be an integral component of early intervention programs treating psychiatrically stable schizophrenia outpatients.
Psychiatric Services, 60(11) : 1468-
1476
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Dewa, Carolyn
S., Zipursky, Robert B., Chau, Nancy, Furimsky, Ivana, Collins, April, Agid, Ofer, Goering, Paula
Objective: This pilot study compared the effectiveness of specialized care that was home based versus hospital based for individuals
experiencing their first psychotic episode. Method: A randomized controlled trial design was used. A total of 29 subjects were interviewed at
baseline, 3 and 9 months. Repeated measures analysis of variance was employed to test for statistically significant changes over time within and
between groups with regard to community psychosocial functioning and symptom severity. Results: Our findings indicate that subjects in both the
home-based and hospital-based programmes significantly improved with regard to symptoms and community functioning over time. However, the rates of
change over time were not significantly different between the two programmes. There was a statistically significant difference between programmes
with regard to the proportion of subjects with less than two visits (i.e. either did not attend their first assessment or attended followup visits
after their assessment). Conclusions: This was a modest pilot study and the sample was too small to allow definitive conclusions to be drawn.
However, the results raise questions about differences in initial treatment engagement. They suggest the need for additional research focusing on
interventions that promote initial treatment seeking. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Early Intervention in Psychiatry, 3(4) : 304-311
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Davidson, Michael, Galderisi,
Silvana, Weiser, Mark, Werbeloff, Nomi, Fleischhacker, Wolfgang W., Keefe, Richard S., Boter, Han, Keet, Ireneus
P. M., Prelipceanu,
Dan, Rybakowski, Janusz K., Libiger, Jan, Hummer, Martina, Dollfus, Sonia, Lopez-Ibor, Juan J., Hranov, Luchezar G., Gaebel, Wolfgang, Peuskens, Joseph, Lindefors, Nils, Kahn, Rene S.
Objective: Methods: Results: Conclusion: Cognitive impairment, manifested as
mild to moderate deviations from psychometric norms, is present in many but not all schizophrenia patients. The purpose of the present study was to
compare the effect of haloperidol with that of second-generation antipsychotic drugs on the cognitive performance of patients with schizophreniform
disorder or first-episode schizophrenia.Subjects were 498 patients with schizophreniform disorder or first-episode schizophrenia who were randomly
assigned to open-label haloperidol (1 to 4 mg/day [N=103]), amisulpride (200 to 800 mg/day [N=104]), olanzapine (5 to 20 mg/day [N=105]), quetiapine
(200 to 750 mg/day [N=104]), or ziprasidone (40 to 160 mg/day [N=82]). The Rey Auditory Verbal Learning Test, Trail Making Test Part A and Part B,
WAIS Digit Symbol Test, and Purdue Pegboard Test were administered at baseline and the 6-month follow-up evaluation.Compared with scores at baseline,
composite cognitive test scores improved for all five treatment groups at the 6-month follow-up evaluation. However, there were no overall
differences among the treatment groups. In addition, there was a weak correlation between the degree of cognitive improvement and changes in Positive
and Negative Syndrome Scale scores.Treatment with antipsychotic medication is associated with moderate improvement in the cognitive test performance
of patients who have schizophreniform disorder or who are in their first episode of schizophrenia. The magnitude of improvement does not differ
between treatment with haloperidol and treatment with second-generation antipsychotics. Moreover, cognitive improvement is weakly related to symptom
change.
American Journal of Psychiatry, 166(6) : 675-
682
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Crespo-Facorro, Benedicto, Mata, Ignacio, Ayesa, Rosa, Ramirez-Bonilla, MariLuz, Martinez-Garcia, Obdulia, Vazquez-Barquero, Jose L.
Objective: To
investigate the neurocognitive effectiveness of haloperidol, risperidone, and olanzapine in first-episode schizophrenia-spectrum disorders. Method:
This prospective, randomized, open-label study was conducted from February 2001 to February 2005. Data for the present investigation were obtained
from a large epidemiologic and 3-year longitudinal intervention program of first-episode psychosis (DSM-IV criteria) conducted at the outpatient
clinic and the inpatient unit at the University Hospital Marques de Valdecilla, Santander, Spain. One hundred four patients randomly assigned to
haloperidol (N = 35), olanzapine (N = 30), or risperidone (N = 39) who completed clinical and cognitive evaluations at baseline, 6 months, and 1 year
were included in the final analysis. Thirty-seven healthy individuals were also longitudinally assessed. A neuropsychological battery that comprised
9 cognitive domains was used. The contribution of clinical changes, concomitant medications, and the severity of motor side effects to cognitive
changes was controlled. The main outcome measure was cognitive changes at 1-year follow-up. Results: The 3 treatment groups showed a significant
improvement in cognitive scores after 1 year. The differential cognitive effectiveness between antipsychotics was insignificant. The magnitude of
cognitive changes was similar in the 3 treatment groups and controls, although a greater improvement on the Finger Tapping Test, Trail Making Test B,
and Rey Complex Figure Test was found in the treatment groups. Clinical changes, use of concomitant medications, and the emergence of motor side
effects did not significantly account for cognitive changes over time. Conclusions: Haloperidol, olanzapine, and risperidone were equally effective
in treating cognitive deficits of psychosis. The effect of practice clearly contributes to cognitive score improvements after treatment with
antipsychotics. Our results provide important information regarding the practical utility of antipsychotic treatments to improve cognition and could
have implications for developing novel approaches for cognitive pharmacotherapy in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights
reserved) (journal abstract)
Journal of Clinical Psychiatry, 70(5) : 717-
729
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Cuesta, Manuel J., deJalon, Elena Garcia, Campos, M. Soledad, Peralta, Victor
Background: Cognitive impairment in schizophrenia-spectrum disorders is highly prevalent and notably
influences functional outcomes. Aims: To characterise the cognitive effectiveness of second-generation antipsychotic drugs. Method: One hundred
consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders were admitted. Seventy-seven completed baseline,
1-month and 6-month psychopathological and neuropsychological assessments. Patients were randomised to risperidone or olanzapine treatment. Four
final treatment allocation groups were defined since patients continued treatment in their normal setting: risperidone, olanzapine, mixed and no-
antipsychotic groups. Results: There were no differences in cognitive effectiveness between the four treatment groups. Reliable change index methods
demonstrated that nearly a half of patients showed an improvement in Global Cognitive Score at the 6-month assessment. Improvement on the
neuropsychological tests ranged from 17 to 54%. A strong predictor of cognitive response was poor performance on baseline neuropsychological tests;
response was moderately influenced by a low premorbid scholastic performance and IQ. Conclusions: Cognitive improvement related to second-generation
antipsychotic drugs appeared within the first 4 weeks of treatment and persisted at 6 months irrespective of treatment group. Greater cognitive
dysfunction at baseline and lower premorbid cognitive background predicted cognitive improvement in our sample. (PsycINFO Database Record (c) 2010
APA, all rights reserved) (journal abstract)
British Journal of
Psychiatry, 194(5) : 439-445
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
deKoning, M. B., Bloemen, O. J. N., vanAmelsvoort, T. A. M. J., Becker, H. E., Nieman, D. H., VanDerGaag, M., Linszen, D. H.
Objective: Method: Results: Conclusion: Prediction of transition
to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this
review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio.A literature search in PubMed, EMBASE and
PsycINFO was performed.Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention
suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years.
Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are
more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems.At the present time,
the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice.
Acta Psychiatrica
Scandinavica, 119(6) : 426-442
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Essali, Adib, Al Haj Haasan, Nahla, Li, Chunbo, Rathbone, John
BACKGROUND: Long-term drug treatment of schizophrenia with typical
antipsychotics has limitations: 25 to 33% of patients have illnesses that are treatment-resistant. Clozapine is an antipsychotic drug, which is
claimed to have superior efficacy and to cause fewer motor adverse effects than typical drugs for people with treatment-resistant illnesses.
Clozapine carries a significant risk of serious blood disorders, which necessitates mandatory weekly blood monitoring at least during the first
months of treatment. OBJECTIVES: To evaluate the effects of clozapine compared with typical antipsychotic drugs in people with schizophrenia. SEARCH
STRATEGY: For the current update of this review (March 2006) we searched the Cochrane Schizophrenia Group Trials Register. SELECTION CRITERIA: All
relevant randomised clinical trials (RCTs). DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated
relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed-effect model. We calculated numbers
needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed-effect
model. MAIN RESULTS: We have included 42 trials (3950 participants) in this review. Twenty-eight of the included studies are less than 13 weeks in
duration, and, overall, trials were at significant risk of bias. We found no significant difference in the effects of clozapine and typical
neuroleptic drugs for broad outcomes such as mortality, ability to work or suitability for discharge at the end of the study. Clinical improvements
were seen more frequently in those taking clozapine (n=1119, 14 RCTs, RR 0.72 CI 0.7 to 0.8, NNT 6 CI 5 to 8). Also, participants given clozapine had
fewer relapses than those on typical antipsychotic drugs (n=1303, RR 0.62 CI 0.5 to 0.8, NNT 21 CI 15 to 49). BPRS scores showed a greater reduction
of symptoms in clozapine-treated patients, (n=1145, 16 RCTs, WMD -4.22 CI -5.4 to -3.1), although the data were heterogeneous (Chi2 0.0001, I2 66%).
Short-term data from the SANS negative symptom scores favoured clozapine (n=196, 5 RCTs, WMD -5.92 CI -7.8 to -4.1). We found clozapine to be more
acceptable in long-term treatment than conventional antipsychotic drugs (n=982, 16 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 15 CI 12 to 20). Blood problems
occurred more frequently in participants receiving clozapine (3.2%) compared with those given typical antipsychotics (0%) (n=1031, 13 RCTs, RR 7.09
CI 2.0 to 25.6). Clozapine participants experienced more drowsiness, hypersalivation, or temperature increase, than those given conventional
neuroleptics. However, clozapine patients experienced fewer motor adverse effects (n=1433, 18 RCTs, RR 0.58 CI 0.5 to 0.7, NNT 5 CI 4 to 6).The
clinical effects of clozapine were more pronounced in participants resistant to typical neuroleptics in terms of clinical improvement (n=370, 4 RCTs,
RR 0.71 CI 0.6 to 0.8, NNT 4 CI 3 to 6) and symptom reduction. Thirty-four per cent of treatment-resistant participants had a clinical improvement
with clozapine treatment. AUTHORS' CONCLUSIONS: Clozapine may be more effective in reducing symptoms of schizophrenia, producing clinically
meaningful improvements and postponing relapse, than typical antipsychotic drugs - but data are weak and prone to bias. Participants were more
satisfied with clozapine treatment than with typical neuroleptic treatment. The clinical effect of clozapine, however, is, at least in the short
term, not reflected in measures of global functioning such as ability to leave the hospital and maintain an occupation. The short-term benefits of
clozapine have to be weighed against the risk of adverse effects. Within the context of trials, the potentially dangerous white blood cell decline
seems to be more frequent in children and adolescents and in the elderly than in young adults or people of middle-age.The existing trials have
largely neglected to assess the views of participants and their families on clozapine. More c mmunity-based long-term randomised trials are needed to
evaluate the efficacy of clozapine on global and social functioning as trials in special groups such as people with learning disabilities. CLOZAPINE
VERSUS TYPICAL NEUROLEPTIC MEDICATION FOR SCHIZOPHRENIA: Schizophrenia is a serious, chronic and relapsing mental illness with a worldwide lifetime
prevalence of about one per cent. Schizophrenia is characterised by positive symptoms such as hallucinations and delusions and negative symptoms such
as emotional numbness and withdrawal. One quarter of those who have experienced an episode of schizophrenia recover and the illness does not recur.
Another 25% experience an unremitting illness. Half do have a recurrent illness but with long episodes of considerable recovery from the positive
symptoms. The overall cost of the illness to the individual, their carers and the community is considerable.Antipsychotic medications are classified
into typical and atypical drugs. First generation or 'typical' antipsychotics such as chlorpromazine and haloperidol have been the mainstay of
treatment, and are effective in reducing the positive symptoms of schizophrenia, but negative symptoms are fairly resistant to treatment. In
addition, drug treatments are associated with adverse effects which can often compromise compliance with medication and therefore increase the
incidences of relapse.People who do not respond adequately to antipsychotic medication are sometimes given the 'atypical' antipsychotic drug
clozapine, which has been found to be effective for some people with treatment-resistant schizophrenia. Clozapine is also associated with having
fewer movement disorders than chlorpromazine, but may induce life-threatening decreases in white blood cells (agranulocytosis).We reviewed the
affects of clozapine in people with schizophrenia compared to typical antipsychotics drugs.This review supports the notion that clozapine is more
effective than typical antipsychotics for people with schizophrenia in general, and for those who do not improve on typical antipsychotics in
particular. Clozapine is associated with less movement adverse effects than typical antipsychotic drugs, but it may cause serious blood related
adverse effects. White blood cell count monitoring is mandatory for all people taking clozapine. There is a worry, however, that studies are - at the
very least - moderately prone to bias favouring clozapine. Better conduct and reporting of trials could greatly have increased our confidence in the
results.
Cochrane Database of Systematic
Reviews, (1) :
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jimenez, M., Wade, D., Gee, D., Crisp, K., Pearce, T., Newman, B., Spiliotacopoulos, D., Castle, D., McGorry, P. D.
Objective: Patients with first-episode psychosis are responsive to acute-phase treatments, but
relapse rates are high. This study aimed to evaluate the effectiveness of a psychosocial treatment designed to prevent the second episode of
psychosis compared with standardized early psychosis care. Method: In a randomized controlled trial, conducted at the Early Psychosis Prevention and
Intervention Centre and Barwon Health, Australia, a multimodal individual and family cognitive-behavioral therapy for relapse prevention was compared
with standardized case management within a specialist early psychosis service. Patients aged 15 to 25 years with a first episode of a DSM-IV
psychotic disorder were recruited between November 2003 and May 2005. The main outcome measures were the number of relapses and time to first
relapse. Results: Forty-one first-episode psychosis patients were randomly assigned to the relapse prevention therapy (RPT) and 40 to standardized
case management. At the 7-month follow up, the relapse rate was significantly lower in the therapy condition compared to treatment as usual (p =
.042) and time to relapse was significantly longer for the RPT condition (p = .03). The number needed to treat was 6 over 7 months. Conclusions:
Interim findings suggest that RPT provided within a specialist early psychosis program was effective in reducing relapse in early psychosis when
compared with standardized early psychosis case management. Trial Registration: www.anzctr.org.au Identifier: ACTRN12605000514606. (copyright)
Copyright 2009 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 70(4) : 477-486
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Case management
Kryzhanovskaya, L., Schulz, S. C., McDougle,
C., Frazier, J., Dittmann, R., Robertson-Plouch, C., Bauer, T., Xu, W., Wang, W., Carlson, J., Tohen, M.
Objective To assess olanzapine's efficacy and tolerability in adolescents with
schizophrenia.\rMethod One hundred seven inpatient and outpatient adolescents (olanzapine, n = 72, mean age 16.1 years; placebo, n = 35, mean age
16.3 years) with schizophrenia participated in this randomized (2:1), international, multisite, industry-sponsored trial. All patients met DSM-IV-TR
criteria for schizophrenia, and they were treated for up to 6 weeks with flexible doses of olanzapine (2.5 - 20.0 mg/day) or placebo. Last-
observation-carried-forward mean changes from baseline to endpoint on the anchored version of the Brief Psychiatric Rating Scale for Children,
Clinical Global Impression Scale-Severity of Illness, and Positive and Negative Syndrome Scale (PANSS) were assessed.\rResults More olanzapine-
treated versus placebo-treated patients completed the trial (68.1% versus 42.9%, p = .020). Compared with placebo-treated patients, olanzapine-
treated adolescents had significantly greater improvement in Brief Psychiatric Rating Scale for Children total (p = .003), Clinical Global
Impressions Scale-Severity of Illness (p = .004), PANSS total (p = .005), and PANSS positive scores (p = .002). Olanzapine-treated patients gained
significantly more baseline-to-endpoint weight (4.3 kg versus 0.1 kg, p < .001). Significantly more olanzapine-treated versus placebo-treated
patients gained 7% or greater of their body weight at any time during treatment (45.8% versus 14.7%, p = .002). Prolactin and triglyceride mean
baseline-to-endpoint changes were significantly higher in olanzapine-treated versus placebo-treated adolescents. The incidence of treatment-emergent
significant changes in fasting glucose, cholesterol, or triglycerides did not differ between the groups at endpoint, but significantly more
olanzapine-treated patients had high triglycerides at any time during treatment.\rConclusions Olanzapine-treated adolescents with schizophrenia
experienced significant symptom improvement. Significant increases in weight, triglycerides, uric acid, most liver function tests, and prolactin were
observed during olanzapine treatment.
Journal of the American Academy of Child & Adolescent Psychiatry, 48 : 60-
70
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)