Disorders - psychosis disorders
Findling, Robert, Robb, Adelaide, Nyilas, Margaretta, Forbes, Robert, Jin, Na, Ivanova, Svetlana, Marcus, Ronald, McQuade, Robert, Iwamoto, Taro, Carson, William
Aripiprazole is
a dopamine partial agonist approved for use in adults for short- and long-term treatment of schizophrenia and bipolar disorder. This study was
designed to examine the acute efficacy, safety, and tolerability of aripiprazole for adolescents with schizophrenia. METHOD: This was a 6-week
multicenter, double-blind, randomized, placebo-controlled trial. Subjects 13 to 17 years old with a DSM-IV diagnosis of schizophrenia and a Positive
and Negative Syndrome Scale (PANSS) total score of 70 or more were randomly assigned (1:1:1 ratio) to placebo or 10 or 30 mg/day of aripiprazole. The
primary endpoint was mean change from baseline to endpoint (last observation carried forward) in PANSS total score. Assessments of safety and
tolerability included spontaneously reported adverse events, extrapyramidal symptom scores, serum prolactin concentration, body weight, and metabolic
measures. RESULTS: Of 302 patients, 85% completed the 6-week study. The mean baseline PANSS score was 94.1. At the end of the study, both
aripiprazole doses showed statistically significant differences from placebo in reduction in PANSS total score. Adverse events occurring in more than
5% of either aripiprazole group and with a combined incidence at least twice the rate for placebo were extrapyramidal disorder, somnolence, and
tremor. Mean changes in prolactin were -8.45, -11.93, and -15.14 ng/ml for placebo and 10 mg and 30 mg of aripirazole, respectively. Mean body weight
changes were -0.8, 0.0, and 0.2 kg for placebo and 10 mg and 30 mg of aripiprazole, respectively. CONCLUSION: Both 10- and 30-mg/day doses of
aripiprazole were superior to placebo in the acute treatment of adolescents with schizophrenia. Aripiprazole was generally well tolerated.
American Journal of Psychiatry, 165(11) : 1432-1441
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Bertelsen, Mette, Jeppesen, Pia, Petersen, Lone, Thorup, Anne, Ohlenschlæger, Johan, leQuach, Phuong, Christensen, Torben Østergaard, Krarup,
Gertrud, Jorgensen, Per, Nordentoft, Merete
CONTEXT:\r\rIntensive early treatment for first-episode psychosis has been shown
to be effective. It is unknown if the positive effects are sustained for 5 years.\rOBJECTIVE:\r\rTo determine the long-term effects of an intensive
early-intervention program (OPUS) for first-episode psychotic patients.\rDESIGN:\r\rSingle-blinded, randomized, controlled clinical trial of 2 years
of an intensive early-intervention program vs standard treatment. Follow-up periods were 2 and 5 years.\rSETTING:\r\rCopenhagen Hospital Corporation
and Psychiatric Hospital, Aarhus, Denmark. Patients A total of 547 patients with a first episode of psychosis. Of these, 369 patients were
participating in a 2-year follow-up, and 301 were participating in a 5-year follow-up. A total of 547 patients were followed for 5 years.
\rINTERVENTIONS:\r\rTwo years of an intensive early-intervention program vs standard treatment. The intensive early-intervention treatment consisted
of assertive community treatment, family involvement, and social skills training. Standard treatment offered contact with a community mental health
center.\rMAIN OUTCOME MEASURES:\r\rPsychotic and negative symptoms were recorded. Secondary outcome measures were use of services and social
functioning.\rRESULTS:\r\rAnalysis was based on the principles of intention-to-treat. Assessment was blinded for previous treatment allocation. At
the 5-year follow-up, the effect of treatment seen after 2 years (psychotic dimension odds ratio [OR], -0.32; 95% confidence interval [CI], -0.58 to
-0.06; P = .02; negative dimension OR, -0.45; 95% CI, -0.67 to -0.22; P = .001) had equalized between the treatment groups. A significantly smaller
percentage of patients from the experimental group were living in supported housing (4% vs 10%, respectively; OR, 2.3; 95% CI, 1.1-4.8; P = .02) and
were hospitalized fewer days (mean, 149 vs 193 days; mean difference, 44 days; 95% CI, 0.15-88.12; P = .05) during the 5-year period.\rCONCLUSIONS:
\r\rThe intensive early-intervention program improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years later.
Secondary outcome measures showed differences in the proportion of patients living in supported housing and days in hospital at the 5-year follow-up
in favor of the intensive early-intervention program.
Archives of General Psychiatry, 65(7) : 762-771
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Berger, Gregor E., Proffitt, Tina-Marie, McConchie,
Mirabel, Kerr, Melissa, Markulev, Connie, Yuen, Hok Pan, O'Donnell, Colin, Lubman, Dan, Polari, Andrea, Wood,
Stephen, Amminger, Paul G., McGorry, Patrick D.
OBJECTIVE: To assess dosing, efficacy, and tolerability of quetiapine fumarate in drug-naive first-episode
psychosis. METHOD: We present a prospective, randomized, controlled, single-center, double-blind, fixed-dose, 4-week comparison study of 200 mg/day
versus 400 mg/day of quetiapine in 141 drug-naive acutely ill first-episode psychosis patients (diagnosed according to DSM-IV) aged 15 to 25 years.
The double-blind 4-week trial (Part 1) was followed by a single-blind, naturalistic, flexible-dose 8-week period (Part 2). The main outcome measures
were symptomatic change, functioning, and tolerability. Data were collected from July 2003 until January 2006. RESULTS: The estimated time trends of
the linear mixed-effects modeling indicated that efficacy between the 2 treatment groups in Part 1 was similar for most outcome measures except for 5
measures: the Scale for the Assessment of Negative Symptoms (SANS) anhedonia-asociality subscale (p = .011), the Social and Occupational Functioning
Assessment Scale (p = .020), the Global Assessment of Functioning scale (p = .070), the SANS affective flattening or blunting subscale (p = .051),
and the Udvalg for Kliniske Undersogelser total (p = .056), suggesting that the 200-mg group improved more for the SANS anhedonia-asociality
subscale, whereas the 400-mg group showed a slight deterioration. Social and global functioning also improved more in the 200-mg group than in the
400-mg group. Part 2 of the study revealed that, independent of the initial target dose, when clinicians were able to adjust the dose flexibly, the
dose at 12 weeks was similar between groups and averaged 268 mg/day. CONCLUSION: Our study in acutely ill drug-naive first-episode psychosis patients
suggests that quetiapine is a safe and well-tolerated antipsychotic medication. In contrast to multiepisode patients, dosing should be more
conservative in untreated new-onset cases. An initial dose of 250 to 300 mg/day of quetiapine is proposed as a primary target dose in drug-naive
first-episode psychosis patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00449397. Copyright 2008 Physicians Postgraduate Press,
Inc.
Journal of Clinical Psychiatry, 69(11) : 1702-14
- Year: 2008
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Berger, Gregor E., Proffitt, Tina-Marie, McConchie, Mirabel, Yuen, HokPan, Wood, Stephen J., Amminger, Paul, Brewer, Warrick, McGorry, Patrick D.
Objective: To investigate if ethyl-eicosapentaenoic acid (E-EPA) augmentation improves
antipsychotic efficacy and tolerability in first-episode psychosis (FEP). Method: We performed a 12-week, randomized, double-blind, placebo-
controlled trial of 2-g E-EPA augmentation in 80 FEP patients. Sixty-nine patients were eligible for analysis; a post hoc analysis was computed for a
subgroup of nonaffective FEP patients (N = 53). The first participant was included in November 2000 and the last participant completed the trial in
August 2003. Primary outcome measures were symptom change scores and time to first response, while tolerability measures and cumulative antipsychotic
dose were secondary outcome measures. Results: Analysis of covariance controlling for baseline symptoms found no significant mean difference between
E-EPA and placebo at week 12 for symptom change scores. Cox regression analysis revealed a significant treatment by diagnosis interaction (p = .024)
for time to first response favoring E-EPA in nonaffective psychosis. Post hoc analysis for cumulative response rates further confirmed a higher
response rate at week 6 (42.9% [15/35] vs. 17.6% [6/34] for all participants, p = .036; 54.2% [13/24] vs. 17.2% [5/29] for the nonaffective psychosis
subset, p = .008); however, the difference at week 12 was no longer significant. Analysis of secondary outcome measures revealed that E-EPA-augmented
participants needed 20% less antipsychotic medication between weeks 4 through 6 (p = .03), had less extrapyramidal side effects in the initial 9
weeks (p < .05 for all participants and for all time-points), and reported less constipation (p = .011) and fewer sexual side effects (p = .016) than
those treated with antipsychotic medication alone. Conclusion: The findings suggest that E-EPA may accelerate treatment response and improve the
tolerability of antipsychotic medications. However, it was not possible to demonstrate a sustained symptomatic benefit of E-EPA in early psychosis,
possibly due to a ceiling effect, since a high proportion of first-episode patients already achieve symptomatic remission with antipsychotic
medication alone. Further controlled trials in nonaffective early psychosis seem warranted. (PsycINFO Database Record (c) 2009 APA, all rights
reserved) (journal abstract).
Journal of Clinical Psychiatry, 68(12) : 1867-
1875
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Bechdolf, Andreas, Wagner, Michael, Veith, Verena, Ruhrmann, Stephan, Pukrop, Ralf, Brockhaus-Dumke,
Anke, Berning, Julia, et-al
Aim: Improvement of social adjustment is a major aim of indicated prevention in young
people at risk of developing psychosis. The present study explores the effect of specific cognitive behaviour therapy (CBT) as compared with
supportive counselling (SC) on social adjustment in people in a potential early initial prodromal state of psychosis (EIPS) primarily defined by
self-experienced cognitive thought and perception deficits (basic symptoms). Methods: A total of 128 help-seeking outpatients in the EIPS were
randomized to receive either specific CBT or SC for 12 months. Social adjustment was assessed with the Social Adjustment Scale II (SAS II) at
baseline, time of transition or post treatment Results: From 113 patients, who completed the SAS II at intake, 67 (59.3%) completed the SAS
assessments at time of transition or post treatment. Both specific CBT and SC resulted in improvements in scales of SAS II, with no significant
between-group differences post treatment. Conclusions: Although treatment in specially designed early detection and intervention centres improves
functioning of people in the EIPS, specific CBT was not superior to SC. One could hypothesize that additional vocational rehabilitation, case
management and involvement of multidisciplinary teams are needed to further improve short-term outcome of specific interventions on this dimension.
(PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Early Intervention in Psychiatry, 1(1) : 71-78
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy
Harvey, P. O., Lepage, M., Malla, A.
Objective: To assess the effectiveness of enriched intervention
(EI) on symptomatic and functional outcomes, compared with standard care (SC). Method: Studies were retrieved from search engines and, using a
metaanalytic approach, we compared EI trials with SC trials. Eleven EI sample trials (1053 patients) and 6 SC sample trials (500 patients), totalling
data from 1553 patients (69% male), were examined. We calculated the effect sizes (ESs) of both symptomatic and functional improvement over a
follow-up period of about 1 year. Results: Significant differences between EI and SC were observed at follow-up for the improvement of both positive
and negative symptoms, respectively: positive, EI = -1.54 (95%CI, -1.63 to -1.45 ) and SC = -1.07 (95%CI, -1.19 to -0.94 ) (Q between =
40.3, df 1, P < 0.001); negative, EI = -0.44 (95%CI, -0.53 to -0.35) and SC = -0.18 (95%CI, -0.31 to -0.05) (Qbetween = 10.6, df 1, P <
0.01). We also observed a significant difference between the EI and the SC groups for functional improvement over the follow-up period with mean EI =
1.11 (95%CI, 0.99 to 1.23) and SC = 0.63 (95%CI, 0.49 to 0.77) (Q between = 24.5, df 1, P < 0.001). Conclusions: There is now quantitative
evidence across multiple studies and sites to indicate that EIs for patients with recent-onset psychosis are significantly more effective than SC for
symptomatic and functional improvement over a period of about 1 year.
Canadian Journal of Psychiatry., 52(7) : 464-472
- Year: 2007
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any)
Keefe, R. S. E., Sweeney, J. A., Gu, H., Hamer, R. M., Perkins, D. O., McEvoy, J. P., Lieberman, J. A.,
Objective: The authors sought to compare the effects of olanzapine, quetiapine, and risperidone on neurocognitive
function in patients with early psychosis. Method: In a 52-week double-blind, multicenter study, 400 patients early in the course of psychotic
illness (<5 years) were randomly assigned to treatment with olanzapine (2.5-20 mg/day), quetiapine (100-800 mg/day), or risperidone (0.5-4 mg/day).
The mean modal daily dose was 11.7 mg (SD=5.3) for olanzapine, 506 mg (SD=215) for quetiapine, and 2.4 mg (SD=1.0) for risperidone. A total of 224
patients completed neurocognitive assessments at baseline and at 12 weeks, and 81 patients also completed them at 52 weeks. Neurocognitive composite
scores were calculated from the neurocognitive battery used in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and from the
Brief Assessment of Cognition in Schizophrenia. Results: At week 12, there was significant improvement in neurocognition for each treatment (p<0.01),
but no significant overall difference between treatments. Composite z score improvements on the CATIE neurocognitive battery were 0.17 for
olanzapine, 0.33 for quetiapine, and 0.32 for risperidone. Composite z score improvements on the Brief Assessment of Cognition in Schizophrenia were
0.19 for olanzapine, 0.34 for quetiapine, and 0.22 for risperidone. Statistically significant relationships between improvements in neurocognition
and functional outcome were observed at weeks 12 and 52. Conclusions: Olanzapine, quetiapine, and risperidone all produced significant improvements
in neurocognition in early-psychosis patients. Although cognitive improvements were modest, their clinical importance was suggested by relationships
with improvements in functional outcome.
American Journal of Psychiatry., 164(7) : 1061-1071
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Gaebel, W., Riesbeck, M., Wolwer, W., Klimke, A., Eickhoff, M., Von Wilmsdorff, M., Jockers-Scherubl, M.
C., et-al
Objective: Second-generation
antipsychotics (SGAs) have proven superior to first-generation antipsychotics regarding relapse prevention, mainly in multiple-episode patients.
Practice guidelines recommend SGAs as first-line treatment particularly in first-episode patients, although evidence for this group is still limited.
Accordingly, the hypothesis of whether 1-year relapse rate in first-episode schizophrenia under maintenance treatment with risperidone is lower
compared to haloperidol in low dose was tested.\rMethod: Between November 2000 and May 2004, 1372 patients had been screened for eligibility in the
inpatient facilities of 13 German psychiatric university hospitals. 159 remitted patients were enrolled after treatment of an acute first episode of
schizophrenia according to ICD-10 F20 criteria. In the randomized controlled trial, double-blind antipsychotic treatment with risperidone or
haloperidol was maintained in a targeted dose of 2 to 4 mg/day for 1 year. 151 patients were eligible for analysis. For 127 patients, this was a
continuation trial after 8 weeks of randomized, double-blind, acute treatment with the same drugs; 24 patients were additionally randomly assigned
after open acute treatment.\rResults: With both antipsychotics (risperidone, N = 77; haloperidol, N = 74), no relapse evolved. Additionally,
according to 2 post hoc defined measures of \"marked clinical deterioration,\" significant differences occurred neither in the 2 respective
deterioration rates (risperidone = 9%/23%; haloperidol = 8%/22%) nor in time until deterioration. Both antipsychotics were equally effective
regarding significant symptom reduction and improvement in quality of life. Extrapyramidal symptoms were slightly higher with haloperidol. The
overall dropout rate of 68%, however, was not significantly different between the 2 drug groups.\rConclusion: Against the background of an overall
favorable outcome, the hypothesized difference between risperidone and low-dose haloperidol regarding relapse prevention could not be supported for
this sample of patients with firstepisode schizophrenia. Possible design-related reasons for this finding are discussed. With regard to the high
dropout rate, special programs are needed to keep schizophrenia patients who are in their early acute and postacute illness course in effective and
safe treatment.
Journal of
Clinical Psychiatry, 68(11) : 1763-1774.
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
McEvoy, J. P., Lieberman, J. A., Perkins, D. O., Hamer, R. M., Gu, H., Lazarus, A., Sweitzer,
D., Olexy, C., Weiden, P., Strakowski, S. D.
Objective: This 52-week randomized, double-blind, flexible-dose, multicenter study evaluated the overall effectiveness (as measured by
treatment discontinuation rates) of olanzapine, quetiapine, and risperidone in patients early in the course of psychotic illness. Method: Patients
were randomly assigned to treatment with olanzapine (2.5-20 mg/day), quetiapine (100-800 mg/day), or risperidone (0.5-4 mg/day) administered in
twice-daily doses. Statistical analyses tested for noninferiority in all-cause treatment discontinuation rates up to 52 weeks (primary outcome
measure) based on a prespecified noninferiority margin of 20%. Results: A total of 400 patients were randomly assigned to treatment with olanzapine
(N=133), quetiapine (N=134), or risperidone (N=133). The mean modal prescribed daily doses were 11.7 mg for olanzapine, 506 mg for quetiapine, and
2.4 mg for risperidone. At week 52, all-cause treatment discontinuation rates were 68.4%, 70.9%, and 71.4% for olanzapine, quetiapine, and
risperidone, respectively. Reductions in total score on the Positive and Negative Syndrome Scale (PANSS) were similar for the three treatment groups,
but reductions in PANSS positive subscale scores were greater in the olanzapine group (at 12 weeks and at 52 weeks or withdrawal from study) and the
risperidone group (at 12 weeks). The most common elicited adverse events for olanzapine were drowsiness (53%), weight gain (51%), and insomnia (38%);
for quetiapine, drowsiness (58%), increased sleep hours (42%), and weight gain (40%); and for risperidone, drowsiness (50%), menstrual irregularities
in women (47%), and weight gain (41%). Conclusions: Olanzapine, quetiapine, and risperidone demonstrated comparable effectiveness in early-psychosis
patients, as indicated by similar rates of all-cause treatment discontinuation.
American Journal of
Psychiatry., 164(7) : 1050-1060
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Morrison, A. P., French,
P., Parker, S., Roberts, M., Stevens, H., Bentall, R. P., Lewis, S. W.
There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the
possibility of preventing the development of psychosis. A randomized controlled trial compared cognitive therapy (CT) over 6 months with monthly
monitoring in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year
period. Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period,
but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making
progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%.
There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of
developing psychosis. copyright The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All
rights reserved.
Schizophrenia Bulletin., 33(3) : 682-687
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Ohlenschlaeger, J., Thorup, A., Petersen, L., Jeppesen, P., Koster, A., Munkner, R., Nordentoft, M.
Little evidence exists
concerning the optimal treatment for patients with first-episode schizophrenia-spectrum disorders and the effect on traditional outcomes. The aim was
to investigate whether optimal treatment models have an effect on the level of use of coercion and on traditional outcomes. Hospital-based
Rehabilitation, an intensified inpatient treatment model, Integrated Treatment, an intensified model of Assertive Community Treatment, and standard
treatment were compared for patients with first-episode schizophrenia-spectrum disorders. Ninety-four patients with first-episode schizophrenia-
spectrum disorders estimated to benefit from long-term hospitalization were included consecutively from the Copenhagen OPUS-trial and randomized to
the three treatment models. At 1-year follow-up, Hospital-based Rehabilitation and Integrated Treatment had better scores on symptoms in the negative
dimension and on client satisfaction. Integrated Treatment had fewer bed-days, more patients living in non-supervised accommodation, and better score
on quality of life. No differences were found as to the use of coercion. This study adds to the evidence that intensified treatment models are
superior to standard treatment. A higher number of bed-days in Hospital-based Rehabilitation did not influence the effect on the outcomes
measured.
Nordic Journal of Psychiatry., 61(5) : 369-
378
- Year: 2007
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Kennedy, E., Kumar, A., Datta, S. S.
Background: Childhood-onset schizophrenia is schizophrenia with onset prior to the age of 13 years. Although it is rare, people who
suffer from schizophrenia at an early age appear to have a clinically severe form of the illness with poor long-term prognosis. Antipsychotic
medication is one way of managing this rare but serious mental illness. Objectives: To examine the effects of antipsychotic medication for
childhood-onset schizophrenia. Search strategy: We searched the Cochrane Schizophrenia Group Trials Register (November 2006 and February 2007),
inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors of trials for
additional information. Selection criteria: We included all randomised clinical trials involving children and young people with a diagnosis of
childhood onset schizophrenia (i.e. with a diagnosis of schizophrenia before the age of 13) comparing any antipsychotic drug with another
antipsychotic or placebo. Data collection and analysis: We reliably selected, quality assessed and extracted data fromtrials. We excluded data
wheremore than 50% of participants in any group were lost to follow up. For homogenous dichotomous data we calculated random effects, relative risk
(RR) and its 95% confidence interval (CI) and, where appropriate, number needed to treat (NNT) on an intention-to-treat basis. For normal continuous
data we calculated the weighted mean difference (WMD). Main results: From a total of 2062 citations, we identified six relevant trials. We
categorised trials into three comparisons: atypical versus typical, atypical versus atypical and typical versus typical antipsychotic drugs. The only
comparison to find any differences between treatment groups was atypical versus typical antipsychotic drugs. A few results from one study favoured
the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia (n=21, WMD CGAS 17.00 CI 7.74 to
26.26; n=21, WMD Bunney-Hamburg Psychosis Rating Scale -3.60 CI -6.64 to -0.56). Participants on clozapine, however, were three times more likely to
have drowsiness (1 RCT, n=21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17) and half of the children receiving clozapine had neutropenia (1 RCT, n=21,
RR 12, CI 0.75 to192.86). Authors' conclusions: There are few relevant trials and, presently, there is little conclusive evidence regarding the
effects of antipsychotic medication for those with early onset schizophrenia. Some benefits were identified in using the atypical antipsychotic
clozapine compared with haloperidol but the benefits were offset by an increased risk of serious adverse effects. Larger, more robust, trials are
required. Copyright (copyright) 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, (4) :
- Year: 2007
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)