BackgroundSchizophrenia is a chronic disease of global importance. The second-generation antipsychotic quetiapine has a favorable side-effect profile, however, its clinical effectiveness has been called into question when compared with first-generation antipsychotics such as haloperidol. This study evaluates the efficacy and tolerability of quetiapine versus haloperidol for first-episode schizophrenia in the outpatient setting.Methods156 adult patients with first-episode schizophrenia participated in an outpatient clinical trial and were randomized to quetiapine (200 mg/d; n = 78) or haloperidol (5 mg/d; n = 78). The study medications were titrated to a mean daily dose of 705 mg for quetiapeine and 14 mg for haloperidol. The patients were assessed at baseline, six weeks, and twelve weeks. The primary outcome measures were positive and negative scores of the Positive and Negative Syndrome Scale (PANSS). Secondary measures were Global Assessment of Functioning (GAF) scale for overall psychosocial functioning, and Simpson-Angus Scale (SAS) for extra-pyramidal symptoms.ResultsAt twelve weeks, the quetiapine group had a greater decrease in PANSS positive (18.9 vs. 15.3, p = 0.013) and negative scores (15.5 vs. 11.6, p = 0.012), however, haloperidol showed a greater decrease in general psychopathology score (23.8 vs. 27.7, p = 0.012). No significant difference between groups were found for total PANSS (58.3 vs. 54.8, p = 0.24) and GAF (45.7 vs. 46.2, p = 0.79).ANOVA identified significant group interactions on PANSS positive (F = 18.72, df = 1.6,52.4, p < 0.0001), negative (F = 5.20, df = 1.1,35.7, p < 0.0001), depression/anxiety (F = 106.49, df = 1.14,37.8, p < 0.0001), and total scores (F = 7.51, df = 1.4,45.6, p = 0.001).SAS (8.62 vs. 0.26, p < 0.0001) and adverse events of akathisia (78% vs. 0%, p = 0.000), parkinsonism (66.6% vs. 0%, p < 0.0001), and fatigue (84.6% vs. 66.6%, p = 0.009) were greater in haloperidol compared to quetiapine, whereas headache was more common in quetiapine treated patients (11.5% vs. 35.9%, p < 0.0001).ConclusionsQuetiapine has greater efficacy for positive and negative symptoms with less extra-pyramidal symptoms than haloperidol when used for first-episode schizophrenia in the outpatient setting.

Introduction and aim of the study:Little is known about the qualitative and quantitative differences in the use of antipsychotics in Arab countries. This study is aimed to examine and compare the prescribing pattern of antipsychotics in two different Arab settings and specifically determine the factors influencing polypharmacy.Materials and methods:This cross-sectional study was conducted in Jordan (National Center for Mental Health Hospital, Amman) and Egypt (Mansoura University Hospital, Mansoura) and included 162 inpatients [g1] with schizophrenia. Patients were surveyed using a standardized protocol.[g2]Results:There were no significant differences between Egyptians and Jordanians with respect to; demographic, anthropometric, polypharmacy or mean maximum dose of antipsychotics. Jordanians had significantly lower number of hospitalizations and relapses than Egyptian patients. Atypical than typical first antipsychotics were prescribed more to Jordanians compared to Egyptian patients. Irrespective of the patients’ nationalities, the mean hospitalizations, and relapse were predictors of polypharmacy.Conclusions:Antipsychotic prescribing pattern differs between the Egyptians and Jordanian patients with schizophrenia[g3]. The risks with polytherbay calls for improving the prescribing patterns of antipsychotic drugs in Arab region to establish guidelines on the proper indications and uses for antipsychotic drugs.

The phenomenon of population aging which was defined as an increase in the median age of the population is already a major social and health problem in a developing country such as Saudi Arabia and represents a challenge to the psychiatric profession (Hafez et al., 2000).