A Practical Clinical Trial Comparing Haloperidol, Risperidone, and Olanzapine for the Acute Treatment of First-Episode Nonaffective Psychosis

Crespo‐Facorro, Benedicto; Pérez-Iglesias, Rocí­o; Ramírez-Bonilla, Mariluz; Martínez-Garcia, Obdulia; Llorca, Javier; Vázquez‐Barquero, José Luís

doi:10.4088/jcp.v67n1004

Cited by 142 publications

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“…Clinical effectiveness is determined by both efficacy and tolerability, and it applies to patients in real-world treatment settings. In first episode of psychosis, similar clinical efficacy has been found between second generation of antipsychotics (SGAs) and low doses of first-generation antipsychotics (FGAs; Crespo-Facorro et al 2006, 2011Kahn et al 2008;Lieberman 1996;Lieberman et al 2003). The existence of differences in safety and tolerability leads to different treatment discontinuation rates among antipsychotics in the short term.…”

Section: Introductionmentioning

confidence: 93%

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Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis

et al. 2011

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Section: Introductionmentioning

confidence: 93%

“…Detailed analysis of treatment efficacy at 6 weeks and 1 year in this population has been previously reported (Crespo-Facorro et al 2006, 2011.…”

Section: Secondary Outcome Measures: Efficacy and Safetymentioning

confidence: 99%

Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis

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“…Studies focused on the correlation of atypical antipsychotics with weight gain and insulin resistance have shown that occasionally there is no significant difference among the atypical antipsychotics and that Olanzapine and Clozapine have more involvement with weight gain and the disruption of glucose regulation [31][32][33][34] than other drugs. Crespo-Facorro et al determined that, although there is no difference in efficacy and tolerability, Olanzapine causes more weight gain compared to Risperidone [35], and Van Winkel et al have drawn attention to the fact that Clozapine carried the highest risk of changing plasma glucose levels among schizophrenia and schizoaffective disorder patients using Risperidone, Aripiprazole or Clozapine [36]. Newcomer et al found clinically significant weight loss, a marked drop in TG and total cholesterol levels and a marked increase in HDL levels in obese patients who had been using Olanzapine, after 16 th week of switching to Aripipirazole [37].…”

Section: Discussionmentioning

confidence: 99%

The Effects of Atypical Antipsychotic Usage Duration on Serum Adiponectin Levels and Other Metabolic Parameters

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Objective: Although atypical antipsychotics are well-tolerated and eff ective treatment options for schizophrenia, they have metabolic side eff ects, including weight gain and increased risk of Type II Diabetes Mellitus (DM). Adiponectin, produced exclusively in adipocytes, is the most abundant serum adipokine. Low levels of adiponectin are correlated with DM, insulin resistance and coronary heart disease. Usage of atypical antipsychotics may create a risk of metabolic syndrome. The aim of this study was to evaluate the eff ects of antipsychotic usage on parameters related to development of metabolic syndrome. Materials and Methods:A total of 27 patients (n=27) (13 women and 14 men) were recruited from our out-patient psychiatry clinic. All patients had been treated with atypical antipsychotics for at least 3 months and were in remission. Patients were evaluated for levels of HDL (High Density Lipoprotein), LDL (Low Density Lipoprotein ), TG (Triglyceride) total cholesterol and fasting blood glucose, body weight, BMI (Body Mass Index), waist circumference and serum adiponectin levels.Results: Serum adiponectin levels were signifi cantly lower (p:0.000) and body weights were signifi cantly higher (p:0.003) in the patients who had been using atypical antipsychotics for longer than a year in comparison to patients who had been using atypical antipsychotics for one year or less. Conclusion:Our fi ndings supported the hypothesis that the length of administration of atypical antipsychotics has an eff ect on metabolic changes. They also highlight the fact that when investigating metabolic changes generated by atypical antipsychotic eff ects, the length of time that the patient has been on the atypical antipsychotics should also be considered.

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“…These definitions were used in three studies that assessed haloperidol over six or 12 weeks (Crespo-Facorro et al, 2006;Lieberman et al, 2003b;Sanger et al, 1999). In all three studies the incidence of parkinsonism and akathisia in haloperidol-treated patients was approximately 50% over six to 12 weeks, which was approximately double or greater than the rate seen with the SGA comparator(s) with the differences being statistically significant (Table 2).…”

Section: Eps Rating Scale Outcomesmentioning

confidence: 99%

“…An analysis of the last observed value on a rating scale will ignore the impact of treatment and may obscure differences between antipsychotics. E m s le y e t a l ( 1 9 9 9 ) * S a n g e r e t a l ( 1 9 9 9 ) * L ie b e r m a n e t a l ( 2 0 0 3 b ) * G r e e n e t a l ( Lieberman et al (2003b) and Green et al (2006) are analyses at different time points from a single trial, as are Crespo-Facorro et al (2006. Möller et al (2008) is one of two publications from the GRSN trial; the second publication (Gaebel et al, 2007) assessed a longer time period, did not provide anticholinergic prescribing rates but reported that the difference between drugs was non-significant.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Antipsychotic drugs and extrapyramidal side effects in first episode psychosis: a systematic review of head–head comparisons

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This systematic review aimed to determine whether the risk of extrapyramidal side effects (EPS) differed between antipsychotic drugs used in first episode psychosis (FEP). We identified 11 RCTs comparing two or more antipsychotics in FEP and reporting on EPS. All trials assessed one or more second generation antipsychotics (SGAs), one assessed chlorpromazine, one zuclopenthixol and seven trials assessed haloperidol. Assessment and reporting of EPS varied. Compared with one or more SGA comparators, haloperidol was associated with significantly higher rates/severity of parkinsonism (seven trials) and akathisia (six trials) and greater use of anticholinergics (five trials) and beta-blockers (two trials). Two trials with low-dose haloperidol (≤ 4 mg) showed significantly worse EPS outcomes versus a SGA. Two of four long-term haloperidol trials (≥ 1 year) found a higher dyskinesia-risk with haloperidol versus olanzapine and risperidone respectively; the remaining two trials found no difference (various SGA comparators). There was an EPS advantage for clozapine versus chlorpromazine (one trial) and risperidone versus zuclopenthixol (one trial). There was little evidence of EPS-differences between SGAs, possibly reflecting use of low doses. We conclude that SGAs offer an EPS advantage over FGAs in FEP though the evidence largely relates to comparisons with haloperidol. Standardized assessment and reporting of EPS would assist future research. Keywords Method Search strategyWe conducted a PubMed search, with no starting date limit, up to April 2011 using terms 'first episode schizophrenia' and 'antipsychotic' with limits specified as 'Humans, Randomized Controlled Trial and English'. The abstracts of all papers were reviewed to determine whether they met inclusion/exclusion criteria and if there was doubt the full paper was examined. Additional studies, identified through the reference list of papers in the primary search or known to the authors, were reviewed to see if they met inclusion/exclusion criteria. Inclusion criteria1. RCT comparing two or more antipsychotic drugs. 2. Diagnosis of schizophrenia plus related disorders including schizophreniform disorder and schizoaffective disorder made according to standard criteria (any). 3. Patients explicitly described as 'first episode' by the authors. Although we did not define this further we recorded key criteria that the researchers employed to define this population, e.g. maximum age, maximum duration of illness and maximum cumulative antipsychotic treatment length. 4. EPS assessed using a standard rating scale. 5. Quantitative data on incidence or severity of EPS provided. 6. Paper published in English. Exclusion criteria1. Studies of a single antipsychotic. 2. Non-randomized studies. 3. Studies of early onset schizophrenia (i.e. samples largely composed of subjects < 18 years old). AnalysisKey data from the studies that met the inclusion/exclusion criteria were extracted. This included EPS ratings for parkinsonism, akathisia, dyskinesia and dystonia made us...

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A Practical Clinical Trial Comparing Haloperidol, Risperidone, and Olanzapine for the Acute Treatment of First-Episode Nonaffective Psychosis

Cited by 142 publications

References 0 publications

Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis

Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis

The Effects of Atypical Antipsychotic Usage Duration on Serum Adiponectin Levels and Other Metabolic Parameters

Antipsychotic drugs and extrapyramidal side effects in first episode psychosis: a systematic review of head–head comparisons

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