Effectiveness of Antipsychotic Treatments for Schizophrenia

Dossenbach, M.; Erol, Almıla; Kessaci, Mohand el Mahfoud; Shaheen, Mostafa; Sunbol, Mohammed M.; Boland, J.; Hodge, Andrew; O'Halloran, R.A.; Bitter, István

doi:10.4088/jcp.v65n0305

Cited by 74 publications

(6 citation statements)

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“…While there is research supporting the benefits of switching when warranted [22-24], others have challenged this notion [25]. The CATIE study has given rise to multiple efforts to provide guidance on medication switching [26-29].…”

Section: Discussionmentioning

confidence: 99%

Construct validity of 2 measures to assess reasons for antipsychotic discontinuation and continuation from patients’ and clinicians’ perspectives in a clinical trial

Faries

Ascher-Svanum

Phillips

et al. 2012

BMC Med Res Methodol

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BackgroundLittle is known about the specific reasons for antipsychotic discontinuation or continuation from patients’ or clinicians’ perspectives. This study aimed to assess the construct validity of 2 new measures of the Reasons for Antipsychotic Discontinuation/Continuation (RAD): RAD-I (a structured interview assessing the patient’s perspective) and RAD-Q (a questionnaire assessing the clinician’s perspective).MethodsData were used from a 12-week antipsychotic trial of schizophrenia patients in which the RAD was administered at study entry and at study completion (or discontinuation). Construct validity was assessed through comparisons of RAD responses, clinicians’ responses to a standard patient disposition form identifying reasons for patient’s study discontinuation, and several standard psychiatric measures. Percent agreement quantified the correspondence between patient and clinician scores.ResultsPatients indicating lack of improvement/worsening of positive symptoms as a ‘somewhat’ to ‘primary’ reason for medication discontinuation had statistically significantly less improvement in Positive and Negative Syndrome Scale positive score than patients not reporting these as a reason (concurrent validity). Similar results were observed for the RAD negative symptom, functional, social support, and adherence items, whereas the mood and cognitive items were not significantly associated with change scores on standard psychiatric measures. Responses to the RAD were also weakly associated with variables that theoretically should not be related to them (divergent validity). Level of agreement between the clinician- and patient-rated RAD scores was high (60%-100%).ConclusionsInitial validation of the RAD suggests that the instruments are valid tools for gathering detailed information regarding reasons for antipsychotic discontinuation and continuation from patients’ and clinicians’ perspectives.

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Section: Discussionmentioning

confidence: 99%

Construct validity of 2 measures to assess reasons for antipsychotic discontinuation and continuation from patients’ and clinicians’ perspectives in a clinical trial

Faries

Ascher-Svanum

Phillips

et al. 2012

BMC Med Res Methodol

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“…In meta-analytical studies of antipsychotic therapy for schizophrenia, which incorporated data from numerous randomized clinical trials, olanzapine was found to confer greater efficacy compared to haloperidol [17] risperidone and ziprasidone [18]. Furthermore, patients treated with olanzapine were consistently found to stay longer on treatment compared to those treated with haloperidol [23,31,44-49], risperidone [21,23,24,28,48-56] and ziprasidone [21,27,57-59]. Thus, antipsychotic treatment choice may influence patients' improvement in symptom severity, their treatment duration and their functional outcomes as measured, in this study, by productivity levels.…”

Section: Discussionmentioning

confidence: 99%

Change in level of productivity in the treatment of schizophrenia with olanzapine or other antipsychotics

et al. 2011

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BackgroundWhen treating schizophrenia, improving patients' productivity level is a major goal considering schizophrenia is a leading cause of functional disability. Productivity level has been identified as the most preferred treatment outcome by patients with schizophrenia. However, little has been done to systematically investigate productivity levels in schizophrenia. We set out to better understand the change in productivity level among chronically ill patients with schizophrenia treated with olanzapine compared with other antipsychotic medications. We also assessed the links between productivity level and other clinical outcomes.MethodsThis post hoc analysis used data from 6 randomized, double-blind clinical trials of patients with schizophrenia or schizoaffective disorder, with each trial being of approximately 6 months duration. Change in productivity level was compared between olanzapine-treated patients (HGBG, n = 172; HGHJ, n = 277; HGJB, n = 171; HGLB, n = 281; HGGN, n = 159; HGDH, n = 131) and patients treated with other antipsychotic medications (separately vs. haloperidol [HGGN, n = 97; HGDH, n = 132], risperidone [HGBG, n = 167; HGGN, n = 158], quetiapine [HGJB, n = 175], ziprasidone [HGHJ, n = 271] and aripiprazole [HGLB, n = 285]). Productivity was defined as functional activities/work including working for pay, studying, housekeeping and volunteer work. Productivity level in the prior 3 months was assessed on a 5-point scale ranging from no useful functioning to functional activity/work 75% to 100% of the time.ResultsChronically ill patients treated with olanzapine (OLZ) experienced significantly greater improvement in productivity when compared to patients treated with risperidone (RISP) (OLZ = 0.22 ± 1.19, RISP = -0.03 ± 1.17, p = 0.033) or ziprasidone (ZIP) (OLZ = 0.50 ± 1.38, ZIP = 0.25 ± 1.27, p = 0.026), but did not significantly differ from the quetiapine, aripiprazole or haloperidol treatment groups. Among first episode patients, OLZ therapy was associated with greater improvements in productivity levels compared to haloperidol (HAL), during the acute phase (OLZ = -0.31 ± 1.59, HAL = -0.69 ± 1.56, p = 0.011) and over the long-term (OLZ = 0.10 ± 1.50, HAL = -0.32 ± 1.91, p = 0.008). Significantly more chronically ill and first episode patients treated with olanzapine showed moderately high (>50%-75% of the time) and high levels of productivity (>75%-100% of the time) at endpoint, when compared to risperidone or haloperidol-treated patients (p < .05), respectively. Higher productivity level was associated with significantly higher study completion rates and better scores on the positive, negative, disorganized thoughts, hostility and depression subscales of the Positive and Negative Symptom Scale (PANSS).ConclusionsSome antipsychotic medications significantly differed in beneficial impact on productivity level in the long-term treatment of patients with schizophrenia. Findings further highlight the link between clinical and functional outcomes, showing significant associations between high...

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“…There are few, but notable examples of cross-national observational studies of comparable scale including the W-SOHO (Worldwide-Schizophrenia Outpatient Health Outcome) study, which pooled data from the SOHO (Schizophrenia Outpatient Health Outcome) observational study in 10 Western European countries and the IC-SOHO (Inter-Continental SOHO) study in 27 other countries [1,12,13]; the METEOR study in 16 European countries [14]; and the randomized SCoP safety trial on schizophrenia subjects across Europe and Asia [15]. However, due to the paucity of published data summarizing cross-national information on comorbidities and risk factors prevalent in schizophrenia subjects, we highlight key country and region-specific comparisons from other schizophrenia trial populations whenever available.…”

Section: Discussionmentioning

confidence: 99%

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

Kane¹,

Fleischhacker²,

Kolitsopoulos³

et al. 2012

OJPsych

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Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in different clinical settings across 18 countries. ZODIAC was a randomized, open-label, one-year, large simple trial (LST) that enrolled 18,239 individuals with schizophrenia. Methods: Subjects were randomized to open-label treatment with ziprasidone (n = 9120) or olanzapine (n = 9119) in naturalistic (usual care) settings and followed for one year. Study sites (n = 749) applied minimal selection criteria in an attempt to make the study population as representative as possible of those receiving treatment in "real world" circumstances across the countries. Results: Mean patient age was 41 years, 55% were male, 34% were markedly ill or presented with more severe disease, and 66% of subjects had one or more select comorbid conditions [i.e. heart attack, stroke, hypertension, CAD/angina, high cholesterol/triglycerides, diabetes, or overweight (BMI ≥ 25)] at baseline. History of suicide attempt was greatest in the US (38%), compared with Sweden (34%), Brazil/South America (26%), Asia (23%), and Eastern Europe (20%). Overweight or obesity was the most prevalent comorbid risk factor, representing 60% of enrolled subjects, 70% of US subjects compared with 30% in Asia and 52% -64% in the other regions studied. High cholesterol/triglycerides levels were found in 23% of US subjects compared with a relatively low prevalence in other countries (3% -11%). History of cardiovascular or diabetes-related comorbidities was found in 31% of subjects. Current smoking (46.5%) and past smoking (11.8%) were common with men dominating the proportion of current smokers: US (61%); Asia (60%); Sweden (50%); Eastern Europe (49%); and Latin America (44%). Conclusions: Our findings indicate substantial baseline variations across countries in demographics, comorbid conditions, and psychiatric disease history. These data provide an international epidemiologic picture of schizophrenia and may help guide future research and treatment initiatives.

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Effectiveness of Antipsychotic Treatments for Schizophrenia

Cited by 74 publications

References 0 publications

Construct validity of 2 measures to assess reasons for antipsychotic discontinuation and continuation from patients’ and clinicians’ perspectives in a clinical trial

Construct validity of 2 measures to assess reasons for antipsychotic discontinuation and continuation from patients’ and clinicians’ perspectives in a clinical trial

Change in level of productivity in the treatment of schizophrenia with olanzapine or other antipsychotics

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

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