Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: Observational versus randomized studies results

Haro, Josep María; Suarez, David L.; Novick, Diego; Brown, Jacqueline; Usall, Judith; Naber, Dieter

doi:10.1016/j.euroneuro.2006.09.005

Cited by 117 publications

(113 citation statements)

References 28 publications

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“…The consistency of the current findings with previous research supports the modesty of benefits from an initial antipsychotic drug trial to most patients, suggesting the need to find alternative treatments. This is well supported by data from large trials showing that patients show a high rate of treatment discontinuation, and switching medications is common (Falkai, 2008;Haro et al, 2007;Lieberman et al, 2005).…”

Section: Discussionsupporting

confidence: 53%

Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Response in the Treatment of Schizophrenia

Kinon

Chen

Ascher-Svanum

et al. 2009

Neuropsychopharmacol

165

168

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Our objective was to prospectively assess whether early (ie, 2 weeks) response to an antipsychotic predicts later (12-week) response and whether 'switching' early non-responders to another antipsychotic is a better strategy than 'staying'. This randomized, double-blind, flexible-dosed, 12-week study enrolled 628 patients diagnosed with schizophrenia or schizoaffective disorder. All initiated treatment with risperidone. Early response was defined as X20% improvement on the Positive and Negative Syndrome Scale (PANSS) total score following 2 weeks of treatment. Early responders (ERs) continued on risperidone, whereas early non-responders (ENRs) were randomized (1 : 1) to continue on risperidone 2-6 mg/day or switch to olanzapine 10-20 mg/day for 10 additional weeks. Compared with ENRs, risperidone ERs showed significantly greater reduction in PANSS total score (end point; po001). Early response/nonresponse was highly predictive of subsequent clinical outcomes. Switching risperidone ENRs to olanzapine at week 2 resulted in a small but significantly greater reduction in PANSS total score (end point; p ¼ 0.020) and in depressive symptoms (end point; p ¼ 0.004); the reduction in PANSS was greater among those who were still moderately ill at 2 weeks. Switching risperidone ENRs to olanzapine also resulted in significantly greater increases in triglycerides, a significantly greater decrease in prolactin, and significantly less treatmentemergent dyskinesia. This is the first study to prospectively show that early response/non-response to an antipsychotic (risperidone) is a reliable clinical marker of subsequent clinical outcomes and that a 'switching' strategy based on this information may lead to greater clinical improvement than staying on a drug for a longer period in some patients.

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Section: Discussionsupporting

confidence: 53%

Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Response in the Treatment of Schizophrenia

Kinon

Chen

Ascher-Svanum

et al. 2009

Neuropsychopharmacol

165

168

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show abstract

“…Contudo, para além de sua implícita contribuição para a efetividade das práticas em saúde coletiva, ao avaliar uma "situação de vida real" 28,29 , os resultados aqui apresentados reforçam a viabilidade da utilização de instrumentos estatísticos aliados ao raciocínio clínico na abordagem de fenô-menos tipológicos.…”

Section: Limitaçõesunclassified

Aplicabilidade da classificação de alcoolismo tipo A/tipo B

Ribeiro

Souza

et al. 2009

J. bras. psiquiatr.

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“…It should also be noticed that these results, besides being useful to the discussion of the effectiveness of health practices -once evaluating a "real life" situation 34,35 -, strengthens the usefulness of using statistical instruments grounded on clinical reasoning when tackling the typological pheno mena 9,20,29 . In conclusion, we should stress that this approximate replication study identified two distinct clusters that held similar features to those described for the Type A/Type B classification.…”

Section: Discussionmentioning

confidence: 99%

A possible contribution to improving the therapeutic potentials of Babor's Typology of Alcohol Dependent Patients

Ribeiro

Ferreira

2015

J. bras. psiquiatr.

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Objective: The objective of this study was to replicate Babor's Typology and to explore clinical features related to personality traits that may underlie this classification, in order to improve its therapeutic possibilities. Methods: Observational prospective study on a group of 273 male alcoholics. After a replication of Babor's variables, Cluster Analysis, Chi-Square -applied on clinical variables related to a Lappda Tipology -and Kappa tests were performed. Results: The study identified two distinct clusters that held similar features to those described for the Type A/Type B classification. Besides presenting a lower socio-economic situation, Cluster 2 patients were associated with higher vulnerability and severe clinical features and also differed from Cluster 1 in their response to treatment. These replicated clusters retained connections and also differences in relation to the variables derived from the Lappda Typology. Conclusion: Considering that each of the two replicated clusters seem to be associated to different personality traits -according to their correlations to the affective, cognitive and behavioral dimensions brought forward by the Lappda Typology -it is acceptable that this study may contribute to the development of more comprehensive and effective therapeutic strategies specifically tailored to target more specific personality traits of these subgroups of alcoholic patients. REsuMOObjetivo: O objetivo deste estudo foi replicar a tipologia do Babor e explorar características clínicas relacionadas a traços de personalidade que podem estar subjacentes a essa classificação, a fim de melhorar suas possibilidades terapêuticas. Métodos: Estudo observacional prospectivo em um grupo de 273 alcoolistas masculinos. Depois de uma replicação das variáveis de Babor, foram realizados Análise de Cluster, testes de Qui-quadrado -aplicados em variáveis clínicas relacionadas com uma tipologia desenvolvida pelo Lappda -e testes Kappa. Resultados: O estudo identificou dois clusters distintos que mantiveram características semelhantes àquelas descritas na classificação Tipo A/Tipo B. Além de apresentar uma pior situação socioeconômica, os pacientes do Cluster 1 foram associados a maior vulnerabilidade e a características clínicas de maior gravidade; e também diferiram do Cluster 2 em sua res-

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Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: Observational versus randomized studies results

Cited by 117 publications

References 28 publications

Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Response in the Treatment of Schizophrenia

Early Response to Antipsychotic Drug Therapy as a Clinical Marker of Subsequent Response in the Treatment of Schizophrenia

Aplicabilidade da classificação de alcoolismo tipo A/tipo B

A possible contribution to improving the therapeutic potentials of Babor's Typology of Alcohol Dependent Patients

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