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Heres S, Cordes J, Feyerabend S, Schmidt-Kraepelin C, Musil R, Riedel M, Spellmann I, Langguth B, Landgrebe M, Fran E, Petcu C C, Hahn E, Ta TMT, Matei V, Dehelean L, Papava I, Leweke FM, van der List T, Tamasan SC, Lang FU, Naber D, Ruhrmann S, Wolff-Menzler C, Juckel G, Ladea M, Stefanescu C, Lautenschlager M, Bauer M, Zamora D, Horowitz M, Davis JM, Leucht S. Changing the Antipsychotic in Early Nonimprovers to Amisulpride or Olanzapine: Randomized, Double-Blind Trial in Patients With Schizophrenia. Schizophr Bull 2022; 48:1273-1283. [PMID: 35857811 PMCID: PMC9673269 DOI: 10.1093/schbul/sbac068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Meta-analyses have shown that the majority of patients with schizophrenia who have not improved after 2 weeks of treatment with an antipsychotic drug are unlikely to fully respond later. We hypothesized that switching to another antipsychotic with a different receptor binding profile is an effective strategy in such a situation. STUDY DESIGN In total, 327 inpatients with an acute exacerbation of schizophrenia were randomized to double-blind treatment with either olanzapine (5-20 mg/day) or amisulpride (200-800 mg/day). Those patients who had not reached at least 25% Positive-and-Negative-Syndrome-Scale (PANSS) total score reduction from baseline after 2 weeks (the "non-improvers") were rerandomized double-blind to either staying on the same compound ("stayers") or to switching to the other antipsychotic ("switchers") for another 6 weeks. The primary outcome was the difference in the number of patients in symptomatic remission between the combined "switchers" and the "stayers" after 8 weeks of treatment, analyzed by logistic regression. STUDY RESULTS A total of 142 nonimprovers were rerandomized at week two. 25 (45.5 %) of the 'stayers' compared to 41 (68.3 %) of the "switchers" reached remission at endpoint (p = .006). Differences in secondary efficacy outcomes were not significant, except for the PANSS negative subscore and the Clinical-Global-Impression-Scale. "Switchers" and "stayers" did not differ in safety outcomes. CONCLUSIONS Switching "non-improvers" from amisulpride to olanzapine or vice-versa increased remission rates and was safe. The superiority in the primary outcome was, however, not paralleled by significant differences in most secondary efficacy outcomes and the effect was only apparent at the last visit making replications of longer duration necessary.
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Affiliation(s)
- Stephan Heres
- To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine Kbo-Klinik für Psychiatrie und Psychotherapie Nord, Schwabing, kbo-Tagesklinik und Institutsambulanz Nord des Isar-Amper-Klinikums München Ost Kölner Platz 1, Haus 7 80804 Munich, Germany, tel: 49 (0) 89 412 006 158, fax: 49 (0) 89 412 006 172, e-mail:
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Sandra Feyerabend
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Christian Schmidt-Kraepelin
- Department of Psychiatry and Psychotherapy, LVR-Clinic Düsseldorf, Medical Faculty, Heinrich-Heine-University, Duesseldorf NW, Germany,Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Florence Nightingale Hospital, Düsseldorf NW, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Marion von Tessin Memory-Zentrum GmbH, Munich BY, Germany
| | - Ilja Spellmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany,Klinikum Stuttgart, Zentrum für Seelische Gesundheit, Stuttgart BW, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany,Department of Psychiatry and Psychotherapy, kbo Lech-Mangfall-Hospital Agatharied, St.-Agatha-Str. 1a, 83734 Hausham BY, Germany
| | - Elmar Fran
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg BY, Germany
| | - Camelia Petcu C
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Tam M T Ta
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Valentin Matei
- Psychiatry Department, University of Medicine and Pharmacy ”Carol Davila” Bucharest, ”Prof. Dr. Alexandru Obregia” Psychiatric Hospital, Berceni Str 10-12, Bucharest, Romania
| | - Liana Dehelean
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Translational Research, and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Center for Studies in Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - Ion Papava
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania,Centre for Cognitive Research in Neuropsychiatric Pathology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara TS, Romania
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, 94 Mallet St, Camperdown NSW 2050, Sydney, Australia,Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany
| | - Till van der List
- Central Institute of Mental Health, Heidelberg University I5, 68159 Mannheim BW, Germany,Practise for Psychiatry and Psychotherapie Nowackanlage 15, 76137 Karlsruhe BW, Germany
| | - Simona C Tamasan
- Liaison Psychiatry, “Pius Branzeu” County Emergency Hospital, Timisoara TS, Romania
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Ulm BW, Germany
| | - Dieter Naber
- Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne NW, Germany
| | - Claus Wolff-Menzler
- Klinik für Psychiatrie und Psychotherapie Universitätsmedizin Göttingen, Göttingen, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Psychotherapy and Preventive Medicine Ruhr University, Bochum, Germany
| | - Maria Ladea
- DMU IMPACT (Departement Medico-Universitaire de Psychiatrie et d'Addictologie) Groupe Hospitalier Henri MONDOR, Créteil, France
| | | | - Marion Lautenschlager
- ZfP Südwürttemberg, Bad Schussenried, Germany,Charité University Medicine, Campus Mitte, Berlin BE, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Daisy Zamora
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany,Department of Psychiatry, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, USA
| | - Mark Horowitz
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - John M Davis
- Department of Psychiatry, University of Illinois, Chicago, IL, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
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Leucht S, Winter-van Rossum I, Heres S, Arango C, Fleischhacker WW, Glenthøj B, Leboyer M, Leweke FM, Lewis S, McGuire P, Meyer-Lindenberg A, Rujescu D, Kapur S, Kahn RS, Sommer IE. The optimization of treatment and management of schizophrenia in Europe (OPTiMiSE) trial: rationale for its methodology and a review of the effectiveness of switching antipsychotics. Schizophr Bull 2015; 41:549-58. [PMID: 25786408 PMCID: PMC4393704 DOI: 10.1093/schbul/sbv019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Most of the 13 542 trials contained in the Cochrane Schizophrenia Group's register just tested the general efficacy of pharmacological or psychosocial interventions. Studies on the subsequent treatment steps, which are essential to guide clinicians, are largely missing. This knowledge gap leaves important questions unanswered. For example, when a first antipsychotic failed, is switching to another drug effective? And when should we use clozapine? The aim of this article is to review the efficacy of switching antipsychotics in case of nonresponse. We also present the European Commission sponsored "Optimization of Treatment and Management of Schizophrenia in Europe" (OPTiMiSE) trial which aims to provide a treatment algorithm for patients with a first episode of schizophrenia. METHODS We searched Pubmed (October 29, 2014) for randomized controlled trials (RCTs) that examined switching the drug in nonresponders to another antipsychotic. We described important methodological choices of the OPTiMiSE trial. RESULTS We found 10 RCTs on switching antipsychotic drugs. No trial was conclusive and none was concerned with first-episode schizophrenia. In OPTiMiSE, 500 first episode patients are treated with amisulpride for 4 weeks, followed by a 6-week double-blind RCT comparing continuation of amisulpride with switching to olanzapine and ultimately a 12-week clozapine treatment in nonremitters. A subsequent 1-year RCT validates psychosocial interventions to enhance adherence. DISCUSSION Current literature fails to provide basic guidance for the pharmacological treatment of schizophrenia. The OPTiMiSE trial is expected to provide a basis for clinical guidelines to treat patients with a first episode of schizophrenia.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, München, Germany;
| | | | - Stephan Heres
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, München, Germany
| | - Celso Arango
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - W. Wolfgang Fleischhacker
- Biological Psychiatry Division, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - Birte Glenthøj
- Center for Neuropsychiatric Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Hospital Center Glostrup, Glostrup, Denmark
| | - Marion Leboyer
- INSERM U955, Translational Psychiatry Team, Créteil, France, Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France, Fondation FondaMental
| | - F. Markus Leweke
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Shôn Lewis
- University of Manchester, Manchester, UK
| | - Phillip McGuire
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatics Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Shitij Kapur
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, London, UK
| | - René S. Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Iris E. Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht, The Netherlands
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3
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Tardy M, Huhn M, Kissling W, Engel RR, Leucht S. Haloperidol versus low-potency first-generation antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2014; 2014:CD009268. [PMID: 25007358 PMCID: PMC10898321 DOI: 10.1002/14651858.cd009268.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Antipsychotic drugs are the core treatment for schizophrenia. Treatment guidelines state that there is no difference in efficacy between antipsychotic compounds, however, low-potency antipsychotic drugs are often clinically perceived as less efficacious than high-potency compounds, and they also seem to differ in their side-effects. OBJECTIVES To review the effects in clinical response of haloperidol and low-potency antipsychotics for people with schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (July 2010). SELECTION CRITERIA We included all randomised trials comparing haloperidol with first-generation low-potency antipsychotic drugs for people with schizophrenia or schizophrenia-like psychosis. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data, we calculated risk ratios (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD), again based on a random-effects model. MAIN RESULTS The review currently includes 17 randomised trials and 877 participants. The size of the included studies was between 16 and 109 participants. All studies were short-term with a study length between two and 12 weeks. Overall, sequence generation, allocation procedures and blinding were poorly reported. We found no clear evidence that haloperidol was superior to low-potency antipsychotic drugs in terms of clinical response (haloperidol 40%, low-potency drug 36%, 14 RCTs, n = 574, RR 1.11, CI 0.86 to 1.44 lowquality evidence). There was also no clear evidence of benefit for either group in acceptability of treatment with equivocal difference in the number of participants leaving the studies early due to any reason (haloperidol 13%, low-potency antipsychotics 17%, 11 RCTs, n = 408, RR 0.82, CI 0.38 to 1.77, low quality evidence). Similar equivocal results were found between groups for experiencing at least one adverse effect (haloperidol 70%, low-potency antipsychotics 35%, 5 RCTs n = 158, RR 1.97, CI 0.69 to 5.66, very low quality evidence ). More participants from the low-potency drug group experienced sedation (haloperidol 14%, low-potency antipsychotics 41%, 2 RCTs, n = 44, RR 0.30, CI 0.11 to 0.82, moderate quality evidence), orthostasis problems (haloperidol 25%, low-potency antipsychotics 71%, 1 RCT, n = 41, RR 0.35, CI 0.16 to 0.78) and weight gain (haloperidol 5%, low-potency antipsychotics 29%, 3 RCTs, n = 88, RR 0.22, CI 0.06 to 0.81). In contrast, the outcome 'at least one movement disorder' was more frequent in the haloperidol group (haloperidol 72%, low-potency antipsychotics 41%, 5 RCTs, n = 170, RR 1.64, CI 1.22 to 2.21, low quality evidence). No data were available for death or quality of life. The results of the primary outcome were robust in several subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS The results do not clearly show a superiority in efficacy of haloperidol compared with low-potency antipsychotics. Differences in adverse events were found for movement disorders, which were more frequent in the haloperidol group, and orthostatic problems, sedation and weight gain, which were more frequent in the low-potency antipsychotic group. The quality of studies was low, and the quality of evidence for the main outcomes of interest varied from moderate to very low, so more newer studies would be needed in order to draw a definite conclusion about whether or not haloperidol is superior or inferior to low-potency antipsychotics.
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Affiliation(s)
- Magdolna Tardy
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Maximilian Huhn
- Universitätsklinikum der Technischen Universität MünchenKlinik und Poliklinik für Psychiatrie und PsychotherapieKlinikum rechts der IsarMünchenBavariaGermany81675
| | - Werner Kissling
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieMöhlstr. 26MünchenGermany81675
| | - Rolf R Engel
- Ludwig‐Maximilians‐University MunichPsychiatric HospitalNussbaumstr. 7MuenchenGermany80336
| | - Stefan Leucht
- Technische Universität MünchenDepartment of Psychiatry and PsychotherapyIsmaningerstrasse 22MünchenGermany81675
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Abstract
BACKGROUND Perazine is an old phenothiazine derivative used for the treatment of people with schizophrenia and is reputed to have a low level of extrapyramidal adverse effects. As far as we are aware, its use is limited to Germany, Poland, the former Yugoslavia and the Netherlands. OBJECTIVES To examine the effects of perazine for those with schizophrenia or related psychoses in comparison with placebo, no treatment or other antipsychotic medications. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register, which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile. We searched the references of all included studies for further trials. We contacted pharmaceutical companies and authors of trials. We updated this search on 16th July 2012. SELECTION CRITERIA We selected all randomised controlled trials that compared perazine with other treatments for people with schizophrenia or schizophrenia-like psychoses, or both. DATA COLLECTION AND ANALYSIS The review authors (SL, BH, BHe) independently inspected the citations and where possible abstracts and ordered papers for re-inspection and quality assessment. We independently extracted data. We calculated the risk ratio (RR) and 95% confidence interval (CI) using a random-effects model. For continuous data, we calculated mean differences (MD). We inspected all data for heterogeneity, assessed trials for risk of bias and created summary of findings tables using GRADE. MAIN RESULTS The review now includes seven trials with a total of 479 participants. In only one trial, with 95 participants, perazine appeared superior to 'active placebo' (trimipramine) at five weeks for the outcome of 'no important global improvement' (n = 95, RR 0.43 CI 0.2 to 0.8, low quality evidence), but there was no statistically significant difference in most measures of mental state. Perazine did not induce more general adverse events than placebo but more participants received at least one dose of antiparkinson medication (n = 95, RR 4.50 CI 1.0 to 19.5, very low quality evidence).Six small trials comparing perazine with other antipsychotics, including 384 participants in total, were incompletely reported and the outcomes were presented in various ways so that meta-analysis was not possible on most occasions. In the six studies, a similar number of participants receiving perazine or comparator antipsychotics (amisulpride, haloperidol, olanzapine, ziprasidone, zotepine) left the studies early (n = 384, RR 0.97 CI 0.68 to 1.38, low quality evidence). The results on efficacy could not be meta-analysed because the authors presented their results in very different ways. No obvious differences in adverse events between perazine and other antipsychotics could be derived from the limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a way that was suitable for use in meta-analysis, but three small comparisons with the second-generation antipsychotics zotepine and amisulpride showed no higher risk of akathisia (n = 111, RR 0.31 CI 0.1 to 1.1), dyskinesia (n = 111, RR 0.47 CI 0.1 to 3.5), parkinsonism (n = 81, RR 1.21 CI 0.5 2.8) or tremor (n = 40, RR 0.80 CI 0.3 to 2.6) with perazine. AUTHORS' CONCLUSIONS The number, size and reporting of randomised controlled perazine trials are insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics but this is based on small comparisons. This should be clarified in larger, well-designed trials.
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Affiliation(s)
- Stefan Leucht
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaningerstrasse 22MünchenGermany81675
| | - Bartosz Helfer
- Technische Universität München Klinikum rechts der IsarKlinik und Poliklinik für Psychiatrie und PsychotherapieIsmaningerstrasse 22MünchenGermany81675
| | - Benno Hartung
- University Hospital DuesseldorfInstitute for Legal MedicineMoorenstr. 5DuesseldorfGermany40225
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Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Thibaut F, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry 2012; 13:318-78. [PMID: 22834451 DOI: 10.3109/15622975.2012.696143] [Citation(s) in RCA: 396] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F; Bandelow et al. 2008b, World J Biol Psychiatry 9:242). This first part of the updated guidelines covers the general descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.
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Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University of Goettingen, Goettingen, Germany.
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Storch EA, Larson MJ, Shapira NA, Ward HE, Murphy TK, Geffken GR, Valerio H, Goodman WK. Clinical predictors of early fluoxetine treatment response in obsessive-compulsive disorder. Depress Anxiety 2007; 23:429-33. [PMID: 16841343 DOI: 10.1002/da.20197] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Despite wide use, relatively little is known about sociodemographic and clinical characteristics that predict early fluoxetine response. What research has been conducted has produced inconsistent findings, which may be due to the statistical procedures used, and no studies to date have examined predictors of early fluoxetine treatment response. Sixty adults with obsessive-compulsive disorder (OCD) completed an open-label fluoxetine trial for 8 weeks (up to 40 mg) after a 1-week, single-blind, placebo run-in before baseline assessment. The baseline and posttreatment assessment battery included the Yale-Brown Obsessive Compulsive Scale, the Hamilton Rating Scale for Depression, and the Yale Global Tic Severity Scale. Patient characteristics included illness duration, age, age of onset, gender, and pharmacological treatment history. Independent t-tests and multiple logistic regression analysis showed that longer illness duration, older age, and greater symptom severity were associated with nonresponse. Our findings highlight the impact of functional psychiatric impairment on determining those who may respond to treatment. Furthermore, findings suggest early predictors of patients with certain characteristics who may ultimately need adjunctive care to facilitate response.
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Affiliation(s)
- Eric A Storch
- Department of Psychiatry, University of Florida, Gainesville, Florida 32610, USA.
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Abstract
BACKGROUND Perazine is an old phenothiazine derivative used for the treatment of people with schizophrenia and is reputed to have a low level of extrapyramidal adverse effects. As far as we are aware, its use is limited to Germany, Poland, the former Yugoslavia and the Netherlands. OBJECTIVES To examine the effects of perazine for those with schizophrenia, and schizophrenia-like psychoses. SEARCH STRATEGY We searched the Cochrane Schizophrenia Group's register which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile (last update of the review March 2005). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of trials. SELECTION CRITERIA We selected all randomised controlled trials that compared perazine with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS We independently (SL, BH) inspected citations and where possible abstracts and ordered papers for re-inspection and quality assessment. We independently extracted data. We excluded data if loss to follow up was greater than 50%. For homogeneous dichotomous data we calculated the Relative Risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). We inspected all data for heterogeneity. MAIN RESULTS We included six trials with a total of 288 participants. In only one trial with 95 participants, perazine appeared superior to 'active placebo' (trimipramine) at five weeks for the outcome of 'no important global improvement' (n=95, RR 0.43 CI 0.2 to 0.8, NNT 4 CI 2 to 13), but there was no statistically significant difference in most measures of mental state. Perazine did not induce more general adverse events than placebo, but more participants received at least one dose of antiparkinson medication (n=95, RR 4.50 CI 1.0 to 19.5, NNH 6 CI 4 to 33). Five small trials comparing perazine with other antipsychotics, including in total only 193 participants, were incompletely reported and the outcomes were presented in various ways so that meta-analysis was not possible in most occasions. A similar number of participants receiving perazine or comparator antipsychotics left the studies early (n=193, RR 0.85, CI 0.5 to 1.4). The results on efficacy were controversial and need further assessment by randomised controlled trials. No obvious differences in adverse events between perazine and other antipsychotics could be derived from the limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a suitable way for use in meta-analysis, but three small comparisons with the atypical antipsychotics zotepine and amisulpride showed no higher risk of akathisia (n=111, RR 0.31 CI 0.1 to 1.1), dyskinesia (n=111, RR 0.47 CI 0.1 to 3.5), parkinsonism (n=81, RR 1.21 CI 0.5 2.8) or tremor (n=40, RR 0.80 CI 0.3 to 2.6) with perazine. AUTHORS' CONCLUSIONS The number, size and reporting of randomised controlled perazine trials is insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics, and this should be clarified in larger, well-designed trials.
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Affiliation(s)
- S Leucht
- Klinikum rechts der Isar der TU-München, Klinik für Psychiatrie und Psychotherapie, Ismaningerstr. 22, München, Germany, 81675.
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8
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Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia. World J Biol Psychiatry 2005; 6:132-91. [PMID: 16173147 DOI: 10.1080/15622970510030090] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
These guide lines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBO). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of schizophrenia, as well as the management of the acute phase treatment. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Saarland, Homburg/Saar, Germany
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Abstract
BACKGROUND Perazine is an old phenothiazine derivative used for the treatment of people with schizophrenia which has a reputed low level of extrapyramidal side-effects. However, its use is restricted in the sense that - to the best knowledge of the reviewers - it is only marketed in Germany, Poland, Yugoslavia and the Netherlands. OBJECTIVES To examine the effects of perazine for those with schizophrenia, and schizophrenia-like psychoses. SEARCH STRATEGY Electronic searches of the Cochrane Schizophrenia Group's register which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile were undertaken. References of all included studies were searched for further trials. Pharmaceutical companies and authors of trials were contacted. SELECTION CRITERIA All randomised controlled trials that compared perazine with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS Citations and, where possible, abstracts were independently inspected by two reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the Relative Risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS Six trials with a total of 288 participants are included. According to only one trial with 95 participants perazine appeared superior to active placebo (trimipramine) at five weeks for the outcome of 'no important global improvement' (n=95, RR 0.6, CI 0.3-0.9, NNT 4, CI 2-17), but there was no difference in various measures of mental state. The side-effect risk of perazine compared to placebo could not be estimated because they were not reported. Five small trials including only 193 participants which compared perazine with other antipsychotics were incompletely reported and the outcomes were presented in various ways so that meta-analysis was not possible in most occasions. A similar number of participants receiving perazine or comparator antipsychotics left the studies early (n=193, RR 0.9, CI 0.5-1.4). The results on efficacy were controversial and need further assessment by randomised controlled trials. No obvious differences in adverse events between perazine and other antipsychotics could be derived from these limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a way usable for meta-analysis, but three small comparisons with the atypical antipsychotics zotepine and amisulpride showed no higher risk of akathisia (n=111, RR 0.3, CI 0.1-1.1), dyskinesia (n=111, RR 0.5, CI 0.1-3.5), parkinsonism (n=81, RR 1.2, CI 0.5-2.8) or tremor (n=40, RR 0.8, CI 0.3-2.3) with perazine. REVIEWER'S CONCLUSIONS The number, size and reporting of randomised controlled perazine trials is insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics, and this should be clarified in larger, well-designed trials.
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Affiliation(s)
- S Leucht
- Psychiatrische Klinik und Poliklinik der Technischen Universität München Klinikum rechts der Isar, Ismaningerstr. 22, München, Germany, D-81675.
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