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Pharmacopsychiatry 2012; 45(02): 64-71
DOI: 10.1055/s-0031-1291293
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Risperidone and Olanzapine versus Another First Generation Antipsychotic in Patients with Schizophrenia Inadequately Responsive to First Generation Antipsychotics

Autor*innen

  • J.-J. Chen

    1   Department of General Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan

  • H.-Y. Chan

    1   Department of General Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan
    2   Department of Psychology, Chung Yuan Christian University, Chung-Li, Taiwan
    3   Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan

  • C.-H. Chen

    1   Department of General Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan

  • S. S.-F. Gau

    3   Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan

  • H.-G. Hwu

    3   Department of Psychiatry, National Taiwan University Hospital and School of Medicine, National Taiwan University, Taipei, Taiwan
Weitere Informationen

Publikationsverlauf

received 27. März 2011
revised 17. August 2011

accepted 28. September 2011

Publikationsdatum:
15. November 2011 (online)

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Abstract

Objective:

This study compares the efficacy of risperidone and olanzapine to that of first-generation antipsychotics (FGAs) in patients with schizophrenia, who failed to show a response to initial trials of FGAs.

Method:

This study was an 8-week treatment, randomized, rater-blind, active-control study with 3 treatment arms. 48 patients, who showed inadequate response to 1 FGA, were enrolled and randomized into risperidone, olanzapine, or FGA (haloperidol or trifluoperazine) groups. They were blindly assessed with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale-Severity, and the Extrapyramidal Symptom Rating Scale (ESRS) at baseline and biweekly.

Results:

All 3 groups demonstrated a significant decrease in the PANSS total, positive, and general scores from baseline to endpoint (p-values range from 0.003 to 0.021). There were no significant differences among the 3 groups in score changes. The olanzapine group had significant score reductions than the risperidone and FGAs groups in terms of the ESRS subjective total score and did not experience a significant increase in the dose of anticholinergics. The FGA group demonstrated that extrapyramidal syndrome (EPS) worsened under an increased dosage of anti-EPS drugs. Olanzapine was associated with significant body weight gain (2.69±4.0 kg, p=0.026), but there were no significant group differences on weight gain.

Conclusions:

Haloperidol or trifluoperazine demonstrated similar efficacy as risperidone or olanzapine for patients with schizophrenia who had failed their first trial with a FGA. Related double-blind, fixed dose studies with a larger sample size are needed to confirm the results of our study.

Key words

schizophrenia - risperidone - olanzapine - inadequate response
 

  • References

  • 1 Emsley RA. Partial response to antipsychotic treatment: the patient with enduring symptoms. J Clin Psychiatry 1999; 60 (Suppl. 23) 10-13
    PubMedSuche in Google Scholar
  • 2 Kinon BJ, Kane JM, Johns C et al. Treatment of neuroleptic-resistant schizophrenic relapse. Psychopharmacol Bull 1993; 29: 309-314
    Suche in Google Scholar
  • 3 Keepers GA, Clappison VJ, Casey DE. Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes. Arch Gen Psychiatry 1983; 40: 1113-1117
    CrossrefSuche in Google Scholar
  • 4 Kane J, Honigfeld G, Singer J et al. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789-796
    Suche in Google Scholar
  • 5 Safferman A, Lieberman JA, Kane JM et al. Update on the clinical efficacy and side effects of clozapine. Schizophr Bull 1991; 17: 247-261
    Suche in Google Scholar
  • 6 Walker AM, Lanza LL, Arellano F et al. Mortality in current and former users of clozapine. Epidemiology 1997; 8: 671-677
    CrossrefSuche in Google Scholar
  • 7 Borison RL, Pathiraja AP, Diamond BI et al. Risperidone: clinical safety and efficacy in schizophrenia. Psychopharmacol Bull 1992; 28: 213-218
    Suche in Google Scholar
  • 8 de Oliveira IR, Miranda-Scippa AM, de Sena EP et al. Risperidone versus haloperidol in the treatment of schizophrenia: a meta-analysis comparing their efficacy and safety. J Clin Pharm Ther 1996; 21: 349-358
    CrossrefSuche in Google Scholar
  • 9 Gomez JC, Crawford AM. Superior efficacy of olanzapine over haloperidol: analysis of patients with schizophrenia from a multicenter international trial. J Clin Psychiatry 2001; 62 (Suppl. 02) 6-11
    CrossrefSuche in Google Scholar
  • 10 Tollefson GD, Beasley Jr CM, Tran PV et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. Am J Psychiatry 1997; 154: 457-465
    Suche in Google Scholar
  • 11 Glazer WM. Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality. J Clin Psychiatry 2000; 61 (Suppl. 03) 16-21
    CrossrefSuche in Google Scholar
  • 12 Chan HY, Chang CJ, Chiang SC et al. A randomised controlled trial of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonism. J Psychopharmacol 2010; 24: 91-98
    Suche in Google Scholar
  • 13 Chan HY, Chiang SC, Chang CJ et al. A randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced tardive dyskinesia. J Clin Psychiatry 2010; 71: 1226-1233
    CrossrefSuche in Google Scholar
  • 14 Bondolfi G, Dufour H, Patris M et al. Risperidone versus clozapine in treatment-resistant chronic schizophrenia: a randomized double-blind study. The Risperidone Study Group. Am J Psychiatry 1998; 155: 499-504
    Suche in Google Scholar
  • 15 Breier A, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry 1999; 45: 403-411
    CrossrefSuche in Google Scholar
  • 16 Conley RR, Tamminga CA, Bartko JJ et al. Olanzapine compared with chlorpromazine in treatment-resistant schizophrenia. Am J Psychiatry 1998; 155: 914-920
    Suche in Google Scholar
  • 17 Emsley RA, Raniwalla J, Bailey PJ et al. A comparison of the effects of quetiapine (‘seroquel’) and haloperidol in schizophrenic patients with a history of and a demonstrated, partial response to conventional antipsychotic treatment. PRIZE Study Group. Int Clin Psychopharmacol 2000; 15: 121-131
    CrossrefSuche in Google Scholar
  • 18 Tollefson GD, Birkett MA, Kiesler GM et al. Double-blind comparison of olanzapine versus clozapine in schizophrenic patients clinically eligible for treatment with clozapine. Biol Psychiatry 2001; 49: 52-63
    CrossrefSuche in Google Scholar
  • 19 Wirshing DA, Marshall Jr BD, Green MF et al. Risperidone in treatment-refractory schizophrenia. Am J Psychiatry 1999; 156: 1374-1379
    Suche in Google Scholar
  • 20 Emsley RA, Oosthuizen PP, Joubert AF et al. Treatment of schizophrenia in low-income countries. Int J Neuropsychopharmacol 1999; 2: 321-325
    CrossrefSuche in Google Scholar
  • 21 Geddes J, Freemantle N, Harrison P et al. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 2000; 321: 1371-1376
    CrossrefPubMedSuche in Google Scholar
  • 22 Leucht S, Corves C, Arbter D et al. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009; 373: 31-41
    Suche in Google Scholar
  • 23 Gau SS, Chung CH, Gau CS. A pharmacoeconomic analysis of atypical antipsychotics and haloperidol in first-episode schizophrenic patients in Taiwan. J Clin Psychopharmacol 2008; 28: 271-278
    CrossrefSuche in Google Scholar
  • 24 Baldessarini RJ, Cohen BM, Teicher MH. Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychoses. Arch Gen Psychiatry 1988; 45: 79-91
    Suche in Google Scholar
  • 25 Bollini P, Pampallona S, Orza MJ et al. Antipsychotic drugs: is more worse? A meta-analysis of the published randomized control trials. Psychol Med 1994; 24: 307-316
    CrossrefSuche in Google Scholar
  • 26 Janicak PG, Javaid JI, Sharma RP et al. A two-phase, double-blind randomized study of three haloperidol plasma levels for acute psychosis with reassignment of initial non-responders. Acta Psychiatr Scand 1997; 95: 343-350
    CrossrefSuche in Google Scholar
  • 27 Kane JM, Davis JM, Schooler N et al. A multidose study of haloperidol decanoate in the maintenance treatment of schizophrenia. Am J Psychiatry 2002; 159: 554-560
    CrossrefSuche in Google Scholar
  • 28 McEvoy JP, Hogarty GE, Steingard S. Optimal dose of neuroleptic in acute schizophrenia. A controlled study of the neuroleptic threshold and higher haloperidol dose. Arch Gen Psychiatry 1991; 48: 739-745
    CrossrefSuche in Google Scholar
  • 29 Stone CK, Garve DL, Griffith J et al. Further evidence of a dose-response threshold for haloperidol in psychosis. Am J Psychiatry 1995; 152: 1210-1212
    Suche in Google Scholar
  • 30 Davis JM, Chen N. Dose response and dose equivalence of antipsychotics. J Clin Psychopharmacol 2004; 24: 192-208
    Suche in Google Scholar
  • 31 Rifkin A, Doddi S, Karajgi B et al. Dosage of haloperidol for schizophrenia. Arch Gen Psychiatry 1991; 48: 166-170
    CrossrefSuche in Google Scholar
  • 32 Kapur S, Zipursky R, Jones C et al. Relationship between dopamine D(2) occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry 2000; 157: 514-520
    CrossrefSuche in Google Scholar
  • 33 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261-276
    Suche in Google Scholar
  • 34 Peuskens J. Risperidone in the treatment of patients with chronic schizophrenia: a multi-national, multi-centre, double-blind, parallel-group study versus haloperidol. Risperidone Study Group. Br J Psychiatry 1995; 166: 712-726
    CrossrefSuche in Google Scholar
  • 35 Volavka J, Czobor P, Sheitman B et al. Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. Am J Psychiatry. 2002; 1 59 255-262
    Suche in Google Scholar
  • 36 Lindenmayer JP, Czobor P, Volavka J et al. Olanzapine in refractory schizophrenia after failure of typical or atypical antipsychotic treatment: an open-label switch study. J Clin Psychiatry 2002; 63: 931-935
    CrossrefSuche in Google Scholar
  • 37 Guy W. The Clinical Global Impression Scale. In: ECDEU Assessment Manual for Psychopharmacology. US Dept of Health, Education and Welfare publication (ADM) 76-338. Rockville, MD: National Institute of Mental Health; 1976: 218-222
    Suche in Google Scholar
  • 38 Chouinard G, Jones B, Remington G et al. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J Clin Psychopharmacol 1993; 13: 25-40
    Suche in Google Scholar
  • 39 Chouinard G, Margolese HC. Manual for the extrapyramidal symptom rating scale (ESRS). Schizophr Res 2005; 76: 247-265
    CrossrefSuche in Google Scholar
  • 40 Conley RR, Mahmoud R. A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder. Am J Psychiatry 2001; 158: 765-774
    CrossrefSuche in Google Scholar
  • 41 Sadock BJ, Sadock VA. Dopamine Receptor Antagonists: Typical Antipsychotics. In: Sadock BJ, Sadock VA. (eds.) Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 10 th Ed. Philadelphia: Lippincott Williams & Wilkins; 2007. pp 1044-1055
    Suche in Google Scholar
  • 42 Sadock BJ, Sadock VA. Serotonin-Dopamine Antagonists: Atypical Antipsychotics. In: Sadock BJ, Sadock VA. (eds.) Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 10 th Ed. Philadelphia: Lippincott Williams & Wilkins; 2007. 1091-1098
    Suche in Google Scholar
  • 43 Marder SR, Meibach RC. Risperidone in the treatment of schizophrenia. Am J Psychiatry 1994; 151: 825-835
    Suche in Google Scholar
  • 44 Conley RR, Kelly DL, Nelson MW et al. Risperidone, quetiapine, and fluphenazine in the treatment of patients with therapy-refractory schizophrenia. Clin Neuropharmacol 2005; 28: 163-168
    CrossrefSuche in Google Scholar
  • 45 Leucht S, Pitschel-Walz G, Abraham D et al. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophr Res 1999; 35: 51-68
    CrossrefSuche in Google Scholar
  • 46 Lieberman JA, Stroup TS, McEvoy JP et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209-1223
    Suche in Google Scholar
  • 47 Simpson MM, Goetz RR, Devlin MJ et al. Weight gain and antipsychotic medication: differences between antipsychotic-free and treatment periods. J Clin Psychiatry 2001; 62: 694-700
    CrossrefSuche in Google Scholar
  • 48 Ascher-Svanum H, Stensland M, Zhao Z et al. Acute weight gain, gender, and therapeutic response to antipsychotics in the treatment of patients with schizophrenia. BMC Psychiatry 2005; 5: 3
    CrossrefPubMedSuche in Google Scholar
  • 49 Ascher-Svanum H, Stensland MD, Kinon BJ et al. Weight gain as a prognostic indicator of therapeutic improvement during acute treatment of schizophrenia with placebo or active antipsychotic. J Psychopharmacol 2005; 19 (Suppl. 06) 110-117
    CrossrefSuche in Google Scholar