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

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
› Author Affiliations
Further Information

Publication History

received 27 March 2011
revised 17 August 2011

accepted 28 September 2011

Publication Date:
15 November 2011 (eFirst)

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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