Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis. Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Antipsychotic drug effects on brain morphology in first-episode psychosis. Antipsychotic medication for childhood-onset schizophrenia. Different Effects of Typical and Atypical Antipsychotics on Grey Matter in First Episode Psychosis: the ÆSOP Study Prescribing for inpatients with schizophrenia: an international multi-center comparative study. Treatment adherence associated with conventional and atypical antipsychotics in a large state Medicaid program. Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Antipsychotic switching: results from a one-year prospective, observational study of patients with schizophrenia A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode WEIGHT GAIN AND ANTIPSYCHOTICS. DATA FROM EUFEST STUDY. Effectiveness of maintenance treatments with atypical and typical antipsychotics in stable schizophrenia with early stage: 1-year naturalistic study Antipsychotics Associated with the Development of Type 2 Diabetes in Antipsychotic-Naïve Schizophrenia Patients Evaluation of the Individual Safe Correction of Antipsychotic Agent Polypharmacy in Japanese Patients with Chronic Schizophrenia: Validation of Safe Corrections for Antipsychotic Polypharmacy and the High-Dose Method Characteristics and use patterns of patients taking first-generation depot antipsychotics or oral antipsychotics for schizophrenia. Effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care.
INTRODUCTION Symptom amelioration in older patients with very late onset schizophrenia-like psychosis ( VLOSLP ) is often difficult , with limited psychotropic response reports yielding variable findings . Information about atypical ( second generation ) antipsychotic use in this population is scant . METHODS A consecutive sample of geriatric psychiatry out patients and in patients with psychotic disorders were retrospectively identified over a 31-month period based on systematic information abstract ion from an electronic medical record ( e-record ) . After exclusion criteria were applied , 8/138 out patients and 13/362 in patients met inclusion criteria for VLOSLP and had been naturalistically treated with an atypical antipsychotic during hospitalization or nine months of outpatient care . M and atorily completed e-record st and ardized symptom severity response ratings were converted into positive treatment response thresholds . RESULTS 38 % of out patients and 77 % of in patients ( mean age = 76 years for both groups ; mean age of onset of psychosis = 70 years for out patients and 74 years for in patients ) met criteria for positive treatment response to an atypical antipsychotic ( either aripiprazole , olanzapine , quetiapine , or risperidone ) with sign/symptom amelioration , rather than eradication . CONCLUSIONS Various atypical antipsychotics at geriatric doses yielded a positive treatment response in nearly two-thirds of VLOSLP patients . Patients with less chronic , more severe symptoms responded at a higher rate . Prospect i ve , double-blind , placebo-controlled trials with representative subject sample s are needed to vali date these preliminary findings This study prospect ively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior  among patients with schizophrenia under " usual care " conditions in the community . Participants ( n = 229 ) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina . Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment , sociodemographic characteristics , clinical features , and violence outcomes . Treatment with atypical antipsychotic medications ( clozapine , risperidone , or olanzapine ) was found to significantly reduce the risk of violent behavior , whereas treatment with conventional neuroleptics did not have this same beneficial effect . A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period . Concurrent reductions in psychotic symptoms , substance abuse , and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk . Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior BACKGROUND Pathomorphologic brain changes occurring as early as first-episode schizophrenia have been extensively described . Longitudinal studies have demonstrated that these changes may be progressive and associated with clinical outcome . This raises the possibility that antipsychotics might alter such pathomorphologic progression in early-stage schizophrenia . OBJECTIVE To test a priori hypotheses that olanzapine-treated patients have less change over time in whole brain gray matter volumes and lateral ventricle volumes than haloperidol-treated patients and that gray matter and lateral ventricle volume changes are associated with changes in psychopathology and neurocognition . DESIGN Longitudinal , r and omized , controlled , multisite , double-blind study . Patients treated and followed up for up to 104 weeks .  Neurocognitive and magnetic resonance imaging ( MRI ) assessment  s performed at weeks 0 ( baseline ) , 12 , 24 , 52 , and 104 . Mixed-models analyses with time-dependent covariates evaluated treatment effects on MRI end points and explored relationships between MRI , psychopathologic , and neurocognitive outcomes . SETTING Fourteen academic medical centers ( United States , 11 ; Canada , 1 ; Netherl and s , 1 ; Engl and , 1 ) . PARTICIPANTS Patients with first-episode psychosis ( DSM-IV ) and healthy volunteers . INTERVENTIONS R and om allocation to a conventional antipsychotic , haloperidol ( 2 - 20 mg/d ) , or an atypical antipsychotic , olanzapine ( 5 - 20 mg/d ) . MAIN OUTCOME MEASURES Brain volume changes assessed by MRI . RESULTS Of 263 r and omized patients , 161 had baseline and at least 1 postbaseline MRI evaluation .  Haloperidol-treated patients exhibited significant decreases in gray matter volume , whereas olanzapine-treated patients did not . A matched sample of healthy volunteers ( n = 58 ) examined contemporaneously showed no change in gray matter volume . CONCLUSIONS Patients with first-episode psychosis exhibited a significant between-treatment difference in MRI volume changes .  Haloperidol was associated with significant reductions in gray matter volume , whereas olanzapine was not . Post hoc analyses suggested that treatment effects on brain volume and psychopathology of schizophrenia may be associated . The differential treatment effects on brain morphology could be due to haloperidol-associated toxicity or greater therapeutic effects of olanzapine BACKGROUND : Childhood-onset schizophrenia is schizophrenia with onset prior to the age of 13 years . Although it is rare , people who suffer from schizophrenia at an early age appear to have a clinical ly severe form of the illness with poor long-term prognosis . Antipsychotic medication is one way of managing this rare but serious mental illness . OBJECTIVES : To examine the effects of antipsychotic medication for childhood-onset schizophrenia . SEARCH STRATEGY : We search ed the Cochrane Schizophrenia Group Trials Register ( November 2006 and February 2007 ) , inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors of trials for additional information . SELECTION CRITERIA : We included all r and omised clinical trials involving children and young people with a diagnosis of childhood onset schizophrenia ( i.e. with a diagnosis of schizophrenia before the age of 13 ) comparing any antipsychotic drug with another antipsychotic or placebo . DATA COLLECTION AND ANALYSIS : We reliably selected , quality assessed and extracted data from trials . We excluded data where more than 50 % of participants in any group were lost to follow up . For homogenous dichotomous data we calculated r and om effects , relative risk ( RR ) and its 95 % confidence interval ( CI ) and , where appropriate , number needed to treat ( NNT ) on an intention-to-treat basis . For normal continuous data we calculated the weighted mean difference ( WMD ) . MAIN RESULTS : From a total of 2062 citations , we identified six relevant trials . We categorised trials into three comparisons : atypical versus typical , atypical versus atypical and typical versus typical antipsychotic drugs . The only comparison to find any differences between treatment groups was atypical versus typical antipsychotic drugs . A few results from one study favoured the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia ( n=21 , WMD CGAS 17.00 CI 7.74 to 26.26 ; n=21 , WMD Bunney-Hamburg Psychosis Rating Scale -3.60 CI -6.64 to -0.56 ) . Participants on clozapine , however , were three times more likely to have drowsiness ( 1 RCT , n=21 , RR 3.30 CI 1.23 to 8.85 , NNH 2 CI 2 to 17 ) and half of the children receiving clozapine had neutropenia ( 1 RCT , n=21 , RR 12 , CI 0.75 to 192.86 ) . AUTHORS ' CONCLUSIONS : There are few relevant trials and , presently , there is little conclusive evidence regarding the effects of antipsychotic medication for those with early onset schizophrenia . Some benefits were identified in using the atypical antipsychotic clozapine compared with haloperidol but the benefits were offset by an increased risk of serious adverse effects . Larger , more robust , trials are required Typical antipsychotic drugs act on the dopaminergic system , blocking the dopamine type 2 ( D2 ) receptors . Atypical antipsychotics have lower affinity and occupancy for the dopaminergic receptors , and a high degree of occupancy of the serotoninergic receptors 5-HT2A . Whether these different pharmacological actions produce different effects on brain structure remains unclear . We explored the effects of different types of antipsychotic treatment on brain structure in an epidemiologically based , nonr and omized sample of patients at the first psychotic episode . Subjects were recruited as part of a large epidemiological study ( ÆSOP : aetiology and ethnicity in schizophrenia and other psychoses ) . We evaluated 22 drug-free patients , 32 on treatment with typical antipsychotics and 30 with atypical antipsychotics .  We used high-resolution MRI and voxel-based methods of image analysis . The MRI analysis suggested that both typical and atypical antipsychotics are associated with brain changes . However , typicals seem to affect more extensively the basal ganglia ( enlargement of the putamen ) and cortical areas ( reductions of lobulus para central is , anterior cingulate gyrus , superior and medial frontal gyri , superior and middle temporal gyri , insula , and precuneus ) , while atypical antipsychotics seem particularly associated with enlargement of the thalami . These changes are likely to reflect the effect of antipsychotics on the brain , as there were no differences in duration of illness , total symptoms scores , and length of treatment among the groups . In conclusion , we would like to suggest that even after short-term treatment , typical and atypical antipsychotics may affect brain structure differently BACKGROUND This study compares prescription practice s for acute in patients with schizophrenia among six academic departments located in China , Japan , Hungary , and the U.S. METHODS Prescription data for a sample of 429 in patients from six academic departments were collected on a r and omly chosen census day . All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years . RESULTS While patients at the different centers varied in their demographic and clinical characteristics , i. e. , age , sex , and length of illness , a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied ( i. e. , number and dose antipsychotics , atypical and depot antipsychotics , other psychotropic drugs , multiple antipsychotics , and daily dose ) except antidepressant use . In most cases these differences persisted even after adjusting for demographic and clinical characteristics ( age , sex , and length of illness ) of the subjects . Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs , including anticholinergics , anticonvulsants , benzodiazepines , and non-benzodiazepine hypnotics .  Anticholinergic use was more common with typical antipsychotics . Rates of atypical antipsychotic drug use were lowest in the Japanese center . The Japanese center had by far the highest mean daily dose of antipsychotics .  CONCLUSIONS The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia . The results also confirm previous findings that prescribing practice s for schizophrenia vary greatly among centers and countries . A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs , such as anticholinergics , hypnotics , anticonvulsants , and benzodiazepines , administered in multiple daily doses OBJECTIVES Rates of medication adherence over a one-year period were assessed among out patients with schizophrenia who initiated therapy with conventional or atypical antipsychotic agents .  METHODS Data were drawn from paid medical and pharmacy cl aims for a r and om sample of 10 percent of all California Medicaid ( " Medi-Cal " ) recipients . Out patients with schizophrenia who were aged 18 years or older and who initiated monotherapy with a conventional or atypical antipsychotic medication in the last quarter of 1997 were identified . The percentages of patients who discontinued antipsychotic therapy or who had a switch in medications over a one-year period were determined . The use of selected concomitant medications was also assessed . Data were analyzed by means of chi square tests and multivariate statistics that adjusted for demographic and clinical differences between medication groups . RESULTS A total of 298 patients who initiated therapy with a conventional ( N=93 ) or atypical ( N=205 ) antipsychotic medication were identified . The groups were similar in mean age ( about 42 years ) and gender distribution ( about 54 percent were male ) . Compared with patients who received conventional antipsychotics , those receiving atypical antipsychotics were significantly less likely to have a switch in medication and to use concomitant anticholinergic and anxiolytic medications . In each group , antipsychotic medication was available for about 60 percent of days over one year of follow-up . CONCLUSIONS Compared with the use of conventional antipsychotics , the use of atypical antipsychotic medications was associated with significantly less treatment switching and less use of concomitant medications . However , undertreatment , evidence d by a lack of prescription refills , occurred among patients taking both medication classes , which highlights the need for further research on nonadherence CONTEXT Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia . Adding psychosocial treatment may produce greater improvement in functional outcome than does medication treatment alone . OBJECTIVE To evaluate the effectiveness of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia . DESIGN R and omized controlled trial . SETTING Ten clinical sites in China . PARTICIPANTS Clinical sample of 1268 patients with early-stage schizophrenia treated from January 1 , 2005 , through October 31 , 2007 . Intervention Patients were r and omly assigned to receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of psychoeducation , family intervention , skills training , and cognitive behavior therapy administered during 48 group sessions . MAIN OUTCOME MEASURES The rate of treatment discontinuation or change due to any cause , relapse or remission , and assessment s of insight , treatment adherence , quality of life , and social functioning . RESULTS The rates of treatment discontinuation or change due to any cause were 32.8 % in the combined treatment group and 46.8 % in the medication-alone group . Comparisons with medication treatment alone showed lower risk of any-cause discontinuation with combined treatment ( hazard ratio , 0.62 ; 95 % confidence interval , 0.52 - 0.74 ; P < .001 ) and lower risk of relapse with combined treatment ( 0.57 ; 0.44 - 0.74 ; P < .001 ) . The combined treatment group exhibited greater improvement in insight ( P < .001 ) , social functioning ( P = .002 ) , activities of daily living ( P < .001 ) , and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey ( all P < or = .02 ) . Furthermore , a significantly higher proportion of patients receiving combined treatment obtained employment or accessed education ( P = .001 ) . CONCLUSION Compared with those receiving medication only , patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment discontinuation or change , a lower risk of relapse , and improved insight , quality of life , and social functioning . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00654576 ABSTRACT Objective : The Health Outcomes of a Canadian Community Cohort ( HOCCC ) study is a 1-year prospect i ve observational study of out patients with schizophrenia or related psychotic disorders . The purpose of the study was to compare effectiveness of antipsychotic treatment as measured by 1-year treatment completion rates . Design and methods : Patients ( N = 929 ) were enrolled if in the course of usual clinical practice they switched to a second-generation antipsychotic ( SGA ) . Observational data were collected for up to 1 year . The primary analysis compared 1-year treatment-completion rates for the olanzapine cohort with the other SGA cohort ( quetiapine , risperidone , clozapine ) , using a chi-squared test . Results : Of 929 patients enrolled , 64.8 % ( 516/796 ) of evaluable patients completed 1 year of treatment . There was no statistically significant difference in the proportion of treatment completers between the olanzapine cohort ( 67.4 % , 256/380 ) and the other SGA cohort ( 62.5 % , 260/416 ) . Treatment-completion rates were risperidone 62.0 % ( 127/205 ) , quetiapine 63.7 % ( 123/193 ) and clozapine 55.6 % ( 10/18 ) . Antipsychotic polypharmacy was common . Patients treated with olanzapine or risperidone had significantly higher increases in BMI than quetiapine-treated patients . There were no major differences between olanzapine monotherapy and pooled other SGA monotherapy groups in status of extrapyramidal symptoms from baseline to endpoint . Conclusions : Olanzapine and other SGAs exhibited similar rates of 1-year treatment completion . Further study of medication combinations is needed , given their perceived clinical value , and the high frequency of antipsychotic polypharmacy in clinical practice . Limitations : As most patients received several psychotropics and power was reduced in monotherapy analyses , comparisons between cohorts must be interpreted cautiously . Comparisons between individual antipsychotics were post hoc and not powered a priori . Accuracy and completeness of adverse event information for drugs other than olanzapine is limited OBJECTIVE Data on the effectiveness of antipsychotics in the early phase of schizophrenia are limited . The authors examined the risk of rehospitalization and drug discontinuation in a nationwide cohort of 2,588 consecutive patients hospitalized for the first time with a diagnosis of schizophrenia between 2000 and 2007 in Finl and . METHOD The authors linked national data bases of hospitalization , mortality , and antipsychotic prescriptions and computed hazard ratios , adjusting for the effects of sociodemographic and clinical variables , the temporal sequence of the antipsychotics used , and the choice of the initial antipsychotic for each patient . RESULTS Of 2,588 patients , 1,507 ( 58.2 % ) collected a prescription for an antipsychotic during the first 30 days after hospital discharge , and 1,182 ( 45.7 % , 95 % confidence interval [CI]=43.7 - 47.6 ) continued their initial treatment for 30 days or longer . In a pairwise comparison between depot injections and their equivalent oral formulations , the risk of rehospitalization for patients receiving depot medications was about one-third of that for patients receiving oral medications ( adjusted hazard ratio=0.36 , 95 % CI=0.17 - 0.75 ) . Compared with oral risperidone , clozapine ( adjusted hazard ratio=0.48 , 95 % CI=0.31 - 0.76 ) and olanzapine ( adjusted hazard ratio=0.54 , 95 % CI=0.40 - 0.73 ) were each associated with a significantly lower rehospitalization risk . Use of any antipsychotic compared with no antipsychotic was associated with lower mortality ( adjusted hazard ratio=0.45 , 95 % CI=0.31 - 0.67 ) . CONCLUSIONS In Finl and , only a minority of patients adhere to their initial antipsychotic during the first 60 days after discharge from their first hospitalization for schizophrenia . Use of depot antipsychotics was associated with a significantly lower risk of rehospitalization than use of oral formulations of the same compounds . Among oral antipsychotics , clozapine and olanzapine were associated with more favorable outcomes . Use of any antipsychotic was associated with lower mortality BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder Context Schizophrenia is a chronic disease most frequently necessitating lifelong antipsychotic treatment . Selecting which antipsychotic is to be prescribed in an individual schizophrenia patient represents an important clinical decision that need to take into account efficacy and side effects . Objective Evaluating weight gain related with one year antipsychotic treatment in antipsychotic naive first-episode schizophrenia patients . Design This study is an analysis of weight gain associated with typical or atypical antipsychotics used in European First Episode Schizophrenia Trial ( EUFEST ) study . Subjects and Methods 113 first episode naïve antipsychotic schizophrenia patients included in EUFEST - Romanian cohort , who were r and omized to one of the 5 treatment arms .  Weight was obtained at baseline , 3 , 6 , 9 and 12 months for the 5 antipsychotics ( typical-Haloperidol ; atypical-Olanzapine , Amisulpride , Ziprasidone , Quetiapine ) . Results There are no statistically significant differences between groups treated with typical or atypical antipsychotics or between any individual antipsychotics concerning weight gain during the study . Weight gain was the highest in the first 3 months ( 57.49 % ) for all the studied neuroleptics . At the end of the study , the less increase was observed with ziprasidone ( 3.87 kg ) and the highest with olanzapine ( 9.83 kg ) . Conclusion Increase in weight has taken place for each individual neuroleptic , but also as a group ( all neuroleptics ) in the first three months ( 57.49 % ) . Therefore , we should address the issue of weight gain with great care , especially in first period of antipsychotic administration , in order to fast deploy intervention tailored to maintain pre-treatment weight Rationale The relative effectiveness of the atypical antipsychotic drugs and conventional agents in patients with early-stage schizophrenia has not been comprehensively determined . Objectives The aim of our study was to evaluate the efficacy and safety of seven antipsychotic drugs for the maintenance treatment in patients with early-stage schizophrenia . Methods In a 12-month open-label , prospect i ve observational , multicenter study , 1,133 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine , sulpiride , clozapine , risperidone , olanzapine , quetiapine , or aripiprazole . The primary measure was the rate of treatment discontinuation for any reason . Secondary outcomes included measures for clinical and functional outcomes and tolerability . Results The percentage of patients discontinued treatment within 12 months was 41.4 % for chlorpromazine , 39.5 % for sulpiride , 36.7 % for clozapine , 40.2 % for risperidone , 39.6 % for olanzapine , 46.9 % for quetiapine , and 40.2 % for aripiprazole , a nonsignificant difference ( p = 0.717 ) ; there were no significant differences among these seven treatments on discontinuation due to relapse , intolerability , patient decision , or nonadherence ( all p values ≥ 0.260 ) . Extrapyramidal symptoms were more prominent in chlorpromazine and sulpiride treatment groups . Anticholinergic side effects were most common with clozapine and chlorpromazine . Weight gain was most common with olanzapine and clozapine . Conclusions The efficacy of seven antipsychotic medications for the maintenance treatment appeared similar in early-stage schizophrenia . With regard to the high dropout rate and side effects , special programs are needed to keep efficacy and safety of antipsychotics maintenance treatment for schizophrenia with early Diabetes mellitus occurs in schizophrenia patients at higher rates than in the general population . Reasons for this elevated risk are poorly understood and have not been examined prospect ively in antipsychotic-naïve , first-episode patients . This study aims to determine which antipsychotics are associated with diabetes development in antipsychotic-naïve schizophrenia patients . All antipsychotic-naïve patients diagnosed with schizophrenia in Denmark between 01 January 1997 and 31 December 2004 , followed until 31 December 2007 , allowing for ⩾3 years follow-up , unless death or diabetes onset occurred . Risk factors for the time to diabetes onset were assessed , including antipsychotics taken for at least 180 defined daily doses in the first year after first antipsychotic prescription ( ‘ initial treatment ’ ) . Risk factors for diabetes incidence were assessed , including antipsychotic use within 3 months before diabetes onset or study end ( ‘ current treatment ’ ) . Of 7139 patients , followed for 6.6 years ( 47 297 patient years ) , 307 developed diabetes  ( annual incidence rate : 0.65 % ) . Time to diabetes onset was significantly shorter in patients with higher age ( hazard ratio ( HR ) : 1.03 , confidence interval ( CI ) : 1.02–1.03 ) and those with ‘ initial ’ treatment of olanzapine ( HR : 1.41 , CI : 1.09–1.83 ) , mid-potency first-generation antipsychotics ( FGAs ) ( HR : 1.60 , CI : 1.07–2.39 ) , antihypertensive ( HR : 1.87 , CI : 1.13–3.09 ) , or lipid-lowering drugs ( HR : 4.67 , CI : 2.19–10.00 ) . Significant factors associated with diabetes within 3 month of its development included treatment with low-potency FGAs ( odds ratio ( OR ) : 1.52 , CI : 1.14–2.02 ) , olanzapine ( OR : 1.44 , CI : 1.98–1.91 ) , and clozapine ( OR : 1.67 , CI : 1.14–2.46 ) , whereas aripiprazole was associated with lower diabetes risk ( OR : 0.51 , CI : 0.33–0.80 ) . In addition to general diabetes risk factors , such as age , hypertension , and dyslipidemia , diabetes is promoted in schizophrenia patients by initial and current treatment with olanzapine and mid-potency FGAs , as well as by current treatment with or low-potency first-generation antipsychotics and clozapine , whereas current aripiprazole treatment reduced diabetes risk . Patients discontinuing olanzapine or mid-potency FGA had no increased risk of diabetes compared with patient not treated with the drugs at anytime Background : Polypharmacy for schizophrenia treatment is not justified by the available clinical evidence . We evaluated a treatment reduction approach that reduces the dose and number of antipsychotic medications simultaneously prescribed to patients . Methods : In a r and omized open study of the Safe Correction of Antipsychotic Polypharmacy and High-Dose Prescriptions program funded by the Japanese Ministry of Health , Labour , and Welfare , we evaluated a drug reduction method consisting of a  dose reduction intervention performed on 163 patients with schizophrenia for twelve or 24 weeks . One antipsychotic medication was removed each week from each patient ’s treatment regimen by reducing the dose by 0 to 50 chlorpromazine equivalents .  Data on health-related indices of quality of life , clinical symptoms , and risk of side effects were analyzed using a two-way repeated- measures mixed linear model . Results : Despite a 23 % reduction in antipsychotic dose , no differences in outcomes were observed between the dose reduction and observation groups ( effect size = 0.001 – 0.085 , P = .24–.97 ) , despite high statistical power ( 1-β = 0.48–0.97 ) . The findings are limited by the nonuniformity of the participants ’ treatment history , duration , and dose reduction amount . Dose reduction protocol patients exhibited no difference in psychotic symptoms or adverse events compared with the observation group . Conclusions : Importantly , the low dropout rate in our study ( 6.9 % of participants withdrew because of patient factors and 23.8 % for all secondary reasons ) indicates that our “ slowly ” method is well tolerated . We hope that this approach will result in therapeutic improvements OBJECTIVE Investigators compared patient characteristics and antipsychotic use patterns between individuals with schizophrenia treated in usual care with first-generation depot antipsychotics and those treated with oral antipsychotics ( first- or second-generation or both ) .  METHODS Analyses used data from the U.S. Schizophrenia Care and Assessment Program , a large , prospect i ve study of treatment for schizophrenia conducted July 1997 through September 2003 . Participants were assessed at enrollment and every six months thereafter with patient self-report , vali date d psychiatric measures , and systematic extraction of medical records . Individuals treated with a first-generation depot antipsychotic at any time during the three-year study ( N=569 ) were compared with those treated with only oral antipsychotics  ( N=1,617 ) on characteristics at enrollment and medication use pattern during the year after enrollment . RESULTS Compared with patients receiving only oral antipsychotics , participants treated with depot medications ( haloperidol or fluphenazine decanoate ) were more likely to be African American ( p<.001 ) ; less likely to be a veteran ( p=.005 ) ; had more psychiatric hospitalizations in the year before enrollment ( p<.001 ) ; and were more likely to have been arrested ( p<.001 ) , to use alcohol and illicit substances ( p<.001 ) , and to show higher psychopathology , particularly psychotic symptoms and disorganized thinking ( p<.01 for both ) . In the year after enrollment , participants treated with depot medications had a high mean medication possession ratio ( 91 % ) , and most of the medication regimens ( 68 % ) were augmented with oral antipsychotics for prolonged duration s ( median of 144 days ) . CONCLUSIONS Patients with schizophrenia treated with first-generation depot antipsychotics differed from those treated with only oral antipsychotics . Findings suggest that first-generation depot antipsychotics might address some unmet needs of a unique subgroup of patients with schizophrenia BACKGROUND In two recent r and omised clinical trials , a meta- analysis and in an effectiveness study analysing routine data from the U.S. Veterans Administration the superiority of the newer atypical drugs over typical antipsychotic drugs , concerning both their efficacy and their side-effect profile , has been question ed . AIMS OF THE STUDY To analyse the effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care . METHODS Cohort study using routine care data from a statutory sickness fund with 5.4 million insured in Germany . To be included , patients had to be discharged with a diagnosis of schizophrenia in 2003 and fulfil membership criteria . Main outcome measures were rehospitalisation rates , mean hospital bed days , mean length of stay , cost of inpatient and pharmaceutical care to the sickness fund during follow-up and medication used to treat side-effects . RESULTS 3121 patients were included into the study . There were no statistically significant differences in the effectiveness of atypical and typical antipsychotics on rehospitalisation during follow-up ( rehospitalisation rate ratio 1.07 , 95 % confidence interval 0.86 to 1.33 ) . However , there were consistent observations of atypical antipsychotics being more effective for severe cases of schizophrenia ( 14.6 % of study population ; > 61 prior bed days per year in 2000 - 2002 ) in the follow-up period , whereas for the other severity strata typical antipsychotics seemed more effective in reducing various rehospitalisation outcomes .  Patients treated with atypical antipsychotics  received significantly less prescriptions for anticholinergics or tiaprid ( relative risk 0.26 , 95 % confidence interval 0.18 to 0.38 ) . DISCUSSION The effectiveness of atypical antipsychotics for schizophrenia on rehospitalisation measures appeared similar to that of typical antipsychotics . With the exception of severe cases , the higher costs for atypical antipsychotics were not offset by savings from reduced inpatient care . Major limitations include the lack of statistical power for subgroup analyses , the lack of clinical severity scale data and of life-course medical history data which both increase the risk of residual confounding by disease severity . CONCLUSIONS This study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH CARE PROVISION AND USE From a clinical perspective , this study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH POLICIES Routine data studies can yield valuable information for policy decision-makers on the costs and the effectiveness of pharmaceuticals in routine care , complementing efficacy data from r and omised clinical trials currently used for licensing and reimbursement decisions . IMPLICATION S FOR FURTHER RESEARCH The non-significant differences in the effectiveness of atypical compared to typical antipsychotics according to severity of disease should be investigated in a prospect i ve observational study or in a r and omised clinical trial
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis .
However , atypical antipsychotic medications may be more acceptable to young people because fewer symptomatic adverse effects are seen in the short term .
Little evidence is available to support the superiority of one atypical antipsychotic medication over another , but side effect profiles are different for different medications .
Treatment with olanzapine , risperidone and clozapine is often associated with weight gain .
Aripiprazole is not associated with increased prolactin or with dyslipidaemia .
Adolescents may respond better to st and ard-dose as opposed to lower-dose risperidone , but for aripiprazole and ziprasidone , lower doses may be equally effective .
BACKGROUND Schizophrenia often presents in adolescence , but current treatment guidelines are based largely on studies of adults with psychosis .
Over the past decade , the number of studies on treatment of adolescent-onset psychosis has increased .
The current systematic review collates and critiques evidence obtained on the use of various atypical antipsychotic medications for adolescents with psychosis .
OBJECTIVES To investigate the effects of atypical antipsychotic medications in adolescents with psychosis .
We review ed in separate analyses various comparisons of atypical antipsychotic medications with placebo or a typical antipsychotic medication or another atypical antipsychotic medication or the same atypical antipsychotic medication but at a lower dose .