Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Relationship of Cognition to Clinical Response in First-Episode Schizophrenia Spectrum Disorders. [Clozapine in the treatment of schizophrenia]. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naı̈ve patients with schizophrenia Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode Factors Involved in Outcome and Recovery in Schizophrenia Patients Not on Antipsychotic Medications: A 15-Year Multifollow-Up Study Management of negative symptoms among patients with schizophrenia attending multiple-family groups. Short term neurocognitive effects of treatment with ziprasidone and olanzapine in recent onset schizophrenia Correlates of cognitive deficits in first episode schizophrenia Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial Three-year antipsychotic effectiveness in the outpatient care of schizophrenia: Observational versus randomized studies results Antipsychotic medication and social cue recognition in chronic schizophrenia A prognostic study of clinical dimensions in adolescent-onset psychoses. Extent of attaining and maintaining symptom remission by antipsychotic medication in the treatment of chronic schizophrenia: Evidence from the CATIE study Effect of antipsychotic medication alone vs combined with psychosocial intervention on outcomes of early-stage schizophrenia: A randomized, 1-year study. Extracting spurious messages from noise and risk of schizophrenia-spectrum disorders in a prodromal population.
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 First-episode schizophrenia ( FES ) spectrum disorders are associated with pronounced cognitive dysfunction across all domains . However , less is known about the course of cognitive functioning , following the first presentation of psychosis , and the relationship of cognition to clinical course during initial treatment . The present longitudinal study examined the magnitude of neurocognitive impairment , using the MATRICS Consensus Cognitive Battery , in patients experiencing their first episode of psychosis at baseline and after 12 weeks of r and omized antipsychotic treatment with either aripiprazole or risperidone .  At baseline , FES patients evidence d marked impairments in cognitive functioning . Notably , performance on the mazes task of planning and reasoning significantly predicted the likelihood of meeting stringent criteria for positive symptom remission during the first 12 weeks of the trial . Performance on indices of general cognitive function , working memory , and verbal learning improved over time , but these improvements were mediated by improvements in both positive and negative symptoms . We did not detect any differential effects of antipsychotic medication assignment ( aripiprazole vs risperidone ) on cognitive functioning . Our results suggest that a brief paper- and -pencil measure reflecting planning/reasoning abilities may index responsivity to antipsychotic medication . However , improvements in cognitive functioning over time were related to clinical symptom improvement , reflecting " pseudospecificity . Schizophrenia is associated with brain abnormalities and is typically evidence d by disorganized speech and behavior , delusions , and hallucinations ; it usually requires extended hospitalization . Its incidence in the western world is estimated at 4 - 7 cases/10,000/year . A method of shortening hospitalization and improving level of functioning is the use of unique medication , including clozapine , which has been in use in Israel for the past 6 years . We report 327 patients who participated in a community rehabilitation program and were treated with clozapine .  They were compared with 417 patients who corresponded to the guidelines of the Director of Mental Health Services for treatment with clozapine , but were not treated with it for reasons not defined in the guidelines . The study included those 25 - 44 and 45 - 64 years of age and according to the division of the population of patients hospitalized in both government and private hospitals . The project demonstrates the savings from use of clozapine as opposed to the alternative of hospitalizing these patients . It also shows the complexity and difficulty in assimilating new technologies , in relation to the influence of social considerations and supplier/insurer accounting on the patterns of technological assimilation OBJECTIVE This study examined the treatment response of patients with first-episode schizophrenia and schizoaffective disorder and potential predictors of response . METHOD First-episode patients were assessed on measures of psychopathology , cognition , social functioning , and biological parameters and treated according to a st and ardized algorithm . RESULTS One hundred eighteen patients ( 52 % male , mean age 25.2 years ) entered the study . The cumulative percentage of patients responding by 1 year was 87 % ; the median time to response was 9 weeks . The following variables were significantly associated with less likelihood of response to treatment : male sex , obstetric complications , more severe hallucinations and delusions , poorer attention at baseline , and the development of parkinsonism during antipsychotic treatment . Variables not significantly related to treatment response were diagnosis ( schizophrenia versus schizoaffective disorder ) , premorbid functioning , duration of psychotic symptoms prior to study entry , baseline disorganization , negative and depressive symptoms , baseline motor function , akathisia and dystonia during treatment , growth hormone and homovanillic acid measures , psychotic symptom activation to methylpheni date , and magnetic resonance measures . CONCLUSIONS Patients with first-episode schizophrenia and schizoaffective disorder have high rates of response to antipsychotic treatment ; there are specific clinical and pathobiologic predictors of response The early course of neuropsychological dysfunction in schizophrenia and the impact of treatment on these deficits need to be better specified . A sample of 45 patients with schizophrenia underwent five neuropsychological evaluations from prior to treatment with antipsychotic treatment through a 2-year follow-up period . A comparison sample of 33 matched healthy individuals underwent neuropsychological evaluations at similar time points . At baseline , a generalized deficit across cognitive domains was evident for the schizophrenia sample . After 6 weeks of treatment , patients showed modest improvements in visual memory and visual perception , but a decline in verbal memory . Verbal memory performance returned to baseline levels by the 6-month follow-up while deficits in other neuropsychological domains persisted throughout the 2-year period . Relatively static and generalized neuropsychological dysfunction , evident from illness onset , is consistent with neurodevelopmental rather than neurodegenerative models of schizophrenia 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 This prospect i ve longitudinal 15-year multifollow-up research studied whether  unmedicated patients with schizophrenia can function as well as schizophrenia patients on antipsychotic medications . If so , can differences in premorbid characteristics and personality factors account for this ? One hundred and forty-five patients , including 64 with schizophrenia , were evaluated on premorbid variables , assessed prospect ively at index hospitalization , and then followed up 5 times over 15 years . At each follow-up , patients were compared on symptoms and global outcome . A larger percent of schizophrenia patients not on antipsychotics showed periods of recovery and better global functioning ( p < .001 ) . The longitudinal data identify a subgroup of schizophrenia patients who do not immediately relapse while off antipsychotics and experience intervals of recovery . Their more favorable outcome is associated with internal characteristics of the patients , including better premorbid developmental achievements , favorable personality and attitudinal approaches , less vulnerability , greater resilience , and favorable prognostic factors . The current longitudinal data suggest not all schizophrenia patients need to use antipsychotic medications continuously throughout their lives OBJECTIVE Outcomes for negative symptoms over a one-year period were examined in two groups of patients , one receiving psychoeducational multiple-family group treatment and one receiving st and ard care .  METHODS A total of 63 out patients , ages 18 to 45 years , with DSM-IV diagnoses of schizophrenic disorders were r and omly assigned to st and ard care or multiple-family group psychoeducation treatment at a large mental health center in Spokane , Washington . Treatment assignment was stratified by whether patients were taking typical or atypical antipsychotic medications . Negative symptom status was monitored monthly for one year by raters blind to group assignment and measured as a composite of five symptoms using the Modified Scale for the Assessment of Negative Symptoms . RESULTS When the analysis controlled for baseline negative symptoms , participants in the multiple-family group experienced significantly reduced negative symptoms compared with those receiving st and ard care . Taking atypical antipsychotic medication or having a diagnosis of substance abuse was not associated with the severity of negative symptoms . An additional analysis of the five individual negative symptoms indicated small but consistent group differences on all dimensions except inattention . Negative symptoms were significantly correlated with relapse to acute illness but not with outpatient or inpatient service use . CONCLUSIONS The study demonstrated that a psychoeducational multiple-family group intervention was more effective than st and ard care in managing negative symptoms over a 12-month period . The results are particularly relevant because negative symptoms are associated with relapse , poor social and occupational functioning , cognitive impairment , and lower subjective quality of life BACKGROUND Cognitive deficits are a core feature in schizophrenia . Cognitive deficits appear to be present at the onset of schizophrenia and persist after remission of psychotic symptoms . As cognitive deficits are associated with poor functional outcome , they form an important focus of treatment . There are relatively few head-to-head comparisons of the effects of second generation antipsychotics on cognition in recent onset schizophrenia . This is the first study to compare the effects of a short term treatment of olanzapine versus ziprasidone on cognitive functioning in recent onset schizophrenia . An earlier study conducted in chronic patients revealed an enhancement of cognition after treatment for both agents , but the extent of improvement was not significantly different between ziprasidone and olanzapine . METHOD Patients with recent onset schizophrenia with limited previous exposure to medical treatment underwent a double blind r and omized controlled treatment trial . Fifty-six patients completed the neuropsychological testing procedure prior to r and omization and after eight weeks of treatment and were included in the analysis . We tested cognitive functioning in general and verbal memory in particular . We calculated a single unweighted composite score based on nine cognitive tests to determine general cognitive functioning . RESULTS Cognition appeared enhanced after treatment , but was not significantly different between treatment groups , neither for the verbal memory measures , nor for the neurocognitive composite score . Furthermore , cognitive enhancement did not correlate to clinical improvement . CONCLUSION Cognitive deficits are not a reason for preferentially prescribing one of the two second generation antipsychotics tested over the other OBJECTIVE The presence of cognitive dysfunction in schizophrenia has been well documented , but questions remain about whether there are relationships between this dysfunction and clinical symptomatology . If present , such relationships should be most clearly observable in patients with first episode schizophrenia ; that is , before the effects of chronic illness , institutionalization , or treatment might confound them . METHOD 307 schizophrenia subjects in their first episode of illness were recruited to participate in a clinical trial comparing the long-term efficacy of haloperidol and risperidone . The psychopathology , cognitive functioning , early treatment history , and duration of untreated psychosis of these subjects were assessed prior to their assignment to r and omized , double-blind treatment . Approximately two-thirds of the subjects were receiving antipsychotic treatment at the time of assessment ; however , the duration of treatment was limited to 12 weeks or less . RESULTS The severity of negative symptoms at the time of assessment was associated with deficits in memory , verbal fluency , psychomotor speed and executive function . Positive symptoms were not associated with cognitive deficits . Also , the duration of untreated illness ( DUI ) prior to assessment was not significantly associated with cognitive impairment . CONCLUSIONS The results of this study of first episode schizophrenia patients suggest that a relationship exists between negative symptoms and cognitive dysfunction . However , that relationship accounts for only a minor portion of the variance ( i.e. , 10 - 15 % ) in the severity of cognitive dysfunction after controlling for a number of potentially confounding factors . This finding provides support for the theory that the neurobiological processes that give rise to symptomatology and cognitive dysfunction in schizophrenia are partially overlapping BACKGROUND Antipsychotic drugs are usually the first line of treatment for schizophrenia ; however , many patients refuse or discontinue their pharmacological treatment . We aim ed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs . METHODS We did a single-blind r and omised controlled trial at two UK centres between Feb 15 , 2010 , and May 30 , 2013 . Participants aged 16 - 65 years with schizophrenia spectrum disorders , who had chosen not to take antipsychotic drugs for psychosis , were r and omly assigned ( 1:1 ) , by a computerised system with permuted block sizes of four or six , to receive cognitive therapy plus treatment as usual , or treatment as usual alone . R and omisation was stratified by study site . Outcome assessors were masked to group allocation . Our primary outcome was total score on the positive and negative syndrome scale ( PANSS ) , which we assessed at baseline , and at months 3 , 6 , 9 , 12 , 15 , and 18 . Analysis was by intention to treat , with an ANCOVA model adjusted for site , age , sex , and baseline symptoms . This study is registered as an International St and ard R and omised Controlled Trial , number 29607432 . FINDINGS 74 individuals were r and omly assigned to receive either cognitive therapy plus treatment as usual ( n=37 ) , or treatment as usual alone ( n=37 ) . Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group , with an estimated between-group effect size of -6.52 ( 95 % CI -10.79 to -2.25 ; p=0.003 ) . We recorded eight serious adverse events : two in patients in the cognitive therapy group ( one attempted overdose and one patient presenting risk to others , both after therapy ) , and six in those in the treatment as usual group ( two deaths , both of which were deemed unrelated to trial participation or mental health ; three compulsory admissions to hospital for treatment under the mental health act ; and one attempted overdose ) . INTERPRETATION Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs . Evidence -based treatments should be available to these individuals . A larger , definitive trial is needed . FUNDING National Institute for Health Research Antipsychotic discontinuation rates are a powerful indicator of medication effectiveness in schizophrenia . We examined antipsychotic discontinuation in the Schizophrenia Outpatient Health Outcomes ( SOHO ) study , a 3-year prospect i ve , observational study in out patients with schizophrenia in 10 European countries . Patients ( n=7728 ) who started antipsychotic monotherapy were analyzed .  Medication discontinuation for any cause ranged from 34 % and 36 % for clozapine and olanzapine , respectively , to 66 % for quetiapine . Compared to olanzapine , the risk of treatment discontinuation before 36 months was significantly higher for quetiapine , risperidone , amisulpride , and typical antipsychotics ( oral and depot ) , but similar for clozapine .  Longer medication maintenance was associated with being socially active and having a longer time since first treatment contact for schizophrenia , whereas higher symptom severity , treatment with mood stabilizers , substance abuse , having hostile behaviour were associated with lower medication maintenance . Antipsychotic maintenance in SOHO was higher than the results of previous r and omized studies Social cognition has received increased attention in schizophrenia research because it is associated with functional outcomes . Psychosocial interventions are being developed to enhance social cognition , however less attention has been paid to the association between antipsychotic medication use and social cognition . This study evaluated whether individuals treated with olanzapine ( n=117 ) or quetiapine ( n=106 ) achieved improvements in social cognition . Participants were drawn from a larger 6-month , multi-site , r and omized , double-blind clinical trial .  Social cognition was assessed using signal detection analysis of performance on the Social Cue Recognition Test . Social functioning was measured with an interpersonal functioning index and a broader quality of life measure . Results revealed that participants in both medication groups improved significantly but modestly on three out of four social cognition subscales . The small observed effect in this trial is generally consistent with previous studies , and supports the need for ongoing research into the biological mechanisms of social cognitive dysfunction in schizophrenia Adolescent-onset psychoses often raise diagnostic difficulties because of the mixture of schizophrenic and affective features . This study examined prospect ively which clinical dimensions contribute to difficulty in initial diagnosis and which clinical features have predictive value for outcomes of  schizophrenia  or affective disorders  , and for eventual psychosocial functioning .  Thirty-six adolescents consecutively admitted for a psychotic episode were followed up for 1 to 4 years . Symptoms were assessed at admission , at discharge , and once a year . DSM-III-R ( APA 1989 ) diagnoses were assessed at admission and once a year . Comparisons were performed across initial and followup diagnostic groups . Positive symptoms did not differentiate the initial clinical pictures , while negative symptoms , manic symptoms , and disorganization differentiated the manic and depressive episodes in the acute phase . When initial positive symptoms ( mainly delusions ) were severe , they predicted a final diagnosis in the schizophrenia spectrum . Poor outcome was associated with more anhedonia-associality and lower functioning scores at admission . Results suggest ( 1 ) a higher vulnerability to positive symptoms in adolescents who will further develop schizophrenia and ( 2 ) the low specificity of affective symptoms at this age BACKGROUND Data on attaining and maintaining symptom remission associated with specific antipsychotic medications are rare and variant . AIMS To examine remission rates and their variation by antipsychotic medication in chronic schizophrenia in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness ( CATIE ) given it has an 18-month duration and representative antipsychotic medications . METHODS Symptom remission was examined using the Remission in Schizophrenia Working Group remission criteria of attaining and maintaining for 6 months with mild ratings on 8 specific Positive and Negative Syndrome Scale ( PANSS ) items . Remission rates were assessed ( a ) up to 18 months across CATIE 's switching phases ( n = 1332 ) ; and ( b ) in phase 1 ( that involved double-blind r and omization to one of five antipsychotic medications ) to compare antipsychotic medication differences in attaining and maintaining remission among patients not in remission at baseline ( n = 941 ) . RESULTS At baseline 16.2 % of patients were in symptomatic remission . Across the medication phases of CATIE only 11.7 % attained and then maintained at least 6 months of symptomatic remission , and 55.5 % ( n = 623 ) experienced no symptom remission at any visit . During the first medication r and omization phase , attaining and maintaining remission for 6 months was highest for the olanzapine ( 12.4 % ) medication group followed by the quetiapine ( 8.2 % ) , perphenazine ( 6.8 % ) , ziprasidone ( 6.5 % ) , and risperidone ( 6.3 % ) groups . CONCLUSIONS As currently defined , remission appears to be a very difficult therapeutic target to attain and maintain in chronic schizophrenia and may differ by antipsychotic medication . Pragmatically , remission gradients may be effectively studied by applying modified duration and symptom criteria 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 Atendency to extract spurious , message-like meaning from meaningless noise was assessed as a risk factor leading to schizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms . These individuals were r and omised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2 . A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition ( olanzapine v. no drug ) and length of speech illusion , with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment
At the time of this review , seven AAPs were available in Canada : aripiprazole clozapine olanzapine paliperidone quetiapine risperidone ziprasidone
Schizophrenia is a mental illness that requires lifelong treatment and is associated with symptoms that include hallucinations , delusions , cognitive impairment , disorganized thoughts , social withdrawal , and low motivation .
Antipsychotic medications are effective at relieving the symptoms of schizophrenia , and they form the foundation of treatment .