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A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis.
J Clin Psychiatry. 2006 Oct; 67(10):1511-21.JC

Abstract

OBJECTIVE

Randomized controlled drug trials have demonstrated that antipsychotic medication is effective to rapidly improve psychotic symptomatology in first-episode psychosis. However, these results may not be generalizable to routine clinical practice. We evaluated the effectiveness, tolerability, and safety of olanza-pine, risperidone, and haloperidol in individuals with first-episode nonaffective psychosis who are representative of clinical practice and who are treated in routine clinical settings.

METHOD

172 patients participated in a practical clinical trial and were randomly assigned to haloperidol (N = 56), risperidone (N = 61), and olanzapine (N = 55). The mean modal daily doses were 5.4 mg/day for halo-peridol, 4 mg/day for risperidone, and 15.3 mg/day for olanzapine; 98.3% of subjects were drug naive at baseline. Data from clinical measures of treatment response and tolerability and safety data from the 6-week acute phase of a large epidemiologic and longitudinal (February 2001 to February 2005) intervention program of first-episode psychosis (schizophrenia spectrum disorders, DSM-IV criteria) are reported.

RESULTS

All 3 treatments showed similar effectiveness in reducing the severity of general, negative, and positive symptomatology after 6 weeks of treatment, as reported by mean change in total Clinical Global Impressions-Severity of Illness scale, Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms scores between baseline and 6 weeks. The proportion of study subjects responding, defined as 40% or greater BPRS total score improvement from baseline, was 57.1% (N = 32 of 56) haloperidol, 52.5% (N = 32 of 61) risperidone, and 63.6% (N = 35 of 55) olanzapine, with no statistical differences among groups. The frequency of extrapyramidal symptoms (chi(2) = 24.519; p < .001) and concomitant anticholinergic medication use (chi(2) = 57.842; p < .0001) was greater with haloperidol than olanzapine or risperidone. Olanzapine-treated patients had significantly more weight gain compared with the haloperidol and risperidone groups (p < .001).

CONCLUSION

Relatively low doses of haloperidol, risperidone, and olanzapine are equally effective for the acute treatment of first-episode nonaffective psychosis under usual conditions of real clinical practice.

Authors+Show Affiliations

University Hospital Marqués de Valdecilla, Department of Psychiatry, Santander, Spain. bcfacorro@humv.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17107241

Citation

Crespo-Facorro, Benedicto, et al. "A Practical Clinical Trial Comparing Haloperidol, Risperidone, and Olanzapine for the Acute Treatment of First-episode Nonaffective Psychosis." The Journal of Clinical Psychiatry, vol. 67, no. 10, 2006, pp. 1511-21.
Crespo-Facorro B, Pérez-Iglesias R, Ramirez-Bonilla M, et al. A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. J Clin Psychiatry. 2006;67(10):1511-21.
Crespo-Facorro, B., Pérez-Iglesias, R., Ramirez-Bonilla, M., Martínez-García, O., Llorca, J., & Luis Vázquez-Barquero, J. (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. The Journal of Clinical Psychiatry, 67(10), 1511-21.
Crespo-Facorro B, et al. A Practical Clinical Trial Comparing Haloperidol, Risperidone, and Olanzapine for the Acute Treatment of First-episode Nonaffective Psychosis. J Clin Psychiatry. 2006;67(10):1511-21. PubMed PMID: 17107241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. AU - Crespo-Facorro,Benedicto, AU - Pérez-Iglesias,Rocío, AU - Ramirez-Bonilla,Mariluz, AU - Martínez-García,Obdulia, AU - Llorca,Javier, AU - Luis Vázquez-Barquero,José, PY - 2006/11/17/pubmed PY - 2007/2/24/medline PY - 2006/11/17/entrez SP - 1511 EP - 21 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 67 IS - 10 N2 - OBJECTIVE: Randomized controlled drug trials have demonstrated that antipsychotic medication is effective to rapidly improve psychotic symptomatology in first-episode psychosis. However, these results may not be generalizable to routine clinical practice. We evaluated the effectiveness, tolerability, and safety of olanza-pine, risperidone, and haloperidol in individuals with first-episode nonaffective psychosis who are representative of clinical practice and who are treated in routine clinical settings. METHOD: 172 patients participated in a practical clinical trial and were randomly assigned to haloperidol (N = 56), risperidone (N = 61), and olanzapine (N = 55). The mean modal daily doses were 5.4 mg/day for halo-peridol, 4 mg/day for risperidone, and 15.3 mg/day for olanzapine; 98.3% of subjects were drug naive at baseline. Data from clinical measures of treatment response and tolerability and safety data from the 6-week acute phase of a large epidemiologic and longitudinal (February 2001 to February 2005) intervention program of first-episode psychosis (schizophrenia spectrum disorders, DSM-IV criteria) are reported. RESULTS: All 3 treatments showed similar effectiveness in reducing the severity of general, negative, and positive symptomatology after 6 weeks of treatment, as reported by mean change in total Clinical Global Impressions-Severity of Illness scale, Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms scores between baseline and 6 weeks. The proportion of study subjects responding, defined as 40% or greater BPRS total score improvement from baseline, was 57.1% (N = 32 of 56) haloperidol, 52.5% (N = 32 of 61) risperidone, and 63.6% (N = 35 of 55) olanzapine, with no statistical differences among groups. The frequency of extrapyramidal symptoms (chi(2) = 24.519; p < .001) and concomitant anticholinergic medication use (chi(2) = 57.842; p < .0001) was greater with haloperidol than olanzapine or risperidone. Olanzapine-treated patients had significantly more weight gain compared with the haloperidol and risperidone groups (p < .001). CONCLUSION: Relatively low doses of haloperidol, risperidone, and olanzapine are equally effective for the acute treatment of first-episode nonaffective psychosis under usual conditions of real clinical practice. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/17107241/A_practical_clinical_trial_comparing_haloperidol_risperidone_and_olanzapine_for_the_acute_treatment_of_first_episode_nonaffective_psychosis_ DB - PRIME DP - Unbound Medicine ER -