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New generation antipsychotics for first episode schizophrenia.
C Rummel1, J Hamann, W Kissling
1Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, Möhlstr. 26, Munich, Germany, 81675.
The Cochrane Database of Systematic Reviews
|October 30, 2003
Summary
Newer antipsychotics show fewer adverse effects than older drugs like haloperidol for first-episode schizophrenia. However, conclusive evidence on long-term compliance and effectiveness is still lacking, requiring further research.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Medicine
Background:
- New generation antipsychotics (NGAs) offer a lower risk of adverse effects compared to conventional antipsychotics such as haloperidol.
- Treatment guidelines often recommend NGAs for individuals experiencing their first episode of schizophrenia.
Purpose of the Study:
- To evaluate the efficacy and safety of NGAs in patients with a first episode of schizophrenia or schizophrenia-like psychoses.
- To compare NGAs against conventional antipsychotics in this specific patient population.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials.
- Searched multiple databases including the Cochrane Schizophrenia Group's register up to March 2002.
- Included trials comparing specific NGAs (e.g., risperidone, olanzapine) with haloperidol, assessing outcomes like early discontinuation, clinical improvement, and adverse events.
Main Results:
- Two short-term studies (n=266) were included, comparing risperidone and olanzapine with haloperidol.
- Olanzapine showed significantly lower early discontinuation rates and greater clinical improvement compared to haloperidol.
- Both risperidone and olanzapine demonstrated fewer adverse events and reduced need for anticholinergic medication compared to haloperidol.
Conclusions:
- Current evidence is inconclusive regarding the long-term benefits of NGAs for first-episode schizophrenia.
- The impact of NGAs on treatment adherence and long-term outcomes remains unclear.
- Well-designed, long-term randomized clinical trials are needed to provide definitive answers.