The stable patient with schizophrenia--from antipsychotic effectiveness to adherence

Long-term treatment of stable schizophrenia focuses on treatment effectiveness, addressing direct efficacy plus treatment adherence, treatment burden, and impact on factors such as weight gain. With the introduction of atypical antipsychotics such as aripiprazole, reduced side effects may lead to improved long-term treatment. The Clinical Trials of Intervention Effectiveness (CATIE) study where 1500 patients were randomised to atypical antipsychotics (olanzapine, quetiapine, risperidone, ziprasidone), or the typical antipsychotic drug perphenazine showed high discontinuation rates of 74% after 18 months, but extrapyramidal side effects were lower after atypical antipsychotic treatment compared with perphenazine. Twenty-six weeks of aripiprazole treatment, assessed in 284 patients in the Schizophrenia Trial of Aripiprazole (STAR) showed that aripiprazole had similar discontinuation rates to the atypical antipsychotics standard of care. In the CATIE study, weight gain was common during treatment. In contrast, STAR demonstrated a favourable weight profile for aripiprazole, with a mean weight loss of 0.41 kg. Results from these naturalistic trials help define the effectiveness of atypical antipsychotics for long-term treatment.