What CATIE did: some thoughts on implications deep and wide

The author discusses five lessons that can be learned from the seminal results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). The lessons extend beyond practice implications to fundamental questions about how psychopharmacology studies are conducted and how results are interpreted and given relevance in regard to prescribing. The author recounts the history of the term "atypical" and how it came to be understood in the context of antipsychotics. The error of using high-dose haloperidol as a comparator in assessments of new antipsychotics -- and of generalizing from the results of these studies -- is also discussed. The CATIE results force uncomfortable questions about the extent of knowledge concerning the clinical pharmacology of a major treatment modality, which the author illustrates by examining possible reasons for the differential clinical actions of clozapine. The author concludes that CATIE benefited both patients and clinicians by opening up to patients the full gamut of antipsychotics for treatment planning and by reinstating to physicians their key skill in expert, individualized prescribing.