Atypical antipsychotic drugs and long-term outcome in schizophrenia

Long-term outcomes for patients with schizophrenia have been disappointing. The article discusses how the typical antipsychotics (clozapine and risperidone) as well as several agents that should be available in the near future (olanzapine, sertindole, quetiapine, and ziprasidone) might improve outcome and then focuses on antipsychotic relapse rates and the newly released antipsychotic olanzapine. Considerable evidence shows that relapse rates for compliant patients maintained on atypical antipsychotics are substantially lower than rates for those maintained on conventional antipsychotics. Also, the decreased extrapyramidal symptom liability of the newer medications will make it easier to prescribe more effective doses of antipsychotic that can maximize relapse prevention without simultaneously interfering with the patient's quality of life or motor functioning. The authors describe clinical observations of olanzapine based on their 3 years of clinical experience using this agent in a phase 3 clinical trial. They suggest that as atypical antipsychotics like olanzapine are more widely used, some problems associated with the long-term use of conventional antipsychotics will diminish, but other issues and concerns will be more common. In particular: (1) Despite their better side effect profiles, atypical antipsychotics will not solve the noncompliance problem. A significant proportion of patients with schizophrenia will still need depot therapy. (2) There will be problems arising from "awakenings" phenomena where patients will become more in touch with their losses and painful inner feelings. It seems likely that the need for rehabilitation services will be increased as more patients improve to the point where they will be amenable to psychiatric rehabilitation.