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Atypical antipsychotics in the treatment of schizophrenia: Systematic review, metaregression and evidence-based treatment recommendations
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ATYPICAL ANTIPSYCHOTICS IN THE TREATMENT OF SCHIZOPHRENIA: SYSTEMATIC REVIEW, METAREGRESSION AND EVIDENCE-BASED TREATMENT RECOMMENDATIONS J.R. Geddes 1 on behalf of the Royal College of Psychiatrists/British Psychological Society Guideline Development G r o u p 1University Department of Psychiatry, WarneJbrdHospital, Oxford OX3 7JX
Introduction: There is uncertainty about the place of the atypical antipsychotic drugs in the treatment of schizophrenia. The RCPsych and BPS GDP systematically reviewed the evidence and produced evidence-based treatment recommendations. Methods: Systematic reviews of randomised controlled trials assessing the effectiveness and tolerability of amisulpride, clozapine, olanzapine, quetiapine, risperidone and sertindole compared with conventional drugs were undertaken. Metaanalysis and meta-regression were used to synthesise the results and to formally investigate heterogeneity between trials. Results: 52 randomised trials including 12,649 patients compared the atypical antipsychotics with conventional drugs. There was substantial heterogeneity between the trials for both symptom reduction and drop-out that the analysis suggested was explained by the dose of conventional drug used in the trials. Using conventional drugs in daily doses of 12mg haloperidol (or equivalent) or less, led to similar efficacy and drop-out as atypical drugs, but still caused higher rates of extra pyramidal side effects. Conclusion: There is no clear evidence that atypical antipsychotics are more effective or have better overall tolerability than conventional drugs. Initial treatment of an episode of schizophrenia should be with a low-dose conventional antipsychotic drug. An atypical drug should be used of a patient (a) has inadequate clinical response to conventional drugs or (b) develops unacceptable EPS at the minimal effective dose of conventional drug.
THE EFFECTS OF TYPICAL AND ATYPICAL NEUROLEPTICS ON NEUROPSYCHOLOGICAL AND OCULOMOTOR FUNCTION IN FIRST-EPISODE SCHIZOPHRENIA
S.B. Hutton, I. Cuthbert, S. Mutsatsa, C. Kennard, T R . E . Barnes, E.M. Joyce
Dept. of Psychiatry, Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine, St. Dunstan's Road, London, W6 8RF Research suggests that atypical neuroleptics may improve performance on certain neurocognitive tasks in patients with schizophrenia. The effects of atypical neuroleptics on oculomotor function arc largely unexplored. The effects of neuroleptic type on both neuropsychological and oculomotor functioning were examined in a group of patients with first-episode schizophrenia. Compared to patients receiving typical neuroleptics, patients receiving olanzapine had better smooth pursuit performance and made less hypometric saccades on a predictive saccade paradigm. Whilst they also made fewer antisaccade errors, this difference was not statistically significant. Only patients receiving typical neuroleptics were impaired relative to controls on the smooth pursuit and predictive paradigms. On the neuropsychological paradigms, patients receiving olanzapine had higher spatial span scores, higher spatial recognition memory scores and made fewer errors on an attentional set shifting task. Only the patients treated with typical neuroleptics performed poorly on these measures compared to controls. Performance on tests of spatial working memory, planning and pattern recognition memory were equally impaired in both patient groups. The two patient groups did not differ in terms of their symptom severity, age, estimated IQ or neuroleptic dose in chlorpromazine equivalent units. These results indicate that olanzapine may improve performance on selective tests of oculomotor and neuropsychological function.
ATYPICAL ANTIPSYCHOTICS IN THE TREATMENT OF SCHIZOPHRENIA: SYSTEMATIC REVIEW, METAREGRESSION AND EVIDENCE-BASED TREATMENT RECOMMENDATIONS J.R. Geddes 1 on behalf of the Royal College of Psychiatrists/British Psychological Society Guideline Development G r o u p 1University Department of Psychiatry, WarneJbrdHospital, Oxford OX3 7JX
Introduction: There is uncertainty about the place of the atypical antipsychotic drugs in the treatment of schizophrenia. The RCPsych and BPS GDP systematically reviewed the evidence and produced evidence-based treatment recommendations. Methods: Systematic reviews of randomised controlled trials assessing the effectiveness and tolerability of amisulpride, clozapine, olanzapine, quetiapine, risperidone and sertindole compared with conventional drugs were undertaken. Metaanalysis and meta-regression were used to synthesise the results and to formally investigate heterogeneity between trials. Results: 52 randomised trials including 12,649 patients compared the atypical antipsychotics with conventional drugs. There was substantial heterogeneity between the trials for both symptom reduction and drop-out that the analysis suggested was explained by the dose of conventional drug used in the trials. Using conventional drugs in daily doses of 12mg haloperidol (or equivalent) or less, led to similar efficacy and drop-out as atypical drugs, but still caused higher rates of extra pyramidal side effects. Conclusion: There is no clear evidence that atypical antipsychotics are more effective or have better overall tolerability than conventional drugs. Initial treatment of an episode of schizophrenia should be with a low-dose conventional antipsychotic drug. An atypical drug should be used of a patient (a) has inadequate clinical response to conventional drugs or (b) develops unacceptable EPS at the minimal effective dose of conventional drug.
THE EFFECTS OF TYPICAL AND ATYPICAL NEUROLEPTICS ON NEUROPSYCHOLOGICAL AND OCULOMOTOR FUNCTION IN FIRST-EPISODE SCHIZOPHRENIA
S.B. Hutton, I. Cuthbert, S. Mutsatsa, C. Kennard, T R . E . Barnes, E.M. Joyce
Dept. of Psychiatry, Division of Neuroscience and Psychological Medicine, Imperial College School of Medicine, St. Dunstan's Road, London, W6 8RF Research suggests that atypical neuroleptics may improve performance on certain neurocognitive tasks in patients with schizophrenia. The effects of atypical neuroleptics on oculomotor function arc largely unexplored. The effects of neuroleptic type on both neuropsychological and oculomotor functioning were examined in a group of patients with first-episode schizophrenia. Compared to patients receiving typical neuroleptics, patients receiving olanzapine had better smooth pursuit performance and made less hypometric saccades on a predictive saccade paradigm. Whilst they also made fewer antisaccade errors, this difference was not statistically significant. Only patients receiving typical neuroleptics were impaired relative to controls on the smooth pursuit and predictive paradigms. On the neuropsychological paradigms, patients receiving olanzapine had higher spatial span scores, higher spatial recognition memory scores and made fewer errors on an attentional set shifting task. Only the patients treated with typical neuroleptics performed poorly on these measures compared to controls. Performance on tests of spatial working memory, planning and pattern recognition memory were equally impaired in both patient groups. The two patient groups did not differ in terms of their symptom severity, age, estimated IQ or neuroleptic dose in chlorpromazine equivalent units. These results indicate that olanzapine may improve performance on selective tests of oculomotor and neuropsychological function.