Abstract
BackgroundLong-stay patients with severe schizophrenia are frequently treated with high doses of first-generation antipsychotics (FGA). Dose reduction or switching to ziprasidone may reduce the severity of negative symptoms or side effects.MethodsIn a randomized double-blind trial, we compared the effect of FGA dose reduction (to equivalent of 5 mg/day haloperidol) (n=24) or switching to ziprasidone 160 mg/day (n=24). Negative symptoms after 1 year of treatment were primary outcome measure. Treatment failure was defined as a prolonged (>4 weeks) or repeated relapse.ResultsNegative symptoms did not change significantly during dose reduction nor was there a significant difference between treatments. Neurological side effects diminished in both conditions. Positive symptoms, excited symptoms, and emotional distress worsened over time with ziprasidone, resulting in a significant difference in favour of FGA dose reduction. More patients in the ziprasidone condition (46%) than in the FGA condition (21%) relapsed. Although some recovered within 4 weeks, treatment failed in 25% of the patients in the ziprasidone condition and in 17% of the patients in the FGA condition (non-significant differences). In about 80% of patients, doses could be reduced without a prolonged increase in symptom severity.DiscussionIn long-stay patients with severe schizophrenia, reducing high doses of FGA to a dose equivalent of 5 mg/day haloperidol or switching to ziprasidone did not improve negative symptoms. Reducing antipsychotic doses was feasible in most patients, although the risk of relapse is substantial. Neither FGA dose reduction nor ziprasidone seems an adequate alternative to clozapine for treatment-resistant schizophrenia.
Highlights
Relapse prevention is a major aim of any treatment for schizophrenia patients
Little is known about the impact of Cognitive Remediation Therapy (CRT) on relapse prevention
During 5- and 8-year follow-up, 78% and 83% of treatment as usual (TAU) patients relapsed compared to 48% and 52% of Integrated Neurocognitive Therapy (INT) patients suggesting a significant benefit of INT
Summary
Accumulating evidence indicates that cognitive remediation(CR) is effective for improving various cognitive deficits in adult patients with schizophrenia. Reports of brain plasticity in older adults and the service needs of chronic mid-aged and older patients with schizophrenia are increasing, very few randomized controlled trials of CR have been conducted in mid-aged and older inpatients with schizophrenia. We investigated the efficacy of individualized CR on the cognitive impairments of mid-aged and older inpatients with schizophrenia within the context of comprehensive psychiatric rehabilitation(PR) by comparing the results obtained with PR only and treatment as usual(TAU). Methods: Fifty-seven mid-aged and older individuals with schizophrenia (age mean: 50.07 sd: 6.01) and mild to moderate cognitive deficits were enrolled. For PR groups (CR+PR group and PR only group) received comprehensive inpatient PR, including optimal
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