The Efficacy and Safety of Conventional and Atypical Antipsychotics in First-Episode Schizophrenia: A Review of the Literature

Abstract

Objective: To review the evidence for the short- and long-term efficacy and safety of conventional and atypical agents in patients with first-episode schizophrenia, and to highlight strategies to improve medication adherence in this patient group. Methods: Studies published or in press between January 1975 and December 2006 that evaluated the efficacy and safety of conventional and atypical antipsychotic agents in first-episode schizophrenia were identified from a literature search using MEDLINE and reviewed. In addition, issues of adherence to medication were reviewed. Results: Seventeen studies were identified that met criteria for inclusion in the review. Results from short-term studies indicate that both atypical and conventional agents produced substantial and significant reductions in symptom severity and psychopathology. However, the long-term studies found advantages for atypical antipsychotics over conventional agents, including faster treatment responses, fewer relapses, more time spent in remission, and better retention of patients in treatment. In general, conventional antipsychotics were associated with more extrapyramidal symptoms, while patients receiving atypical agents experienced greater weight gain and prolactin elevation. Studies that compared dosages suggest that lower doses are as or more effective than higher doses in first-episode patients. Adherence remains a critical problem in the first episode. Long-acting antipsychotic agents that ensure continuous drug delivery and the provision of appropriate psychosocial therapy have the potential to address this problem. Initial data reviewed here suggest that long-acting risperidone, the first atypical antipsychotic available in a long-acting formulation, could be a valuable addition to the armamentarium of pharmacologic treatment strategies for longterm treatment of first-episode schizophrenia. Conclusion: Atypical antipsychotic agents offer advantages in the long-term management of first-episode schizophrenia. A long-acting atypical antipsychotic may provide a novel strategy for patients with first-episode schizophrenia.