Schizophrenia Patient Outcomes Research Articles

Role of paliperidone palmitate 3-monthly in the management of schizophrenia: insights from clinical practice.

Schizophrenia is a complex, chronic psychiatric disorder associated with reduced quality of life and shortened life span. The majority of patients with schizophrenia will relapse within 1 year following an acute episode. The ultimate goals of treatment are to improve functional capabilities, minimize residual symptoms during periods of remission, and decrease relapse frequency and duration, as each relapse brings with it the possibility of a worsening prognosis. Maintaining therapeutic continuity is essential for long-term, positive patient outcomes in schizophrenia. Medication nonadherence and symptomatic relapses magnify the disease burden associated with this disorder. Medication adherence in chronic disease states generally improves with a decrease in dosing frequency. Long-acting injectable (LAI) antipsychotics were developed to improve patient outcomes secondarily to improving medication adherence. Paliperidone palmitate 3-monthly injection (PP3M) is the only LAI available with a quarterly dosing interval. PP3M has been US Food and Drug Administration-approved for use in the long-term maintenance treatment of schizophrenia in patients already controlled on once-monthly PP LAI (paliperidone palmitate once-monthly injection [PP1M]) for a minimum of 4 months. As current evidence supports the efficacy and tolerability of PP3M compared to PP1M and placebo, PP3M appears to be a viable treatment option for patients previously maintained on PP1M. However, to truly establish the place of PP3M in therapy relative to other oral antipsychotics and LAIs, more research is needed. This narrative review aims briefly to describe the pharmacotherapeutic characteristics of PP3M and summarize current literature pertaining to the use of PP3M in the management of schizophrenia.

Long-term behavioural effects of maternal obesity in C57BL/6J mice

Diet is increasingly being recognised as an important contributor to mental health. A diet high in sugar and polyunsaturated fatty acids can have negative consequences for disease symptoms and outcomes in schizophrenia patients. There is also evidence that particular diets can have beneficial, therapeutic-like properties for human brain disorders. Additionally, dietary choices of mothers have been found to affect cognitive domains and anxiety behaviour of offspring. Here we investigated the effects of maternal high fat diet (HFD) on a variety of behavioural domains in offspring and also consider behaviours, which are schizophrenia-relevant. Female C57BL/6 J mice were fed HFD (N = 13) or chow (N = 11) from 6 weeks prior to mating, during gestation and lactation. The male offspring of these mothers were weaned onto chow on PND24 and underwent testing for a range of behavioural outcomes starting at 38 weeks of age. Offspring of HFD mothers were significantly heavier compared to those of control mothers from weaning and throughout the duration of the experiment. Offspring of HFD mothers had significantly improved sensorimotor gating compared to offspring of control mothers but showed no altered behavioural response in tests for cognition, sociability, locomotion or exploration. Future investigations are required to assess which HFD-induced factors are responsible for the effects, e.g. altered maternal nursing behaviour, altered gestational physiology, or others warrants further investigation.

Electroconvulsive Therapy for Agitation in Schizophrenia: Metaanalysis of Randomized Controlled Trials.

BackgroundAgitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported.AimsTo systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia.MethodsSystematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes.ResultsSeven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score (WMD=-1.97, p<0.0001) as well as the PANSS total score at 14 days (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p=0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days (WMD=-5.01, p=0.02). Headache (number-needed-to-harm (NNH)=3, 95%CI=2-4) was more frequent in the ECT alone group compared to AP monotherapy. According to the GRADE approach, the evidence levels of main outcomes were rated as ‘‘very low’’ (37.5%) and “low” (50%).ConclusionPooling of the data based on 7 RCTs from China found no advantage of ECT alone or ECT-APs combination in the treatment of agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations.

Relationship between objectively measured sedentary behavior and health outcomes in schizophrenia patients: The PsychiActive project

This study aimed to investigate possible relationships between sedentary behavior and body mass index (BMI), cardiorespiratory fitness (CRF), and health-related quality of life (HRQoL) in schizophrenia patients. Variables contributing to the variability in sedentary behavior were identified. Eighty-two schizophrenia outpatients (mean age±SD: 41.0±8.7years, 87% men, mean illness duration±SD: 17.1±8.9years) wore a multisensor armband for 7 consecutive full days to objectively measure sedentary behavior. BMI, walking capacity (6-minute walking test) as a proxy for CRF estimation and HRQoL (Short Form 36-Item Health Survey questionnaire version 2) were also assessed. Correlation (Pearson or Spearman coefficients) and multiple regression analysis were used. Sedentary behavior was significantly associated with BMI, CRF, and the physical component summary score of HRQoL (r values, −0.34–0.41; all P<0.001) and remained significant after adjustments for age, illness duration, symptom severity, adherence to Mediterranean diet, smoking, and antipsychotic medication (all P<0.05). BMI, CRF and vitality were identified as determinants of sedentary behavior. Consistent relationships between sedentary behavior and BMI, CRF, and the physical component summary score of HRQoL were found in schizophrenia patients. All the identified determinants of sedentary behavior are modifiable and may be important areas for future interventions in this population.

Biological and cognitive correlates of cortical curvature in schizophrenia

Mean cortical curvature may relate to cortico-cortical connections integrity. We explored the association between prefrontal (PFC) cortical curvature and fractional anisotropy (FA) values for tracts connecting PFC and relevant cortical regions. In schizophrenia Anatomical and diffusion magnetic resonance images were obtained from 34 patients (16 of them first-episodes) and 32 healthy controls. We calculated curvature at rostral lateral prefrontal (RLPF) and superior medial prefrontal (SMPF) areas and mean FA for the tracts respectively connecting RLPF and SMPF areas with anterior caudal cingulate (ACC), superior temporal gyrus (STG) and superior parietal SP regions. Cognitive and clinical data were collected, including baseline symptoms, Clinical Global Impression change scores from baseline to follow-up, illness duration and treatment dosage. Patients showed significantly lower FA values in the tracts linking right RLPF-ACC, right SMPF-SPG and bilaterally PFC-STG. FA values in short-range cortico-cortical connections (linking PFC and ACC) were inversely associated with PFC curvature. In patients, cognitive performance was negatively associated with PFC curvature. Larger curvature values were associated to lack of clinical improvement at follow-up. We conclude that cortical curvature is influenced by integrity in short-range cortico-cortical connections and relates to cognition and clinical outcome in schizophrenia patients.

A multicentric study on cognitive functions in a large sample of patients with schizophrenia and their unaffected first-degree relatives

IntroductionNeurocognition may represent an indicator of genetic risk and poor outcome in schizophrenia patients (SCZ) predicting real life functioning.ObjectivesAs cognitive performance of unaffected first-degree relatives (UR) is intermediate between SCZ and healthy controls (HC), neurocognitive impairment may represent a marker of vulnerability to schizophrenia.AimsTo investigate social and neurocognition in all subjects and their impact on functional capacity of patients as markers of vulnerability.MethodsSample: 922 SCZ, 379 UR and 780 HC. Assessment: MATRICS Consensus Cognitive Battery (neurocognition), Facial Emotion Identification Test and Awareness of Social Inference Test (social cognition) and Specific Level of Functioning Scale (social functioning). Analyses: Structural Equation Model (SEM) analyses to model the impact of all variables on functional outcome.ResultsSCZ scored worse in all domains than UR and HC. UR had significant impairments in all cognitive domains with respect to HC. Cognitive functioning had direct and indirect impacts on functional outcome mainly through social cognition and functional capacity. Social cognition had a direct impact on outcome, independent of neurocognition.ConclusionSCZ and UR display similar patterns of social and neurocognition deficits. Our results confirm a strong impact of neurocogniton on functional outcome. Social cognition has become an interesting object of study and its conceptualization as trait variable and the existence of a continuum between SCZ and UR are hypotheses for further research.AcknowledgementsThe study was carried out within the project “Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Characteristics of motivation and their impacts on the functional outcomes in patients with schizophrenia

BackgroundDeficits of motivation have been considered to be a core feature of schizophrenia, and recent studies have begun to reveal the biological and psychological characteristics and mechanisms underlying the deficits in motivation in schizophrenia patients. The aims of the present study were to investigate the characteristics of motivation in schizophrenia patients using the General Causality Orientations Scale (GCOS), and the impacts of motivational orientations on the functional outcomes in schizophrenia patients. MethodsA total of 53 outpatients with schizophrenia and 38 healthy controls were recruited for this study. The GCOS was used to assess individual tendencies in respect of three different motivational orientations: the autonomy, controlled, and impersonal orientations, corresponding to intrinsic motivation, extrinsic motivation, and amotivation, respectively. The cognitive functioning, psychiatric symptoms, social functioning, and quality of life of the subjects were also assessed. ResultsThe score for autonomy orientation was significantly lower in the patient group than that in the control group, while no significant differences were found between the two groups in respect of the scores for the other two orientations. The autonomy orientation was associated with various clinical variables, and regression analysis identified as one of the variables with the highest predictive accuracy for social functioning. ConclusionsIntrinsic motivation measured by the GCOS in schizophrenia patients was significantly lower than that in healthy controls. The deficits of intrinsic motivation were broadly associated with the clinical features and were a determinant of social functioning. Development of treatments for enhancing intrinsic motivation would be essential for functional recovery in schizophrenia patients.

Defining the minimal clinically important difference (MCID) of the Heinrichs-carpenter quality of life scale (QLS).

To determine the Minimal Clinically Important Difference (MCID) of the Heinrichs-Carpenter Quality of Life Scale (QLS). Data from the "Schizophrenia Trial of Aripiprazole" (STAR) study were used in this analysis. The MCID value of the QLS total score was estimated using the anchor-based method. These findings were substantiated/validated by comparing the MCID estimate to other measurements collected in the study. Half of the patients (49%) showed improvement in Clinical Global Impressions of Severity (CGI-S) during the trial. The estimated MCID of the QLS total score was 5.30 (standard error: 2.60; 95% confidence interval: [0.16; 10.43]; p < 0.05). Patients were divided into two groups: "QLS improvers" (QLS total score increased ≥ six points) and "non-improvers". The QLS improvers had significantly better effectiveness and reported significantly higher levels of preference for their current medications. There was a statistically significant difference between the two groups in the change in two of the four domains of QLS; "Interpersonal relations" and "Intrapsychic foundations" domains during the study. These findings support the value of the estimated MCID for the QLS and may be a useful tool in evaluating antipsychotic treatment effects and improving long-term patient outcomes in schizophrenia. Copyright © 2015 John Wiley & Sons, Ltd.

Impact of paliperidone palmitate versus oral atypical antipsychotics on healthcare outcomes in schizophrenia patients.

To assess impact of initial treatment and time-dependent treatment with paliperidone palmitate (PP) versus oral atypical antipsychotics (OAAs) on healthcare resource utilization and costs. A retrospective longitudinal study was conducted among Medicaid beneficiaries with schizophrenia. Inverse probability treatment weighting method and marginal structural models were used to estimate the impact of treatment on healthcare resource utilization and costs, respectively. Compared to OAAs, PP was associated with lower medical costs (mean monthly cost difference [MMCD] = -US$256; p = 0.008), which offset the higher pharmacy expense (MMCD = US$122; p < 0.001) resulting in nonsignificant cost savings associated with PP (MMCD = -US$91; p = 0.689). PP was associated with comparable overall costs to OAAs, but with significantly lower medical costs, particularly attributable to reduced inpatient visits and long-term care admissions.

Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?

Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction?

Disorganized Symptoms Predicted Worse Functioning Outcome in Schizophrenia Patients with Established Illness.

Patients with schizophrenia were grouped into acutely ill (n=89), not remitted (n=89), and remitted (n=69). Three exploratory stepwise linear regression analyses were performed for each phase of schizophrenia, in which the five PANSS factors and demographic variables were entered as the independent variables and the total Global Assessment of Functioning Scale (GAF) score was entered as the dependent variable. An additional exploratory stepwise logistic regression analysis was performed to predict subsequent remission at discharge in the inpatient population. The Disorganized factor was the most significant predictor for acutely ill patients (p<0.001), while the Hostility factor was the most significant for not-remitted patients and the Negative factor was the most significant for remitted patients (p=0.001 and p<0.001, respectively). In the logistic regression, the Disorganized factor score presented a significant negative association with remission (p=0.007). Higher disorganization symptoms showed the greatest impact in functioning at acute phase, and prevented patients from achieving remission, suggesting it may be a marker of symptom severity and worse outcome in schizophrenia.

The influence of AHI1 variants on the diagnosis and treatment outcome in schizophrenia.

The present study aimed to explore whether four single nucleotide polymorphisms (SNPs) within the AHI1 gene could be associated with schizophrenia (SCZ) and whether they could predict the clinical outcomes in SCZ patients treated with antipsychotics. Four hundred twenty-six (426) in-patients with SCZ and 345 controls were genotyped for four AHI1 SNPs (rs11154801, rs7750586, rs9647635 and rs9321501). Baseline and clinical measures for SCZ patients were assessed through the Positive and Negative Syndrome Scale (PANSS). Allelic and genotypic frequencies in SCZ subjects were compared with those of controls using the χ2 statistics. The repeated-measure ANOVA was used for the assessment of treatment outcomes measured by PANSS changes. The case-control analysis did not show any difference in the genotypic distribution of the SNPs, while in the allelic analysis, a weak association was found between the rs9647635 A allele and SCZ. Furthermore, in the haplotype analysis, three haplotypes resulted in being associated with SCZ. On the other hand, two SNPs (rs7750586 and rs9647635) were associated with clinical improvement of negative symptoms in the allelic analysis, although in the genotypic analysis, only trends of association were found for the same SNPs. Our findings suggest a possible influence of AHI1 variants on SCZ susceptibility and antipsychotic response, particularly concerning negative symptomatology. Subsequent well-designed studies would be mandatory to confirm our results due to the methodological shortcomings of the present study.

EPA-1408 – Cognitive Remediation in Early Psychosis and in At-risk Mental States – Approaches and Efficacy

Cognitive impairments have a high prevalence in schizophrenia, and are important determinants of functional outcome and treatment responsiveness. They are well-documented in chronic schizophrenia patients but are already apparent before the onset of the disorder and are predictive of transition to psychosis. Cognitive Remediation approaches have proved to be effective in enhancing cognitive functions and functional outcome in multi-episode schizophrenia patients. Recent studies suggest that younger people with an early course of illness are even more likely to benefit from these interventions. Therefore, Cognitive Remediation approaches may be especially appropriate for early intervention in psychosis. However, there is still a paucity of studies that evaluated Cognitive Remediation in early psychosis patients and in those symptomatically at-risk for psychosis. Moreover, several approaches are summarized under the umbrella term Cognitive Remediation. Consequently, they differ in content, setting, and practical application. Therefore, it remains rather unclear which type of therapy works best for the specific treatment needs of these patients. Against this background, this presentation will summarize and critically discuss current CRT approaches and their efficacy in early psychosis and in at-risk mental states with regard to cognitions, symptom levels, and functional outcome. Furthermore, we will present novel treatments and study designs specifically developed for early intervention in psychosis.

Facial affect recognition in symptomatically remitted patients with schizophrenia and bipolar disorder

Both schizophrenia and bipolar disorder (BD) have consistently been associated with deficits in facial affect recognition (FAR). These impairments have been related to various aspects of social competence and functioning and are relatively stable over time. However, individuals in remission may outperform patients experiencing an acute phase of the disorders. The present study directly contrasted FAR in symptomatically remitted patients with schizophrenia or BD and healthy volunteers and investigated its relationship with patients' outcomes.Compared to healthy control subjects, schizophrenia patients were impaired in the recognition of angry, disgusted, sad and happy facial expressions, while BD patients showed deficits only in the recognition of disgusted and happy facial expressions. When directly comparing the two patient groups individuals suffering from BD outperformed those with schizophrenia in the recognition of expressions depicting anger. There was no significant association between affect recognition abilities and symptomatic or psychosocial outcomes in schizophrenia patients. Among BD patients, relatively higher depression scores were associated with impairments in both the identification of happy faces and psychosocial functioning.Overall, our findings indicate that during periods of symptomatic remission the recognition of facial affect may be less impaired in patients with BD than in those suffering from schizophrenia. However, in the psychosocial context BD patients seem to be more sensitive to residual symptomatology.

The beneficial effects of combining pharmacological and psychosocial treatment on remission and functional outcome in outpatients with schizophrenia

ObjectiveThe effects of pharmacological and psychosocial treatment on remission and the functional outcome in outpatients with schizophrenia were evaluated. Remission was assessed according to the criteria proposed by the Remission in Schizophrenia Working group and psychosocial functioning according to the Global Assessment of Functioning with a score > 60. Functional outcome was the result of these two variables. MethodOne hundred fifty two patients were randomized to receive either, antipsychotic treatment as usual (TAU) or social skills training and family psychoeducation in addition to TAU. A final sample of 119 patients: n = 68 in the social skills training group, and n = 51 in the TAU group completed the study protocol. Patients were assessed at baseline and at 6-month follow-up. ResultsAt the end of the study, 80% of the patients fulfilled the criteria for symptomatic remission: 62 patients (91.2%) in the social skills training group in contrast to 34 patients (66.7%) in the TAU group. Functional improvement criteria were accomplished by 41 patients (34.5%) at the endpoint of the study. Forty of these patients (58.8%) belonged to social skills training and one patient to customary treatment (χ2 = 41.7, df 1, p < 0.001) and when criteria for symptomatic remission and functional improvement were combined, 39 patients (97.5%) of the social skills training group and one patient (1.9%) of the customary treatment group achieved functional outcome. ConclusionThe results emphasize the need for psychosocial interventions as conjoint to pharmacological treatment to improve functional outcome in schizophrenia patients.

Improving Patient Outcomes in Schizophrenia

Too many patients with schizophrenia do not achieve the ultimate goal of treatment-recovery. The first step to recovery is achieving response to treatment for the acute psychotic episode. Clinicians should routinely use rating scales to measure treatment response. The next phase is remission of symptoms, which is one of the criteria for recovery. Relapses, however, can disrupt remission and hinder recovery by causing rehospitalization, treatment resistance, and loss of gains in function. Medication adherence plays a major role in preventing relapses so that patients can maintain remission and work toward recovery. Clinicians should educate patients about adherence and consider treatment options that will improve adherence. Recovery is attained when patients experience symptom remission, vocational role fulfillment, independent living, and social relationships for at least 2 years. The proportion of patients who reach recovery can be increased when clinicians focus on treatment adherence, consistent symptom measurement, and appropriate treatment plans tailored to each patient.

Psychiatrists&amp;rsquo; awareness of adherence to antipsychotic medication in patients with schizophrenia: results from a survey conducted across Europe, the Middle East, and Africa

BackgroundNonadherence is common among patients with schizophrenia, although the rates vary according to means of assessment and patient population. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes, including increasing the risk of relapse and rehospitalization. Understanding psychiatrists’ perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively.MethodsThe Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January–March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. The survey comprised 20 questions. In addition to recording the demographic details of the 4722 respondents (~12% response rate), it canvassed their preferred methods of assessing adherence, their perceptions of adherence rates, reasons for nonadherence, and strategies to improve adherence.ResultsPsychiatrists estimated that 53% of their patients with schizophrenia were partially/nonadherent during the previous month. They estimated only one-third of patients who deteriorated after stopping medication were able to attribute this to nonadherence. Psychiatrists assessed adherence most often by patient interview. Lack of insight was viewed as the most important cause of medication discontinuation, followed by patients feeling better and thinking their medication unnecessary, and experiencing undesirable side effects. Considerably fewer psychiatrists viewed insufficient efficacy, cognitive impairment, or drug/alcohol abuse as the most important reasons for their patients stopping medication.ConclusionPsychiatrists throughout EMEA recognize the impact of partial/nonadherence to medication, with patient enquiry being the most commonly used means of assessment. There remains a need for more proactive management of patients with schizophrenia, particularly in increasing patient insight of their illness in order to improve adherence and minimize the consequences of relapse. Strategies focused on raising awareness of the importance of adherence are also warranted, with the aim of improving patient outcomes in schizophrenia.

Towards medication-enhancement of cognitive interventions in schizophrenia.

Current antipsychotic medications do little to improve real-life function in most schizophrenia patients. A dispassionate view of the dispersed and variable neuropathology of schizophrenia strongly suggests that it is not currently, and may never be, correctable with drugs. In contrast, several forms of cognitive therapy have been demonstrated to have modest but lasting positive effects on cognition, symptoms, and functional outcomes in schizophrenia patients. To date, attempts to improve clinical outcomes in schizophrenia by adding pro-cognitive drugs to antipsychotic regimens have had limited success, but we propose that a more promising strategy would be to pair drugs that enhance specific neurocognitive functions with cognitive therapies that challenge and reinforce those functions. By using medications that engage spared neural resources in the service of cognitive interventions, it might be possible to significantly enhance the efficacy of cognitive therapies. We review and suggest several laboratory measures that might detect potential pro-neurocognitive effects of drugs in individual patients, using a "test dose" design, aided by specific biomarkers predicting an individual's drug sensitivity. Lastly, we argue that drug classes viewed as "counter-intuitive" based on existing models for the pathophysiology of schizophrenia-including pro-catecholaminergic and NMDA-antagonistic drugs-might be important candidate "pro-cognitive therapy" drugs.

Cognitive functioning in schizophrenia with or without diabetes.

To determine the influence of schizophrenia patients with diabetes on cognitive function. Altogether 78 schizophrenia patients with diabetes and 118 patients with schizophrenia were enrolled and Negative and Positive Syndrome Scale, Wechsler Memory Scale-Revised Visual Reproduction Test, Wechsler Adult Intelligence Scale-Revised Digit Symbol Test, Computerized Wisconsin Card Sorting Test,Trail Making Tests, Part A and B, and Wechsler Adult Intelligence Scale-Revised Digit Span Test were used to assess the clinical syndrome and to test the cognitive function. Impairment of Processing Speed, Attention/Working Memory, Executive Functioning and Visual Memory in schizophrenia patients with diabetes was significantly poorer than that of the schizophrenia patients (all P<0.05). WAIS-R Digit Symbol Test score and Trail Making Test A and B scores were associated with diabetes duration and age at diabetes onset (P<0.01). The impairment of cognitive function in schizophrenia patients with diabetes is severer than schizophrenia patients, suggesting that the prevention and management of diabetes may improve cognitive outcome in schizophrenia patients.

Depressive symptoms and their association with acute treatment outcome in first-episode schizophrenia patients: Comparing treatment with risperidone and haloperidol

Objective. To evaluate depressive symptoms regarding their association with the acute outcome in first-episode schizophrenia comparing risperidone and haloperidol. Method. A total of 274 patients were analysed within a double-blind randomized controlled trial and treated with risperidone or haloperidol. The patients were grouped according to their baseline HAMD-21 total score in a “depressed” (HAMD-21 ≥16) or “non-depressed” (HAMD-21 <16) patient subgroup. PANSS, HAMD-21, GAF, SOFAS and AIMS ratings were performed. Early response was defined as an initial 20% reduction of the PANSS total score from admission to week 2, response as an at least 50% reduction of the PANSS total score from admission to discharge and remission according to the consensus criteria. Results. A total of 124 patients were classified as depressive at baseline with 22 patients still being depressive at discharge. The depressed and non-depressed patients did not significantly differ regarding the treatment with risperidone and haloperidol (P = 0.2270). The depressive patients suffered from significantly more suicidal tendencies (P = 0.0165), had significantly less insight into their illness (P = 0.0152) and featured significantly worse functioning (P = 0.0066). Patients with depressive symptoms achieved remission significantly less often than non-depressed patients. Conclusion. The importance of a specific and adequate treatment of depressive symptoms is highlighted.