|New Details in Schizophrenia Treatment Trial
Two new studies from the Clinical Antipsychotic Trials for Intervention
Effectiveness (CATIE) provide more insights into comparing treatment
options, and to what extent antipsychotic medications help people
with schizophrenia learn social, interpersonal and community living
skills. The new studies are published in the March 2007 issue of
the American Journal of Psychiatry. CATIE, a $42.6 million,
multi-site study, was funded by the National Institutes of Health’s
National Institute of Mental Health (NIMH).
Comparing Newer Antipsychotic Medications After Older
Quetiapine, and to some extent olanzapine, may be more effective
than risperidone among patients who were originally taking, but
had to discontinue, perphenazine — an older, first generation
antipsychotic medication. However, patient responses varied considerably.
“CATIE continues to fine-tune our understanding of how our arsenal
of antipsychotic medications work in real-world settings, but it
also is revealing to us what questions we still must address,” said
NIMH Director Thomas R. Insel, M.D.
Of the 257 patients who were initially randomized to perphenazine
in the CATIE study, 192 discontinued the medication for various
reasons, including ineffectiveness and intolerable side effects.
Among those who discontinued, 114 agreed to be re-randomized to
one of three newer antipsychotic medications — olanzapine,
quetiapine or risperidone.
T. Scott Stroup, M.D., MPH, of the University of North Carolina
at Chapel Hill, and colleagues compared the effectiveness of the
medications by determining how long patients stayed on their assigned
medication. Those taking quetiapine stayed on the longest — averaging
about ten months before discontinuing. Those taking olanzapine
discontinued after an average of about seven months, and those
taking risperidone discontinued after an average of four months.
Although the discontinuation results suggest that olanzapine was
generally on par with quetiapine, patients taking olanzapine experienced
more side effects. While none of those taking quetiapine discontinued
use due to weight gain or metabolic side effects, 13 percent of
those assigned to olanzapine discontinued it due to weight gain
or metabolic problems, and 5 percent of those on risperidone did
“These results reinforce the fact that finding the most effective
medication for each patient sometimes means trying multiple medications,” said
Dr. Stroup. “They remind us of the considerable variability in
clinical circumstances and of our need to be responsive to an individual’s
needs and preferences.”
Schizophrenia Patients’ Social and Community Living Skills
Improve Modestly While on Antipsychotic Medications
Patients with schizophrenia taking antipsychotic medications experience
modest improvements in social, interpersonal and community living
(psychosocial) skills, regardless of what antipsychotic medication
they are taking.
Improvements in psychosocial skills among patients with schizophrenia
have been notoriously difficult to achieve, even when the more
disruptive symptoms of the disease can be controlled. “Helping
patients with schizophrenia restore their psychosocial functioning
remains a challenge,” said NIMH Director Thomas R. Insel, M.D. “These
CATIE results reinforce the growing understanding that we must
do a better job of helping patients get their life skills back
Marvin Swartz, M.D., of Duke University and colleagues evaluated
the social and vocational functioning, interpersonal relationships,
and psychological well-being of 455 participants — about
one-third of all patients in the CATIE study — who completed
an initial evaluation before the study began and were available
to provide data after 12 months of treatment. In the first phase
of the CATIE study, patients were randomly assigned to take either
perphenazine — an older, first-generation antipsychotic medication — or
one of several newer, second-generation medications (olanzapine,
quetiapine, risperidone, or ziprasidone).
The researchers found that those patients who stuck with their
initial treatment showed some improvement in their psychosocial
functioning, and there were no differences among the medications
in making these gains. The results are consistent with previously
reported CATIE results (http://www.nimh.nih.gov/healthinformation/catie.cfm)
in which few differences were seen among perphenazine and the newer,
second-generation antipsychotic medications in effectively reducing
The patients who made the greatest gains were the ones with the
poorest community living skills at the beginning of the study,
but they were also more likely to discontinue treatment early in
the process. As noted in previous CATIE reports, many patients
discontinued their initial treatments because of intolerable side
effects or ineffectiveness.
“Over the long run patients are more likely to function better
in the community if they are able to stay on their initial treatment,
especially those who are the most impaired,” said Dr. Swartz. “More
intensive rehabilitative interventions and outreach may help patients
stick with their treatment and make greater gains.”
Patients who made few gains in community living skills were those
with higher-level psychosocial skills at the beginning of the study.
Swartz and colleagues posit that patients encountered a “ceiling
effect” at which point additional psychosocial skill improvement
was unlikely without additional rehabilitative treatment.
“Overall, the findings reiterate the widely held belief that antipsychotic
medications alone are not sufficient in helping patients make meaningful
gains in real-world functioning,” said Dr. Swartz. “Dedicated rehabilitative
services that help patients learn to function at work and in social
settings are sorely needed.”
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.