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Early intervention with second‐generation antipsychotics in first‐episode psychosis: results of an 8‐week naturalistic study
Author(s) -
Josiassen Richard C.,
Shaughnessy Rita A.,
Filymer Dawn M.,
Donohue Ann Marie,
Kacso Margit,
Finkel Naomi,
Curtis Jessica,
Audino Brett,
Skuban Nina
Publication year - 2010
Publication title -
early intervention in psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.087
H-Index - 45
eISSN - 1751-7893
pISSN - 1751-7885
DOI - 10.1111/j.1751-7893.2010.00163.x
Subject(s) - psychiatry , psychosis , intervention (counseling) , naturalistic observation , early psychosis , schizophrenia (object oriented programming) , psychology , medicine , clinical psychology , social psychology
Objective: The objective was to compare short‐term effectiveness of aripiprazole with three other second‐generation antipsychotics (SGAs) in the treatment of first‐episode psychosis. Method: In a naturalistic, ‘single‐blind’ design, 60 subjects experiencing their first psychotic episode were treated for 8 weeks with aripiprazole ( n = 19), risperidone ( n = 16), olanzapine ( n = 14) or quetiapine ( n = 11). Medication and dosing decisions were made by treating psychiatrists, constrained to once‐a‐day dosing, low initial doses and no clozapine. Weekly ratings were obtained using the Positive and Negative Syndrome Scale (PANSS), Simpson‐Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were also collected weekly. Results: The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly ( P < 0.0005). The between‐group and group by time interaction terms were non‐significant. Similar reductions were seen across all PANSS sub‐scales. At Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups ( P < 0.002). Few instances of extrapyramidal symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained unchanged. Conclusions: Early intervention with low doses of four SGAs led to rapid symptom reduction in first‐episode psychotic patients with severe psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms.