Meds alert: old schizophrenia drug stands up to new ones.
A class of recently developed medications for schizophrenia has rapidly become psychiatrists' treatment of choice. Small, pharmaceutical company-funded trials had suggested that the drugs are safer and more effective than a generation of antipsychotic antipsychotic /an·ti·psy·chot·ic/ (-si-kot´ik) effective in the treatment of psychotic disorders; also, an agent that so acts. Antipsychotics are a chemically diverse but pharmacologically similar class of drugs; besides psychotic substances that has been used since the 1950s.
A new federally funded study of unprecedented size and length calls into question that conclusion. One of the older medications alleviates schizophrenia symptoms about as well as three of the newer, so-called atypical antipsychotics do, say psychiatrist Jeffrey A. Lieberman of Columbia University Columbia University, mainly in New York City; founded 1754 as King's College by grant of King George II; first college in New York City, fifth oldest in the United States; one of the eight Ivy League institutions. and his colleagues.
A fourth atypical antipsychotic, olanzapine, yielded slightly more reduction in symptoms than the other drugs did. However, 9 percent of those receiving olanzapine experienced substantial weight gain and metabolic disturbances that can cause diabetes and shorten life, more than twice the proportion for any other drug in the study.
Two-thirds of patients taking olanzapine stopped using it before the 18-month study ended, but three-quarters of participants randomly assigned to any of the other four drugs halted treatment before the study ended. Patients typically stopped using a drug because of lack of improvement or unacceptable side effects Side effects
Effects of a proposed project on other parts of the firm. .
Schizophrenia patients typically try several antipsychotics Antipsychotics
A class of drugs used to control psychotic symptoms in patients with psychotic disorders such as schizophrenia and delusional disorder. Antipsychotics include risperidone (Risperdal), haloperidol (Haldol), and chlorpromazine (Thorazine). before settling on one. "There's no question that atypical antipsychotics work, but they don't fulfill all expectations," says Lieberman.
Atypical antipsychotics cost up to 10 times as much as the older drugs do. Schizophrenia, which affects roughly 1 in 100 people around the world, is a chronic illness that includes hallucinations Hallucinations Definition
Hallucinations are false or distorted sensory experiences that appear to be real perceptions. These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even , delusions, confused thinking, and severe apathy. Antipsychotic medications primarily quell hallucinations and delusions.
Lieberman's team studied 1,493 patients, 18 to 65 years old, who have schizophrenia. These volunteers were already receiving an antipsychotic medication and various types of psychosocial treatment at any of 57 clinical sites in the United States.
Initial results from the project, which ran from 2001 through 2004, appear in the Sept. 22 New England Journal of Medicine The New England Journal of Medicine (New Engl J Med or NEJM) is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It is one of the most popular and widely-read peer-reviewed general medical journals in the world. .
Participants began treatment with a new drug, randomly chosen from five medications. The four atypical antipsychotics were olanzapine, quetiapine, risperidone, and ziprasidone; the older drug was perphenazine perphenazine /per·phen·a·zine/ (-fen´ah-zen) a phenothiazine used as an antipsychotic and as an antiemetic.
The researchers were surprised to find that muscle rigidity, tremors, and other movement disorders Movement Disorders Definition
Movement disorders are a group of diseases and syndromes affecting the ability to produce and control movement.
Description that psychiatrists had primarily associated with older drugs occurred at the same low rate with all five medications tested. The most-common side effects for the drugs included sleep problems, constipation, and decreased sex drive.
Lieberman's data dovetail dovetail
n a widened or fanned-out portion of a prepared cavity, usually established deliberately to increase the retention and resistance form. with earlier U.S. evidence (SN: 2/9/02, p. 83) and with a recent clinical study in England, described at a schizophrenia conference in April. In the latter test, 250 patients with schizophrenia exhibited comparable improvement over 1 year, regardless of whether they had been randomly assigned to receive an atypical antipsychotic or an older drug.
"These results remind us that some people do very well on cheap and cheerful first-generation drugs," says psychiatrist Peter B. Jones of the University of Cambridge in England, who directed the British study.
The new studies "support the view that we have a big problem with all [antipsychotic] drugs," remarks psychiatrist William T. Carpenter Jr. of the University of Maryland University of Maryland can refer to:
Antipsychotic drugs are a class of medicines used to treat psychosis and other mental and emotional conditions.
Purpose that ease thinking disturbances and apathy, which play crucial disabling roles in schizophrenia, he says.
Olanzapine-induced weight gain and metabolic changes may be especially dangerous, Carpenter notes, because patients with schizophrenia typically smoke, rarely exercise, and eat poorly. "That scares the hell out of me," he says.