Newer antipsychotics

Current Opinion in Psychiatry

Volumn 13, Issue 1, 2000, Pages 11-14

  Marder, Stephen R ^a  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMISULPRIDE; CELL RECEPTOR; CLOZAPINE; HALOPERIDOL; IODOBENZOIC ACID DERIVATIVE; NEUROLEPTIC AGENT; NEW DRUG; OLANZAPINE; QUETIAPINE; RACLOPRIDE; RISPERIDONE; ZIPRASIDONE;

AGRANULOCYTOSIS; CENTRAL NERVOUS SYSTEM; COGNITIVE DEFECT; DROWSINESS; DRUG EFFICACY; EXTRAPYRAMIDAL SYNDROME; HUMAN; HYPERSALIVATION; HYPOTENSION; RECEPTOR AFFINITY; RELAPSE; SCHIZOPHRENIA; SEIZURE; SHORT SURVEY; WEIGHT GAIN;

EID: 0033979303     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200001000-00003     Document Type: Short Survey

References (17)

1. 1 Leucht S, Pitschel-Walz G, Abraham D, Kissling W. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophr Res 1999; 35:51-68. This is an excellent meta-analysis from Germany. The authors computed effect sizes for comparsions of four newer antipsychotics when they are compared with placebo and haloperidol. It demonstrates that effect sizes are moderate for comparisons with placebo, but very small for comparisons with haloperidol. The clearest advantage of these agents over haloperidol is for EPSs.
2. 2-receptor occupancy for clozapine, risperidone and olanzapine. The results suggest that occupancies are similar for risperidone and olanzapine at their effective doses, but that clozapine is effective at lower occupancies.
3. 2A receptor occupancy in schizophrenic patients. Am J Psychiatry 1999; 156:869-875. This study indicates that receptor occupancy can be used to predict the effective clinical dose of an antipsychotic. In this study, the findings indicate that risperidone is likely to be most effective at doses of 3 - 4 mg/day.
4. 2 occupancies of these agents.
5. 5 Rosenheck R, Cramer J, Xu W, Thomas J, Henderson W, Frisman L, Fye C, Charney D, et al. A comparison of clozapine and haloperidol in the treatment of hospitalized patients with refractory schizophrenia. N Engl J Med 1997; 337:809-815.
6. 6 Rosenheck R, Dunn L, Peszke M, Cramer J, Xu W, Thomas J, Charney D, et al. Impact of clozapine on negative symptoms and on the deficit syndrone in refractory schizophrenia. Am J Psychiatry 1999; 156:88-93. The Veterans' Affairs Cooperative study that compared clozapine to haloperidol is probably the best source of information about the long-term impact of receiving these two agents. This study suggests that the earlier reports of advantages of clozapine for negative symptoms might have actually been reporting advantages in secondary negative symptoms.
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8. 8 Buchanan RW, Breier A, Kirkpatrick B, Ball P, Carpenter Jr WT. Positive and negative symptom response to clozapine in schizophrenic patients with and without the deficit syndrome. Am J Psychiatry 1998; 155:751-760. This study stands with the Veterans' Affairs Cooperative Study as being among the important indicators of the effectiveness of clozapine. The 10-week double-blind component found that clozapine was more effective than haloperidol for patients who were able to complete the study. This indicates that clozapine can be viewed as a more effective agent for those patients who are able to tolerate its side effects.
9. 9 Breier AF, Malhotra AK, Su TP, Pinals DA, Elman J, Adler CM, Lafargue RT, Clifton A, Pickar D, et al. Clozapine and risperidone in chronic schizophrenia: effects on symptoms, parkinsonian side effects, and neuroendocrine response. Am J Psychiatry 1999; 156:294-298.
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12. 12 Kern RS, Green MF, Marshall Jr BD, Wirshing WC, Wirshing D, McGurk S, et al. Risperidone vs. haloperidol on reaction time, manual dexterity, and motor learning in treatment-resistant schizophrenia patients, Biol Psychiatry 1998; 44:726-732.
13. 13 Sanger TM, Lieberman J, Tohen M, Grundy S, Beasley C, Tollefson GD. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry 1999; 156:79-87.
14. 14 Tran PV, Dellva MA, Tollefson GD, Wentley AL, Beasley CM. Oral olanzapine versus oral haloperidol in the maintenance treatment of schizophrenia and related psychoses. Br J Psychiatry 1998; 172:499-505.
15. 15 Conley RR, Love RC, Kelley DL, Bartko JJ. Rehospitalization rates of patients recently discharged on a regimen of risperidone or clozapine. Am J Psychiatry 1999; 156:863-668. This interesting study was able to monitor hospitalizations in all of the patients from Maryland state psychiatric facilities who were treated during a particular time. The advantage of this strategy is that it provides information about the effectiveness of these agents in real-world clinical practice.
16. 16 Conley RR, Tamminga CA, Bartko JJ, Richardson C, Peszke M, Lingle J, et al. Olanzapine compared with chlorpromazine in treatment-resistant schizophrenia. Am J Psychiatry 1998; 155:914-920. This is one of the few double-blind comparisons of a new and older antipsychotic that was carried out and analyzed outside of industry. In addition, it provides information about olanzapine in severely ill treatment-refractory patients.
17. 17 Breier A, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. Biol Psychiatry 1999; 45:403-411.