Early treatment of schizophrenia with atypical antipsychotics may improve outcome
05 ноября, 2002
Cannon TD, Huttunen MO, Dahlstr?m M et al. Antipsychotic drug treatment in the prodromal phase of schizophrenia. Am J Psychiatry 2002:159:1230 - 2.
Early drug treatment gives a better long-term outcome for patients with schizophrenia, possibly because it slows deterioration. This Finnish, multicentre, open-label trial showed that starting a low-dose atypical antipsychotic (risperidone) early improved thought and behaviour disturbances in prodromal and first-episode patients.
Four prodromal high-risk adolescents (15 - 20 years) and six first-episode patients (16 - 35 years) were treated with average doses of 1.0 and 1.8mg/day respectively, for up to 12 weeks. The maximum daily dose was 2mg/day and 4mg/day for prodromal and first-episode patients, respectively, although this could be titrated downwards. Neurocognitive measures and symptom ratings were taken at baseline and two follow-ups. They were assessed by the California Verbal Learning Test (CVLT; all subject) the Child Behaviour Checklist (CBC; prodromal) and the Positive and Negative Syndrome Scale (PANSS; first episode).
On average, both groups significantly improved on the CVLT, and on their respective symptom measures (CBC and PANSS). There were minor adverse events (tremor/tic, exhaustion/anxiety, sedation, dystonia, dry mouth/rhinitis) in five subjects, but these resolved.
This study was limited by the small group size, the lack of a placebo control group, and failure to control for practice effects on the neurocognitive tests. Nevertheless, all patients had consistent, statistically significant improvements. The authors concluded it was worth doing a more thorough clinical trial.
