Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia

Jean Pierre Lindenmayer, Pal Czobor, Jan Volavka, Jeffrey A. Lieberman, Leslie Citrome, Brian Sheitman, Joseph Patrick McEvoy, Thomas B. Cooper, Miranda Chakos

Research output: Contribution to journalReview article

61 Citations (Scopus)

Abstract

Background: There has been considerable support for the observation that atypical antipsychotics have a broader range of therapeutic effects than traditional antipsychotics. We are exploring whether this expanded clinical efficacy can also be seen in patients with treatment-resistant schizophrenia. Method: The subjects were 157 treatment-resistant inpatients diagnosed with DSM-IV schizophrenia or schizoaffective disorder. They were randomly assigned to treatment with clozapine, olanzapine, risperidone, or haloperidol in a 14-week double-blind trial and rated with a standard measure of clinical antipsychotic efficacy (Positive and Negative Syndrome Scale [PANSS]). Factor analysis at baseline and endpoint together with changes in 5 PANSS-derived factors were examined. Data were gathered from June 1996 to December 1999. Results: The underlying PANSS factor structure, as indicated by the factor loadings, was essentially identical at baseline and endpoint. At baseline, the excitement factor was followed by the positive, negative, cognitive, and depression/anxiety factors, explaining 49.4% of the total variance. At endpoint, the positive factor was followed by the negative, excitement, cognitive, and depression/anxiety factors, explaining 55.5% of the total variance. The endpoint data indicated statistically significant (p < .05) improvements over time on the positive factor for all 3 atypicals, but not for haloperidol. The negative factor showed significant improvement for clozapine and olanzapine, with significant worsening for haloperidol. Clozapine, olanzapine, and risperidone were superior to haloperidol on the negative factor, while clozapine was also superior to risperidone. The cognitive factor showed significant improvement for all atypicals, as did the depression/anxiety factor. Only clozapine showed improvement on the excitement factor and was superior to both haloperidol and risperidone. Conclusions: Treatment with atypical antipsychotics did not substantially change the underlying PANSS 5-factor structure. However, antipsychotic treatment with all 3 atypical medications was associated with significant improvements on 3 of 5 syndromal domains (positive, cognitive, and depression/anxiety) of schizophrenia. Clozapine and olanzapine also showed improvement on the negative factor. Only clozapine was associated with improvement on the excitement domain. This finding confirms that atypicals are associated with improvement of an expanded spectrum of symptoms in treatment-resistant patients.

Original languageEnglish (US)
Pages (from-to)551-556
Number of pages6
JournalJournal of Clinical Psychiatry
Volume65
Issue number4
DOIs
StatePublished - Apr 1 2004
Externally publishedYes

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olanzapine
Clozapine
Antipsychotic Agents
Schizophrenia
Haloperidol
Risperidone
Anxiety
Depression
Therapeutics
Therapeutic Uses
Diagnostic and Statistical Manual of Mental Disorders
Psychotic Disorders
Statistical Factor Analysis
Inpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Lindenmayer, J. P., Czobor, P., Volavka, J., Lieberman, J. A., Citrome, L., Sheitman, B., ... Chakos, M. (2004). Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia. Journal of Clinical Psychiatry, 65(4), 551-556. https://doi.org/10.4088/JCP.v65n0416

Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia. / Lindenmayer, Jean Pierre; Czobor, Pal; Volavka, Jan; Lieberman, Jeffrey A.; Citrome, Leslie; Sheitman, Brian; McEvoy, Joseph Patrick; Cooper, Thomas B.; Chakos, Miranda.

In: Journal of Clinical Psychiatry, Vol. 65, No. 4, 01.04.2004, p. 551-556.

Research output: Contribution to journalReview article

Lindenmayer, JP, Czobor, P, Volavka, J, Lieberman, JA, Citrome, L, Sheitman, B, McEvoy, JP, Cooper, TB & Chakos, M 2004, 'Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia', Journal of Clinical Psychiatry, vol. 65, no. 4, pp. 551-556. https://doi.org/10.4088/JCP.v65n0416
Lindenmayer JP, Czobor P, Volavka J, Lieberman JA, Citrome L, Sheitman B et al. Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia. Journal of Clinical Psychiatry. 2004 Apr 1;65(4):551-556. https://doi.org/10.4088/JCP.v65n0416
Lindenmayer, Jean Pierre ; Czobor, Pal ; Volavka, Jan ; Lieberman, Jeffrey A. ; Citrome, Leslie ; Sheitman, Brian ; McEvoy, Joseph Patrick ; Cooper, Thomas B. ; Chakos, Miranda. / Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia. In: Journal of Clinical Psychiatry. 2004 ; Vol. 65, No. 4. pp. 551-556.
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