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Patients with Schizophrenia Unlikely to Respond to Treatment Within 4 Weeks if No Response Noted at 1 Week
A DGReview of :"Early prediction of antipsychotic response in schizophrenia"
American Journal of Psychiatry
11/10/2003
By Emma Hitt, PhD
Patients with minimal improvement in schizophrenic symptoms during the first week of treatment with a typical antipsychotic are unlikely to respond within 4 weeks, new research suggests.
To facilitate rapid discharge from inpatient settings, the current managed care environment often dictates a change of antipsychotic medication days after initiation in "nonresponsive" patients. "Unfortunately, there are few empirical data to support this practice," note Christoph U. Correll, MD, with the Hillside Hospital, Glen Oaks, New York, United States, and colleagues.
In their study, 131 acutely ill patients with schizophrenia received 4 weeks of fluphenazine treatment. Brief Psychiatric Rating Scale (BPRS) scores were measured at baseline and each week for 4 weeks.
The relationship between changes in BPRS total score and each factor score following 1 week of treatment were evaluated. Ultimate antipsychotic response was defined as a reduction of 20% or more in the total BPRS baseline score at 4 weeks.
Every patient who displayed an improvement of less than 20% in BPRS total score and 95% of patients who displayed a reduction of less than 20% in BPRS thought disturbance factor score following 1 week of treatment were found to be nonresponders after 4 weeks of treatment, they report.
"These data suggest that patients with minimal improvement in positive symptoms during the first week of treatment with a typical antipsychotic are unlikely to respond to a 4-week trial," Dr. Correll and colleagues conclude. "These data require confirmation and extension to studies with second-generation antipsychotics," they add.
According to the researchers, early BPRS ratings may be useful in identifying nonresponders as early as 7 days into treatment, and could provide the basis for changing antipsychotic treatment. "Furthermore, since symptoms were rated weekly, we cannot exclude that symptom improvement before day 7 of antipsychotic treatment may be as reliable or even more reliable as a predictor than improvement at 1 week," they add.
Am J Psychiatry 2003 Nov;160:11:2063-2065.
"Early prediction of antipsychotic response in schizophrenia"
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