Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial
CONTEXT Neurocognitive impairment in schizophrenia is severe and is an important predictor of functional outcome. The relative effect of the second-generation (atypical) antipsychotic drugs and older agents on neurocognition has not been comprehensively determined. OBJECTIVE To compare the neurocogn...
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| Veröffentlicht in: | Archives of general psychiatry 2007-06, Vol.64 (6), p.633-647 |
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| creator | Keefe, Richard S. E Bilder, Robert M Davis, Sonia M Harvey, Philip D Palmer, Barton W Gold, James M Meltzer, Herbert Y Green, Michael F Capuano, George Stroup, T. Scott McEvoy, Joseph P Swartz, Marvin S Rosenheck, Robert A Perkins, Diana O Davis, Clarence E Hsiao, John K Lieberman, Jeffrey A |
| description | CONTEXT Neurocognitive impairment in schizophrenia is severe and is an important predictor of functional outcome. The relative effect of the second-generation (atypical) antipsychotic drugs and older agents on neurocognition has not been comprehensively determined. OBJECTIVE To compare the neurocognitive effects of several second-generation antipsychotics and a first-generation antipsychotic, perphenazine. DESIGN Randomized, double-blind study of patients with schizophrenia assigned to receive treatment with olanzapine, perphenazine, quetiapine fumarate, or risperidone for up to 18 months as reported previously by Lieberman et al. Ziprasidone hydrochloride was included after its approval by the Food and Drug Administration. SETTING Fifty-seven sites participated, including academic sites and treatment mental health facilities representative of the community. PATIENTS From a cohort of 1460 patients in the treatment study, 817 completed neurocognitive testing immediately prior to randomization and then after 2 months of treatment. MAIN OUTCOME MEASURES The primary outcome was change in a neurocognitive composite score after 2 months of treatment. Secondary outcomes included neurocognitive composite score change at 6 months and 18 months after continued treatment and changes in neurocognitive domains. RESULTS At 2 months, treatment resulted in small neurocognitive improvements of z = 0.13 for olanzapine (P |
| doi_str_mv | 10.1001/archpsyc.64.6.633 |
| format | Article |
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E ; Bilder, Robert M ; Davis, Sonia M ; Harvey, Philip D ; Palmer, Barton W ; Gold, James M ; Meltzer, Herbert Y ; Green, Michael F ; Capuano, George ; Stroup, T. Scott ; McEvoy, Joseph P ; Swartz, Marvin S ; Rosenheck, Robert A ; Perkins, Diana O ; Davis, Clarence E ; Hsiao, John K ; Lieberman, Jeffrey A</creator><creatorcontrib>Keefe, Richard S. E ; Bilder, Robert M ; Davis, Sonia M ; Harvey, Philip D ; Palmer, Barton W ; Gold, James M ; Meltzer, Herbert Y ; Green, Michael F ; Capuano, George ; Stroup, T. Scott ; McEvoy, Joseph P ; Swartz, Marvin S ; Rosenheck, Robert A ; Perkins, Diana O ; Davis, Clarence E ; Hsiao, John K ; Lieberman, Jeffrey A ; CATIE Investigators ; Neurocognitive Working Group</creatorcontrib><description>CONTEXT Neurocognitive impairment in schizophrenia is severe and is an important predictor of functional outcome. The relative effect of the second-generation (atypical) antipsychotic drugs and older agents on neurocognition has not been comprehensively determined. OBJECTIVE To compare the neurocognitive effects of several second-generation antipsychotics and a first-generation antipsychotic, perphenazine. DESIGN Randomized, double-blind study of patients with schizophrenia assigned to receive treatment with olanzapine, perphenazine, quetiapine fumarate, or risperidone for up to 18 months as reported previously by Lieberman et al. Ziprasidone hydrochloride was included after its approval by the Food and Drug Administration. SETTING Fifty-seven sites participated, including academic sites and treatment mental health facilities representative of the community. PATIENTS From a cohort of 1460 patients in the treatment study, 817 completed neurocognitive testing immediately prior to randomization and then after 2 months of treatment. MAIN OUTCOME MEASURES The primary outcome was change in a neurocognitive composite score after 2 months of treatment. Secondary outcomes included neurocognitive composite score change at 6 months and 18 months after continued treatment and changes in neurocognitive domains. RESULTS At 2 months, treatment resulted in small neurocognitive improvements of z = 0.13 for olanzapine (P<.002), 0.25 for perphenazine (P<.001), 0.18 for quetiapine (P<.001), 0.26 for risperidone (P<.001), and 0.12 for ziprasidone (P<.06), with no significant differences between groups. Results at 6 months were similar. After 18 months of treatment, neurocognitive improvement was greater in the perphenazine group than in the olanzapine and risperidone groups. Neurocognitive improvement predicted longer time to treatment discontinuation, independently from symptom improvement, in patients treated with quetiapine or ziprasidone. CONCLUSIONS After 2 months of antipsychotic treatment, all groups had a small but significant improvement in neurocognition. There were no differences between any pair of agents, including the typical drug perphenazine. These results differ from the majority of previous studies, and the possible reasons are discussed.Arch Gen Psychiatry. 2007;64:633-647--></description><identifier>ISSN: 0003-990X</identifier><identifier>EISSN: 1538-3636</identifier><identifier>DOI: 10.1001/archpsyc.64.6.633</identifier><identifier>PMID: 17548746</identifier><identifier>CODEN: ARGPAQ</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adult ; Adult and adolescent clinical studies ; Antipsychotic Agents - therapeutic use ; Benzodiazepines - therapeutic use ; Biological and medical sciences ; Cognition Disorders - diagnosis ; Cognition Disorders - drug therapy ; Cognition Disorders - psychology ; Cohort Studies ; Dibenzothiazepines - therapeutic use ; Double-Blind Method ; Female ; Humans ; Male ; Medical sciences ; Neuropharmacology ; Neuropsychological Tests - statistics & numerical data ; Perphenazine - therapeutic use ; Pharmacology. Drug treatments ; Piperazines - therapeutic use ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychopharmacology ; Psychoses ; Quetiapine Fumarate ; Risperidone - therapeutic use ; Schizophrenia ; Schizophrenia - diagnosis ; Schizophrenia - drug therapy ; Schizophrenic Psychology ; Thiazoles - therapeutic use ; Treatment Outcome</subject><ispartof>Archives of general psychiatry, 2007-06, Vol.64 (6), p.633-647</ispartof><rights>2007 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a347t-5b6fbfb28b963167975a67634d5c3c646751520adb0ab1a9d6facfaa55140d2b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/articlepdf/10.1001/archpsyc.64.6.633$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.64.6.633$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18843550$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17548746$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keefe, Richard S. E</creatorcontrib><creatorcontrib>Bilder, Robert M</creatorcontrib><creatorcontrib>Davis, Sonia M</creatorcontrib><creatorcontrib>Harvey, Philip D</creatorcontrib><creatorcontrib>Palmer, Barton W</creatorcontrib><creatorcontrib>Gold, James M</creatorcontrib><creatorcontrib>Meltzer, Herbert Y</creatorcontrib><creatorcontrib>Green, Michael F</creatorcontrib><creatorcontrib>Capuano, George</creatorcontrib><creatorcontrib>Stroup, T. Scott</creatorcontrib><creatorcontrib>McEvoy, Joseph P</creatorcontrib><creatorcontrib>Swartz, Marvin S</creatorcontrib><creatorcontrib>Rosenheck, Robert A</creatorcontrib><creatorcontrib>Perkins, Diana O</creatorcontrib><creatorcontrib>Davis, Clarence E</creatorcontrib><creatorcontrib>Hsiao, John K</creatorcontrib><creatorcontrib>Lieberman, Jeffrey A</creatorcontrib><creatorcontrib>CATIE Investigators</creatorcontrib><creatorcontrib>Neurocognitive Working Group</creatorcontrib><title>Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial</title><title>Archives of general psychiatry</title><addtitle>Arch Gen Psychiatry</addtitle><description>CONTEXT Neurocognitive impairment in schizophrenia is severe and is an important predictor of functional outcome. The relative effect of the second-generation (atypical) antipsychotic drugs and older agents on neurocognition has not been comprehensively determined. OBJECTIVE To compare the neurocognitive effects of several second-generation antipsychotics and a first-generation antipsychotic, perphenazine. DESIGN Randomized, double-blind study of patients with schizophrenia assigned to receive treatment with olanzapine, perphenazine, quetiapine fumarate, or risperidone for up to 18 months as reported previously by Lieberman et al. Ziprasidone hydrochloride was included after its approval by the Food and Drug Administration. SETTING Fifty-seven sites participated, including academic sites and treatment mental health facilities representative of the community. PATIENTS From a cohort of 1460 patients in the treatment study, 817 completed neurocognitive testing immediately prior to randomization and then after 2 months of treatment. MAIN OUTCOME MEASURES The primary outcome was change in a neurocognitive composite score after 2 months of treatment. Secondary outcomes included neurocognitive composite score change at 6 months and 18 months after continued treatment and changes in neurocognitive domains. RESULTS At 2 months, treatment resulted in small neurocognitive improvements of z = 0.13 for olanzapine (P<.002), 0.25 for perphenazine (P<.001), 0.18 for quetiapine (P<.001), 0.26 for risperidone (P<.001), and 0.12 for ziprasidone (P<.06), with no significant differences between groups. Results at 6 months were similar. After 18 months of treatment, neurocognitive improvement was greater in the perphenazine group than in the olanzapine and risperidone groups. Neurocognitive improvement predicted longer time to treatment discontinuation, independently from symptom improvement, in patients treated with quetiapine or ziprasidone. CONCLUSIONS After 2 months of antipsychotic treatment, all groups had a small but significant improvement in neurocognition. There were no differences between any pair of agents, including the typical drug perphenazine. These results differ from the majority of previous studies, and the possible reasons are discussed.Arch Gen Psychiatry. 2007;64:633-647--></description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cognition Disorders - diagnosis</subject><subject>Cognition Disorders - drug therapy</subject><subject>Cognition Disorders - psychology</subject><subject>Cohort Studies</subject><subject>Dibenzothiazepines - therapeutic use</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neuropharmacology</subject><subject>Neuropsychological Tests - statistics & numerical data</subject><subject>Perphenazine - therapeutic use</subject><subject>Pharmacology. Drug treatments</subject><subject>Piperazines - therapeutic use</subject><subject>Psycholeptics: tranquillizer, neuroleptic</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychopharmacology</subject><subject>Psychoses</subject><subject>Quetiapine Fumarate</subject><subject>Risperidone - therapeutic use</subject><subject>Schizophrenia</subject><subject>Schizophrenia - diagnosis</subject><subject>Schizophrenia - drug therapy</subject><subject>Schizophrenic Psychology</subject><subject>Thiazoles - therapeutic use</subject><subject>Treatment Outcome</subject><issn>0003-990X</issn><issn>1538-3636</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0M1uEzEUBWALgWhoeYBukDd0N8Ee_8zMMopSqNSWSg2CnXXHYzNGM3awHaT26XGUQFfXV_7uWRyELilZUkLoJ4h63KUnvZR8KZeSsVdoQQVrKyaZfI0WhBBWdR35cYbepfSrrETI-i06o43gbcPlAs33Zh-DDj-9y-6PwRtrjc4JB4tXPrtD-hiy0_jODE5DdsEn7Dx-KE_jC_zu8ojXYwy-oEc9uuewG6PxDg4sjwavV9ubDd5GB9MFemNhSub9aZ6jb9eb7fpLdfv18816dVsB402uRC9tb_u67TvJqGy6RoBsJOOD0ExLLhtBRU1g6An0FLpBWtAWQAjKyVD37BxdHXN3Mfzem5TV7JI20wTehH1STemhxPIC6RHqGFKKxqpddDPEJ0WJOnSs_nWsJFdSlY7LzYdT-L6fzfBycSq1gI8nAEnDZCN47dKLa1vOhCDFXR4dzPD_l7c1Iy37C-zQkEc</recordid><startdate>20070601</startdate><enddate>20070601</enddate><creator>Keefe, Richard S. 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Scott</creator><creator>McEvoy, Joseph P</creator><creator>Swartz, Marvin S</creator><creator>Rosenheck, Robert A</creator><creator>Perkins, Diana O</creator><creator>Davis, Clarence E</creator><creator>Hsiao, John K</creator><creator>Lieberman, Jeffrey A</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20070601</creationdate><title>Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial</title><author>Keefe, Richard S. E ; Bilder, Robert M ; Davis, Sonia M ; Harvey, Philip D ; Palmer, Barton W ; Gold, James M ; Meltzer, Herbert Y ; Green, Michael F ; Capuano, George ; Stroup, T. 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Drug treatments</topic><topic>Piperazines - therapeutic use</topic><topic>Psycholeptics: tranquillizer, neuroleptic</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychopharmacology</topic><topic>Psychoses</topic><topic>Quetiapine Fumarate</topic><topic>Risperidone - therapeutic use</topic><topic>Schizophrenia</topic><topic>Schizophrenia - diagnosis</topic><topic>Schizophrenia - drug therapy</topic><topic>Schizophrenic Psychology</topic><topic>Thiazoles - therapeutic use</topic><topic>Treatment Outcome</topic><toplevel>online_resources</toplevel><creatorcontrib>Keefe, Richard S. 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E</au><au>Bilder, Robert M</au><au>Davis, Sonia M</au><au>Harvey, Philip D</au><au>Palmer, Barton W</au><au>Gold, James M</au><au>Meltzer, Herbert Y</au><au>Green, Michael F</au><au>Capuano, George</au><au>Stroup, T. Scott</au><au>McEvoy, Joseph P</au><au>Swartz, Marvin S</au><au>Rosenheck, Robert A</au><au>Perkins, Diana O</au><au>Davis, Clarence E</au><au>Hsiao, John K</au><au>Lieberman, Jeffrey A</au><aucorp>CATIE Investigators</aucorp><aucorp>Neurocognitive Working Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial</atitle><jtitle>Archives of general psychiatry</jtitle><addtitle>Arch Gen Psychiatry</addtitle><date>2007-06-01</date><risdate>2007</risdate><volume>64</volume><issue>6</issue><spage>633</spage><epage>647</epage><pages>633-647</pages><issn>0003-990X</issn><eissn>1538-3636</eissn><coden>ARGPAQ</coden><abstract>CONTEXT Neurocognitive impairment in schizophrenia is severe and is an important predictor of functional outcome. The relative effect of the second-generation (atypical) antipsychotic drugs and older agents on neurocognition has not been comprehensively determined. OBJECTIVE To compare the neurocognitive effects of several second-generation antipsychotics and a first-generation antipsychotic, perphenazine. DESIGN Randomized, double-blind study of patients with schizophrenia assigned to receive treatment with olanzapine, perphenazine, quetiapine fumarate, or risperidone for up to 18 months as reported previously by Lieberman et al. Ziprasidone hydrochloride was included after its approval by the Food and Drug Administration. SETTING Fifty-seven sites participated, including academic sites and treatment mental health facilities representative of the community. PATIENTS From a cohort of 1460 patients in the treatment study, 817 completed neurocognitive testing immediately prior to randomization and then after 2 months of treatment. MAIN OUTCOME MEASURES The primary outcome was change in a neurocognitive composite score after 2 months of treatment. Secondary outcomes included neurocognitive composite score change at 6 months and 18 months after continued treatment and changes in neurocognitive domains. RESULTS At 2 months, treatment resulted in small neurocognitive improvements of z = 0.13 for olanzapine (P<.002), 0.25 for perphenazine (P<.001), 0.18 for quetiapine (P<.001), 0.26 for risperidone (P<.001), and 0.12 for ziprasidone (P<.06), with no significant differences between groups. Results at 6 months were similar. After 18 months of treatment, neurocognitive improvement was greater in the perphenazine group than in the olanzapine and risperidone groups. Neurocognitive improvement predicted longer time to treatment discontinuation, independently from symptom improvement, in patients treated with quetiapine or ziprasidone. CONCLUSIONS After 2 months of antipsychotic treatment, all groups had a small but significant improvement in neurocognition. There were no differences between any pair of agents, including the typical drug perphenazine. These results differ from the majority of previous studies, and the possible reasons are discussed.Arch Gen Psychiatry. 2007;64:633-647--></abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>17548746</pmid><doi>10.1001/archpsyc.64.6.633</doi><tpages>15</tpages></addata></record> |
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| subjects | Adult Adult and adolescent clinical studies Antipsychotic Agents - therapeutic use Benzodiazepines - therapeutic use Biological and medical sciences Cognition Disorders - diagnosis Cognition Disorders - drug therapy Cognition Disorders - psychology Cohort Studies Dibenzothiazepines - therapeutic use Double-Blind Method Female Humans Male Medical sciences Neuropharmacology Neuropsychological Tests - statistics & numerical data Perphenazine - therapeutic use Pharmacology. Drug treatments Piperazines - therapeutic use Psycholeptics: tranquillizer, neuroleptic Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychopharmacology Psychoses Quetiapine Fumarate Risperidone - therapeutic use Schizophrenia Schizophrenia - diagnosis Schizophrenia - drug therapy Schizophrenic Psychology Thiazoles - therapeutic use Treatment Outcome |
| title | Neurocognitive Effects of Antipsychotic Medications in Patients With Chronic Schizophrenia in the CATIE Trial |
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