Antipsychotic drugs comparative studies

The incidence rates for six categories of adverse events of antipsychotic drug use have been compared in a retrospective cohort study of 4140 children and adolescents (mean age 10 years) and 4500 children (mean age 7.2 years) with similar service encounters but not treated with psychotropic drugs /(5 7- Six atypical and two conventional antipsychotic drugs were studied. The overall incidence/prevalence rates in the control and treated groups differed dramatically in obesity/weight gain (8.6% versus 20%), type 2 diabetes (1.9% versus... 

Thirty-five to eighty-seven percent of the patients studied received antiparkinson drugs. Compared to other countries, Japan and Singapore used the most of these antidotes for drug-induced extrapyramidal symptoms. This is most likely related to the frequent use of high-dosage antipsychotic drugs and poly-antipsychotics (see Table 12.3). 

Wilton LV, Heeley El, Pickering RM, et al. Comparative study of mortahty rates and cardiac dysrhythmias in post-marketing surveillance studies of sertindole and two other atypical antipsychotic drugs, risperidone and olanzapine. J Psychophar-macol 2001 15 120-6. 

Efficacy in short-term treatment. From studies in adult schizophrenia, it is evident that clozapine treatment has at least the same or superior antipsychotic effect, compared to typical antipsychotics. In some studies, clozapine was superior with regard to symptom reduction in severe and acute schizophrenic patients. As the guidelines do not allow the use of clozapine as a first-choice drug, most patients have been treated before with at least two atypical or typical antipsychotics. Only one controlled trial has assessed the efficacy of clozapine in child and adolescent psychiatry. In this study (Kumra et ah, 1996), clozapine was found to be superior to haloperidol in all measures of psychosis, and showed a striking superiority for both positive and negative symptoms. 

More recently, two methodologically advanced studies have been published a comparison between four antipsychotic drugs in a trial of 14 weeks duration (Bilder et al., 2002, see Box 7.1) and a study of 2 years duration comparing an atypical with an older typical antipsychotic drug (Green et al., 2002). 

Antipsychotics versus psychotherapy (two comparative studies). Both studies covered large, statistically equivalent groups of patients with productive symptoms one study compared group psychotherapy and antipsychotics the other compared analytically orientated individual therapy and antipsychotics. The results were similar inasmuch as both trials showed the drug therapy to be markedly superior in almost all clinically relevant characteristics and symptoms. 

Serum prolactin concentrations in patients taking longterm (n = 15) or short-term (n = 15) lithium did not differ from controls (613). In another study, when compared with 17 healthy controls, 20 euthymic bipolar patients who had taken lithium for more than 6 months had significantly lower serum prolactin concentrations (9.72 ng/ ml versus 15.56 ng/ml), but prolactin concentrations in short-term lithium users (n = 15) did not differ from controls (614). Antipsychotic drugs were not involved. 

The relation between antipsychotic drug-induced hyperprolactinemia and hypoestrogenism has been studied in 75 women with schizophrenia (762). Serum estradiol concentrations were generally reduced during the entire menstrual cycle compared with reference values. There was hypoestrogenism, defined as serum estradiol concentrations below 30 pg/ml in the follicular phase and below 100 pg/ml in the periovulatory phase, in about 60%. 

It is not clear that so-called antipsychotic drugs are superior to other types of drugs with sedative effects but different mechanisms of action. Lithium, benzodiazepines and opium have been shown to be comparable to neuroleptics in the treatment of psychotic states in some studies. The ability of the neuroleptic drugs to reduce the most characteristic symptoms of psychosis such as hallucinations, delusions and thought disorder have often been interpreted as evidence of their specifically antipsychotic or antischizophrenic action (The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study... 

During 2004 a number of clinical trials were reported involving acute and maintenance studies of lithium, mostly either comparing new atypical antipsychotic drugs with lithium in bipolar disorder or in combined treatment studies. Of the relatively few studies of the adverse effects of lithium, most clustered in the areas of cardiovascular effects and issues regarding lithium toxicity. 

Gomez JC, Sacristan JA, Hernandez J, Breier A, Ruiz Carrasco P, Anton Saiz C, Fontova Carbonell E. The safety of olanzapine compared with other antipsychotic drugs results of an observational prospective study in... 

---