Schizophrenia outcome evaluation

In 2005, an NIMH multisite study called CATIE compared the older neuroleptic perphenazine (Trilafon) and atypical neuroleptics olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and zipra-sidone (Geodon Lieberman et al., 2005a see also Nasrallah, 2007 Rosenheck et al., 2006 Weiden, 2007a). Phase I involved 1,460 patients diagnosed with schizophrenia initially randomly assigned in a doubleblind study to one of the five neuroleptics. The study lasted 18 months, with safety and tolerability outcomes evaluated at 1, 3, 6, 9, 12, 15, and 18 months. 

Collaborative Working Group on Clinical Trial Evaluations. (1998). Measuring outcome in schizophrenia differences among the atypical antipsychotics. 

John Rosen (419 and 420) claimed that direct analysis (a psychoanalytic-like technique) produced improvement in 37 cases of deteriorated schizophrenia. He defined improvement as the ability to live comfortably outside of an institution, with the achievement of psychological integrity, emotional stability, and character structure such that a patient could withstand as much environmental stress as one who never experienced a psychotic episode. The credibility of this claim, however, was shattered by an independent evaluation of these patients outcome. Five years later, a follow-up of Rosen s group found that 37% had not been initially diagnosed as schizophrenic, but rather as psychoneurotic, manic-depressive, or possibly hyperthyroid (e.g., one patient recovered after her thyroid was removed). The remainder met criteria for schizophrenia, and during the next 10 years, 75% had between two and five subsequent readmissions. Thus, Rosen s initial claims were not substantiated because many did not have schizophrenia, and most of those who did were not able to sustain their improvement. 

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