The spurious advance of antipsychotic drug therapy

@article{Tyrer2009TheSA,
  title={The spurious advance of antipsychotic drug therapy},
  author={Peter Tyrer and Tim Kendall},
  journal={The Lancet},
  year={2009},
  volume={373},
  pages={4-5}
}

Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

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Meta-analyses of randomised controlled trials in the early phase of psychosis looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects found no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Second generation antipsychotics reduce dropout rates compared with first generation antipsychotics

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This report provides another argument for turning to new generation antipsychotics as fi rstline treatments for schizophrenia, albeit with the note of caution that post hoc meta-analyses cannot provide defi nitive answers.

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  • 2014
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It is argued that, if psychiatry is to be truly “evidence-based” in the authors' discipline, it needs a radical rethinking of its guiding epistemology: a move from reductionism to hermeneutics.

Early intervention in psychosis: keeping the body in mind.

  • D. ShiersPeter B. JonesS. Field
  • Medicine, Psychology
    The British journal of general practice : the journal of the Royal College of General Practitioners
  • 2009
TLDR
What Lester et al did find was that training could facilitate collaboration between GPs and the new early intervention services, and the obstacles were more about how they worked together.

Psychiatry's identity crisis

Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications

TLDR
Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no ‘spillover’ effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs.

Bennie, M. and Bishop, I. and Godman, B. and Barbui, C. and Raschi, E. and Campbell, S. and Miranda, J. and Gustafsson, L.L. (2013) Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?

TLDR
No change in utilisation patterns for risperidone is expected, although potential to influence prescribing patterns is limited by complexity of disease area, and continued high INN prescribing suggests no problems with generic risperids in practice.

Cost-effectiveness of asenapine in the treatment of schizophrenia in Canada

TLDR
Despite the short time horizon, the lack of compliance data and the assumptions made, this economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine and to most of the atypical antipsychotics frequently used in Canada.
...

References

SHOWING 1-10 OF 13 REFERENCES

Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.

TLDR
Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone.

Cost-effectiveness of second-generation antipsychotics and perphenazine in a randomized trial of treatment for chronic schizophrenia.

TLDR
Treatment with perphenazine was less costly than treatment with second-generation antipsychotics with no significant differences in measures of effectiveness, but the trial was limited by a high dropout rate, and longer-term neurological and metabolic side effects require further study.

Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis

TLDR
There is no clear evidence that atypical antipsychotics are more effective or are better tolerated than conventional antipsychotic drugs.

Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE Trial.

TLDR
After 2 months of antipsychotic treatment, all groups had a small but significant improvement in neurocognition, and after 18 months of treatment, neurocognitive improvement was greater in the perphenazine group than in the olanzapine and risperidone groups.

Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine.

TLDR
In this relatively brief study, the apparently increased comparative risk of agranulocytosis requires that the use of clozapine be limited to selected treatment-resistant patients.

Cost-effectiveness of first- v. second-generation antipsychotic drugs: results from a randomised controlled trial in schizophrenia responding poorly to previous therapy.

  • L. DaviesS. Lewis H. Lloyd
  • Medicine, Psychology
    The British journal of psychiatry : the journal of mental science
  • 2007
TLDR
Conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotic drugs, according to the primary and sensitivity analyses.

Pharmacology of risperidone (R 64 766), a new antipsychotic with serotonin-S2 and dopamine-D2 antagonistic properties.

TLDR
The first clinical studies indicate that two additional therapeutic targets may be obtained with risperidone in the monotherapy of schizophrenia and related disorders: very important contact and mood-elevating properties and extrapyramidal symptoms-free maintenance therapy.

CATIE and CUtLASS: can we handle the truth?

TLDR
Two large, non-commercial clinical trials comparing first- and second-generation antipsychotic drugs for people with chronic schizophrenia in the US and UK have shown unexpected results, with Clozapine outperformed other second- generation drugs.