One-year Outcomes Of Schizophrenia: Evaluating Effectiveness Of Psychosocial Intervention And Comparative Effectiveness Of Antipsychotics

PartⅠEvaluating effectiveness of psychosocial interventionon one-year outcomes of schizophreniaObjectivesTo evaluate the effectiveness of psychosocial intervention onone-year outcomes of schizophreniaMethodsA multicentre, open, randomized and controlled study included 914patients meeting CCMD-3 criteria for schizophrenia. The duration ofillness was no more than 5 years. Patients were randomly assigned toreceive integrated treatment (antipsychotics combined psychosocialintervention), or standard treatment (antipsychotics and general mentalhealth services). The main outcome measures were clinical outcome,insight and compliance, quality of life, cognitive function and socialfunction.Result1. A total of 914 patients with schizophrenia were included in sixmonths follow-up study, 455 randomly assigned to integrated treatmentand 459 to standard treatment. A total of 594 patients with schizophreniawere included in 12 months follow-up study, 309 randomly assigned tointegrated treatment and 285 to standard treatment.2. The rate of discontinuation for any reason was significantlydifferent between integrated treatment and standard treatment (14. l%vs.28.1% at 6 months; 28.2% vs.41.8% at 12 months). The rate of relapsewas significantly different between integrated treatment and standardtreatment (5.1% vs. 14.8% at 6 months; 12.9% vs.19.6% at 12 months).The risk ratio for discontinuation of study treatment with standardtreatment, from the Cox model, was 1.69 (95 percent confidence interval,1.28 to 2.22, P＜0.01), and the risk ratio for relapse with standardtreatment was 1.73 (95 percent confidence interval, 1.15 to 2.60, P＜0.01).3. At the end of 6 months and 12 months, positive and negative syndrome scale scores (PANSS), Montgomery-(?)sberg depression ratingscale scores (MADRS) and clinical global impression ratings (CGI)improved significantly relative to baseline. Patients receiving integratedtreatment showed greater improvement from baseline compared withstandard treatment in CGI.4. At 6 months and 12 months, patients receiving integratedtreatment showed greater improvement from baseline compared withstandard treatment in Insight Treatment Attitude Questionnaire (ITAQ),and patients receiving integrated treatment improved adherence totreatment comparing with standard treatment.5. At 6 months, patients receiving integrated treatment showedgreater improvements from baseline compared with standard treatment in3 domains of the MOS item short from health survey(SF-36)(role-physical, general health and vitality). At 12 months, patientsreceiving integrated treatment showed significantly improvement frombaseline compared with standard treatment in 4 domains of theSF-36(role-physical, general health, vitality and role-emotional).6. At 6 months and 12 months, the improvements of cognitiveperformances were similar in two groups.7. At 6 months and 12 months, patients receiving integratedtreatment showed greater improvements from baseline compared withstandard treatment in global assessment scale (GAS) and social disabilityscreening schedule (SDSS). The rate of employment was higher inintegrated group than standard group (21.1% vs.15.0% at 6 months,34.0% vs.23.9% at 12 months).ConclusionPsychosocial intervention improved clinical outcome, insight andadherence to treatment, quality of life and social function. Theimprovements were consistent at six months and twelve monthsfollow-ups. PartⅡcomparative effectiveness of antipsychotics onone-year outcomes of schizophreniaObjectivesTo compare the effectiveness of seven antipsychotics on one-yearoutcomes of schizophrenia.MethodsA multicentre, open, randomized and controlled study included 914patients meeting CCMD-3 criteria for schizophrenia. The duration ofillness was no more than 5 years. Patients are allocated to one yeartreatment with one of 7 drugs. The main outcome measures were clinicaloutcome, side effects, insight and compliance, quality of life, cognitivefunction and social function.Result1. At baseline, subsets of patients were prescribed monotherapy withchlorpromazine (n=112), sulpiride (n=139), clozapine (n=149),risperidone (n=199), olanzapine (n=111), quetiapine (n=117) andaripiprazole (n=87) in 6 months follow-up study. At baseline, subsets ofpatients were prescribed monotherapy with chlorpromazine (n=61),sulpiride (n=102), clozapine (n=105), risperidone (n=155), olanzapine(n=65), quetiapine (n=72), aripiprazole (n=34) in I2 months follow-upstudy.2. At the end of 6 months and 12 months, the rate of discontinuationfor any reason was similar among groups: chlorpromazine (25.0%,37.7%), sulpiride (18.0%, 30.4%), clozapine(18.1%, 34.3%), risperidone(22.6%, 43.1%), olanzapine (22.5%, 38.5%), quetiapine (26.5%, 43.1%),aripiprazole (13.8%, 17.6%). At the end of 6 months and 12 months, therate of relapse was similar among groups: chlorpromazine(10.7%, 13.1%),sulpiride(12.2%,18.6%), clozapine (9.4%, 19.0%), risperidone (6.5%,12.3%), olanzapine(9.0%, 13.8%), quetiapine (15.4%,25.0%), aripiprazole(8.0%,8.8%). The time to discontinuation for any reason was similaramong the groups. The time to discontinuation for relapse was similaramong the groups. 3. Patients treated with sulpiride, risperidone, olanzapine, quetiapineand aripiprazole had better tolerability regarding extrapyramidalsymptoms (EPS) compared with patients receiving chlorpromazine andclozapine. Patients treated with chlorpromazine, sulpiride and risperidonewere significantly more likely to receive an anticholinergic. Olanzapinehad higher rate of weight gain than other antipsychotics, whilerisperidone resulted in a higher percentage of women with catameniadisturbance than other antipsychotics.4. At 6 months and 12 months, the improvement of ITAQ andadherence to treatment were similar among the groups.5. At 6 months and 12 months, all groups demonstrated similarchanges on the SF-36.6. At 6 months, olanzapine and quetiapine showed greaterimprovements from baseline compared with chlorpromazine and sulpiridein categories achieved of Wisconsin Card Sorting Test (WCST).Risperidone, olanzapine and quetiapine showed greater improvementfrom baseline compared with chlorpromazine in digit span. At 12 monthsolanzapine and quetiapine showed greater improvement from baselinecompared with chlorpromazine and sulpiride in categories achieved ofWCST.7. At 6 months and 12 months, clozapine, risperidone andaripiprazole showed significantly improvement from baseline comparedwith chlorpromazine in GAS. At 6 months, clozapine, risperidone,olanzapine and aripiprazole showed significantly improvement frombaseline compared with chlorpromazine in SDSS. At 12 months,clozapine, risperidone, olanzapine and aripiprazole showed greaterimprovement from baseline compared with chlorpromazine and sulpiridein SDSS.ConclusionClinical outcomes were similar among 7 antipsychotics.Chlorpromazine, sulpiride, clozapine and dsperidone were associatedwith greater EPS. Olanzapine was associated with greater weight gain.Risperidone was associated with greater catamenia disturbance. Effectiveness on quality of life was similar among 7 antipsychotics.Olanzapine and quetiapine appeared to be more effective thanchlorpromazine and sulpiride in cognitive function. Clozapine, olanzapinerispeddone and aripiprazole appeared to be more effective thanchlorpromazine and sulpiride in social function.