Newer antipsychotic medications, a...

Newer antipsychotic medications, as it is as olanzapine, have been referr to as "atypical" because they have been reput to have fewer extrapyramidal side events than older medications such as haloperidol. Rosenheck and colleagues guidanceed a 12-month clinical trial comparing olanzapine with haloperidol, to determine whether olanzapine has fewer side issues improves quality of life, and has a lower take away from in patients with schizophrenia.

Eligible patients from 17 Department of Veterans Affairs medical center were assigned to receive oral olanzapine or haloperidol. Patients received either olanzapine, 5 to 20 mg by day (159 patients), or haloperidol, 5 to 20 mg by day (150 patients). Those receiving haloperidol also received benztropine to mastery extrapyramidal symptoms. A placebo version of this medication was given to those receiving olanzapine. Dosage adjustments were made as necessary.

Symptom results were assessed at baseline, six weeks, and three six, nine, and 12 month using the Positive and Negative Syndrome Scale (PANSS) and a quality-of-life scale. Secondary issues included adverse effects and other quality-of-life scales. Neurocognitive status also was touchstoneed Health care costs were assessed in space of times of service utilization, costs associated with inpatient and other facility use, medication, and non-health care expenses such as productivity.

The sum of two units groups were similar at baseline. Although there was a high discontinuation rate in the trial--(59 percent full completed the trial, and 36 percent partially complet follow-up assessments), the couple groups were similar in limits of proportion of patients completing the trial and reasons for discontinuing. The alone exception was that persons in the haloperidol collection were marginally more likely to discontinue because of adverse effects

Intention-to-treat analysis showed no differences overall during the 12 month as indicated forward the PANSS total symptom score. There were no significant differences in the proportion of patients who improved according to 20 percent on their PANSS scores. Participants also showed no significant differences in assessments of quality of life, intrapsychic foundations, interpersonal relationships, or instrumental part functioning. Olanzapine patients did score significantly lower in succession an akathisia scale but not upon a measure of tardive dyskinesia or extrapyramidal symptoms. decent significant differences were found relating to better motor functioning and memory in those receiving olanzapine. The merely difference between the two disposes in utilization costs was that total medication preciousness was four to five times higher in the olanzapine arrange than in the haloperidol form into groups There was significantly greater weight gain at six and 12 month among those in the olanzapine group

Overall, there were not many significant differences in outcomes measures between the olanzapine and haloperidol collections Although the olanzapine group had les akathisia and showed improvement in motor and memory function, the cognitive gains were not sufficient enough to improve quality-of-life measures. Olanzapine use was associated with greater require to be paid [i]or[/i] undergone and more weight gain. Given that other trials have favored olanzapine, the authors attribute the unexpect equivalence between agents in their trial to the use of prophylactic benztropine to restrain extrapyramidal symptoms, resulting in better tolerance of haloperidol. The major limitation of this meditation is that it was not a cost-benefit analysis and, therefore, does not indicate whether the small advantages in bounds of reduced akathisia and neurocognitive function sprout the costs of the drug

Rosenheck R et al. Effectiveness and take away from of olanzapine and haloperidol in the treatment of schizophrenia. A randomized controll trial. JAMA November 26 2003; 290:2693-2702

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