title: Risperidone, quetiapine, and fluphenazine in the treatment of patients with therapy-refractory schizophrenia.
abstract: This 12-week, double-blind study evaluated the effectiveness of risperidone (4 mg/day), quetiapine (400 mg/day), or fluphenazine (12.5 mg/day) in a stringently defined treatment-resistant population of people with schizophrenia. No differences were noted in total Brief Psychiatric Rating Scale (BPRS) or Clinical Global Impression scores among the drug groups (n = 38). More subjects tended to complete the study on risperidone (69%) or quetiapine (58%) than those treated with fluphenazine (31%; P value not significant). Eighty-nine percent of those who discontinued on fluphenazine (8 of 9) were due to lack of efficacy. Discontinuation due to adverse effects was low, with only 2 subjects (both on quetiapine) stopping due to side effects. Three of 13 risperidone-treated subjects (23%) and 3 of 12 quetiapine-treated subjects (25%) met response criteria (decrease of 20% of total BPRS score), whereas 2 of 13 subjects (15%) responded to fluphenazine. Side effect occurrence was similar among drug groups and EPS ratings on the Simpson Angus Scale improved in all drug groups (quetiapine, 1.64; risperidone, 1.30; fluphenazine, 0.69; P value not significant). Despite the newer class of second-generation antipsychotic medications, this treatment-resistant population remains difficult to treat. Many people have only minimal to modest improvements with antipsychotic treatment and most continue to have residual psychotic symptoms. Treatment with first- and second-generation antipsychotics may demonstrate similar efficacy; however, patients treated with second-generation antipsychotics may be more likely to adhere to treatment.
authors.affiliation: Maryland Psychiatric Research Center, Treatment Research Unit, University of Maryland, Baltimore 21228, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Conley
authors.forename: Deanna L
authors.initials: DL
authors.lastname: Kelly
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Nelson
authors.forename: Charles M
authors.initials: CM
authors.lastname: Richardson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Feldman
authors.forename: Rhonda
authors.initials: R
authors.lastname: Benham
authors.forename: Patricia
authors.initials: P
authors.lastname: Steiner
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.forename: Ijaz
authors.initials: I
authors.lastname: Khan
authors.forename: Ron
authors.initials: R
authors.lastname: McMullen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gale
authors.forename: Marie
authors.initials: M
authors.lastname: Mackowick
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Love
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004351:Drug Resistance; D004409:Dyskinesia, Drug-Induced / Q000453:epidemiology; D005260:Female; D005476:Fluphenazine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012725:Sexual Behavior; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate; D018967:Risperidone; D005476:Fluphenazine