Effects of antipsychotic medications on psychosocial functioning in patients with chronic schizophrenia: findings from the NIMH CATIE study.
OBJECTIVE
This study examined the relative effects of the second-generation antipsychotic drugs and an older representative agent on psychosocial functioning in patients with chronic schizophrenia.


METHODS
Consenting patients were enrolled in the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project. In phase 1, patients were randomly assigned to receive olanzapine, perphenazine, quetiapine, risperidone, or ziprasidone for up to 18 months. Clozapine was included for patients who chose this pathway after discontinuing phase 1 due to inefficacy; all other patients received another second-generation antipsychotic. Psychosocial functioning was assessed using the Quality of Life Scale.


RESULTS
Psychosocial functioning modestly improved for the one-third of phase 1 patients who reached the primary Quality of Life Scale analysis endpoint of 12 months (average effect size 0.19 SD units). Although for several of the drugs individually there were significant changes from baseline, overall there were no significant differences between the different agents. Results were similar at 6 and 18 months. There were no significant differences among the treatment groups in the amount of change in the Quality of Life Scale total score or subscale scores at 6, 12, or 18 months. Patients treated with clozapine in the efficacy pathway made comparable gains. Early treatment discontinuations, especially among patients most impaired at baseline, limited the ability to achieve more substantial functional gains.


CONCLUSIONS
All antipsychotic treatment groups in all phases made modest improvements in psychosocial functioning. There were no differences among them after 6, 12, or 18 months. More substantial improvements would likely require more intensive adjunctive psychosocial rehabilitation interventions.
Swartz
Marvin S
MS
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. swart001@mc.duke.edu
Perkins
Diana O
DO
Stroup
T Scott
TS
Davis
Sonia M
SM
Capuano
George
G
Rosenheck
Robert A
RA
Reimherr
Fred
F
McGee
Mark F
MF
Keefe
Richard S E
RS
McEvoy
Joseph P
JP
Hsiao
John K
JK
Lieberman
Jeffrey A
JA
D000223:Adaptation, Psychological; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002908:Chronic Disease; D003024:Clozapine / Q000627:therapeutic use; D003987:Dibenzothiazepines / Q000627:therapeutic use; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D009315:National Institute of Mental Health (U.S.); D000077152:Olanzapine; D010352:Patient Dropouts; D010546:Perphenazine / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011788:Quality of Life; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D010546:Perphenazine; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine