Early onset of antipsychotic response in the treatment of acutely agitated patients with psychotic disorders.
OBJECTIVE
While the efficacy of antipsychotic medications for the treatment of psychosis is generally established, the speed of onset of antipsychotic action remains controversial. The objective of this study was to evaluate the early response (within the first 24 h) in psychosis with ziprasidone IM treatment, and to determine whether this early effect is distinct from a reduction in agitation symptoms.


METHODS
In a 24-h, double-blind study, hospitalized patients with psychotic disorder and acute agitation were randomized to treatment with fixed doses of IM ziprasidone: 2 mg (N=38) or 20 mg (N=41). Efficacy assessments were based on the PANSS positive subscale and PANSS early psychosis factor score (conceptual disorganization, hallucinatory behavior, and unusual thought content) at 4 and 24 h.


RESULTS
Ziprasidone IM demonstrated a significant dose-related effect (20 mg vs. 2 mg) on both the PANSS early psychosis factor score and the PANSS positive subscale at the first post-baseline time point (4 h), and at 24 h (all p<0.05). There was a significant direct effect of ziprasidone IM on early psychosis at 24 h (p<0.05), distinct from improvement in agitation symptoms.


CONCLUSIONS
These findings suggest, in addition to an early reduction in acute agitation, ziprasidone IM may be associated with a more rapid improvement in psychotic symptoms than previously reported, thus lending further support to the emergent hypothesis of early psychosis improvement in antipsychotic treatment.
Agid
Ofer
O
Center for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada M5T 1R8. Ofer_agid@camh.net
Kapur
Shitij
S
Warrington
Lewis
L
Loebel
Antony
A
Siu
Cynthia
C
D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010879:Piperazines / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D013844:Thiazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone