Reduction of functional disability with atypical antipsychotic treatment: a randomized long term comparison of ziprasidone and haloperidol.
BACKGROUND
Recent interest has focused on the definition and measurement of clinical remission in people with schizophrenia. This study examined the process of development of "functional remission" in a long-term comparative double-blind study of haloperidol and the atypical antipsychotic medication ziprasidone.


METHODS
Community dwelling patients with schizophrenia were randomized to treatment with haloperidol (n=47) or ziprasidone dosed either once or twice daily (n=139). They were re-examined at follow-up intervals that ranged up to 196 weeks. Their community functioning was examined with the Heinrichs-Carpenter Quality of Life Scale (QLS). Total scores for occupational and interpersonal functioning and achievement of improvement milestones across the individual items were both analyzed.


RESULTS
Mixed model repeated measures analyses detected a significant (p<.05) treatment effect over time favoring ziprasidone for interpersonal functioning. While the mixed model was not significant for role functioning, the mean change at endpoint was significantly greater than 0 for the ziprasidone group but not the haloperidol group. Analyses of the distributions of change scores across the items showed that the number of items where endpoint scores were 5 or 6 (reflecting minimal to no impairment) was significantly higher in ziprasidone treated patients, (p=.03).


CONCLUSIONS
Long term treatment with ziprasidone was associated with greater functional gains than treatment with haloperidol, even when the time course of dropout was controlled. Both treatment retention and functional gains favored the atypical treatment in this long-term study. Future long-term studies will be needed to clarify the determinants of these functional changes.
Harvey
Philip D
PD
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. philipdharvey1@cs.com
Pappadopulos
Elizabeth
E
Lombardo
Ilise
I
Kremer
Charlotte M
CM
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010879:Piperazines / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications / Q000188:drug therapy; D013844:Thiazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone; D006220:Haloperidol