title: Early intervention with second-generation antipsychotics in first-episode psychosis: results of an 8-week naturalistic study.
abstract: OBJECTIVE
  The objective was to compare short-term effectiveness of aripiprazole with three other second-generation antipsychotics (SGAs) in the treatment of first-episode psychosis.
  
  
  METHODS
  In a naturalistic, 'single-blind' design, 60 subjects experiencing their first psychotic episode were treated for 8 weeks with aripiprazole (n = 19), risperidone (n = 16), olanzapine (n = 14) or quetiapine (n = 11). Medication and dosing decisions were made by treating psychiatrists, constrained to once-a-day dosing, low initial doses and no clozapine. Weekly ratings were obtained using the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were also collected weekly.
  
  
  RESULTS
  The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly (P < 0.0005). The between-group and group by time interaction terms were non-significant. Similar reductions were seen across all PANSS sub-scales. At Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups (P < 0.002). Few instances of extrapyramidal symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained unchanged.
  
  
  CONCLUSIONS
  Early intervention with low doses of four SGAs led to rapid symptom reduction in first-episode psychotic patients with severe psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms.
authors.affiliation: Drexel University College of Medicine, Philadelphia, Pennsylvania, USA. rcjosiassen@gmail.com
authors.forename: Richard C
authors.initials: RC
authors.lastname: Josiassen
authors.forename: Rita A
authors.initials: RA
authors.lastname: Shaughnessy
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Filymer
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Donohue
authors.forename: Margit
authors.initials: M
authors.lastname: Kacso
authors.forename: Naomi
authors.initials: N
authors.lastname: Finkel
authors.forename: Jessica
authors.initials: J
authors.lastname: Curtis
authors.forename: Brett
authors.initials: B
authors.lastname: Audino
authors.forename: Nina
authors.initials: N
authors.lastname: Skuban
mesh_terms: D000293:Adolescent; D000328:Adult; D017109:Akathisia, Drug-Induced / Q000150:complications; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D005260:Female; D006801:Humans; D008297:Male; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015363:Quinolones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole