Antipsychotic drug treatment in first-episode psychosis: should patients be switched to a different antipsychotic drug after 2, 4, or 6 weeks of nonresponse?
Patients with schizophrenia show symptom reduction early after the initiation of drug treatment, but no consensus has been reached on the number of weeks after which a nonresponding patient should be switched to an alternative treatment. We aimed to test whether patients should be switched to an alternative treatment at 2, 4, or 6 weeks from treatment initiation. Remission within 12 months was assessed in 299 first-episode patients who completed the full 12-month European First-Episode Schizophrenia Trial. Logistic regression analyses were used to test whether the prediction of remission was improved by including assessments obtained 4 or 6 weeks from treatment initiation compared with a prediction based on baseline and 2-week measures only. Based on baseline and 2-week assessments, remission status was correctly predicted in 61% of the patients (positive and negative predictive power, 0.61 and 0.58, respectively; sensitivity, 0.94; and specificity, 0.12). This percentage increased to 63% (positive and negative predictive power, 0.67 and 0.55, respectively; sensitivity, 0.73; and specificity, 0.47) and 68% (positive and negative predictive power, 0.73 and 0.61, respectively; sensitivity, 0.73; and specificity, 0.60) by the inclusion of 4- and 6-week assessments, respectively. Although we confirmed earlier findings that 2-week measures of response are associated with remission, the prediction of remission is significantly improved by the inclusion of 4- and 6-week assessments. However, as the increase in prediction accuracy is modest, it is uncertain whether this improvement is clinically relevant.
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre Utrecht, Utrecht, the Netherlands. e.m.derks@umcutrecht.nl
Eske M
EM
Derks
W Wolfgang
WW
Fleischhacker
Han
H
Boter
Jozef
J
Peuskens
Rene S
RS
Kahn
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D012559:Schizophrenia / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents