title: Clozapine v. chlorpromazine in treatment-naive, first-episode schizophrenia: 9-year outcomes of a randomised clinical trial.
abstract: BACKGROUND
  The differential effects of so-called 'first- and second generation' antipsychotic medications, when given in the first episode, on the long-term outcome of schizophrenia remain to be elucidated.
  
  
  OBJECTIVE
  We compared the 9-year outcomes of individuals initially randomised to clozapine or chlorpromazine.
  
  
  METHODS
  One-hundred and sixty individuals with treatment-naive, first episode schizophrenia or schizophreniform disorder in a mental health centre in Beijing, China were randomised to clozapine or chlorpromazine treatment for up to 2 years,followed by up to an additional 7 years of naturalistic treatment. The primary outcome was remission status for individuals in each group.
  
  
  RESULTS
  Individuals in both groups spent essentially equal amounts of time in each clinical state over the follow-up time period(remission, 78%; intermediate, 8%; relapse, 14%). There were no significant differences on other measures of illness severity. The clozapine group was more likely than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01). There were no significant differences between the two groups on other secondary efficacy outcomes.
  
  
  CONCLUSIONS
  These findings support the comparability in effectiveness between antipsychotic medications but with slightly greater tolerability of clozapine in the treatment of first-episode psychosis.
authors.affiliation: Department of Psychiatry, Columbia University, College of Physicians & Surgeons and New York State Psychiatric Institute, New York, USA.
authors.forename: Ragy R
authors.initials: RR
authors.lastname: Girgis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Li
authors.forename: Kejin
authors.initials: K
authors.lastname: Li
authors.forename: Huiping
authors.initials: H
authors.lastname: Jiang
authors.forename: Chengjing
authors.initials: C
authors.lastname: Wu
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Niu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lieberman
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002681:China; D002746:Chlorpromazine / Q000009:adverse effects / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine; D002746:Chlorpromazine