title: An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia.
abstract: OBJECTIVE
  The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO) for schizophrenia versus treatment-as-usual (TAU), for which evidence has been very scarce.
  
  
  METHODS
  In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS). When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists.
  
  
  RESULTS
  Forty-two patients (21 females, 39.0 ± 10.9 years-old) participated in this study. The baseline PANSS total score indicated the presence of severe psychopathology and was significantly higher in the ALGO group (n = 25; 106.9 ± 20.0) than in the TAU group (n = 17; 92.2 ± 18.3) (P = 0.021). As a result of treatment, there were no significant differences in the PANSS reduction rates, premature attrition rates, as well as in a variety of other clinical measures between the groups. Despite an effort to make each group unique in pharmacologic treatment, it was found that pharmacotherapy in the TAU group eventually became similar in quality to that of the ALGO group.
  
  
  CONCLUSIONS
  While the results need to be carefully interpreted in light of a hard-to-distinguish treatment manner between the two groups and more studies are necessary, algorithm-based antipsychotic treatments for schizophrenia compared well to treatment-as-usual in this study.
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan ; Ohizumi Hospital, Tokyo, Japan.
authors.forename: Jinichi
authors.initials: J
authors.lastname: Hirano
authors.forename: Koichiro
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authors.lastname: Watanabe
authors.forename: Takefumi
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authors.lastname: Suzuki
authors.forename: Hiroyuki
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authors.lastname: Uchida
authors.forename: Ryosuke
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authors.forename: Taishiro
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authors.lastname: Kishimoto
authors.forename: Takashi
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authors.lastname: Nagasawa
authors.forename: Yusuke
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authors.lastname: Tomita
authors.forename: Koichiro
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authors.lastname: Hara
authors.forename: Hiromi
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authors.lastname: Ochi
authors.forename: Yoshimi
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authors.lastname: Kobayashi
authors.forename: Mutsuko
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authors.lastname: Ishii
authors.forename: Akane
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authors.lastname: Fujita
authors.forename: Yoshihiko
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authors.lastname: Kanai
authors.forename: Megumi
authors.initials: M
authors.lastname: Goto
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hayashi
authors.forename: Kanako
authors.initials: K
authors.lastname: Inamura
authors.forename: Fumiko
authors.initials: F
authors.lastname: Ooshima
authors.forename: Mariko
authors.initials: M
authors.lastname: Sumida
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ozawa
authors.forename: Kayoko
authors.initials: K
authors.lastname: Sekigawa
authors.forename: Maki
authors.initials: M
authors.lastname: Nagaoka
authors.forename: Kae
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Mika
authors.initials: M
authors.lastname: Konishi
authors.forename: Ataru
authors.initials: A
authors.lastname: Inagaki
authors.forename: Takuya
authors.initials: T
authors.lastname: Saito
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Motohashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Okubo
authors.forename: Motoichiro
authors.initials: M
authors.lastname: Kato
keywords: algorithm; measurement-based treatment; open-label clinical trial; schizophrenia; treatment-as-usual