June 01, 2007

"Old" Versus "New" Medications for Schizophrenia

Dr. Henry A. Nasrallah, an expert in the field of schizophrenia treatment, was inteviewed by Medscape to discuss results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) as well as Britain's Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS) studies, showing that older antipsychotics may be as effective as the newer ones, and other emerging issues in schizophrenia treatment.

Dr. Nasrallah is a Professor of Psychiatry, Neurology, and Neuroscience and Director of the Schizophrenia Program at the University of Cincinnati College of Medicine, Cincinnati, Ohio.

He explained that the above 2 studies (CUtLASS and CATIE) have generated confusion over the conclusion that older and newer antipsychotic treatments are equally effective. He says that is because of variables in both studies that may modify that conclusion.

In the CATIE study, the variable was tardive dyskinesia, and in the CUtLASS study, there were two different variables - most patients getting the older antipsychotics got them as long lasting (depot) injections, and one of the medications classified as a "first-generation" or "typical" antipsychotic (FGA), is often classified elsewhere as a "second generation" or "atypical" antipsychotic (SGA).

Dr. Nasrallah says that he advocates for depot injections to combat nonadherence to medications and repeated psychotic relapses, which may lead to a worse outcome.

Studies of FGA depots, although they show less relapses, do not show the improved functioning over time that SGA medications do. But, this may be due to the fact that studies using FGA depot injections are often done with patients who have already suffered repeated relapses and have a more severe illness course. Also, there is always the fear that the patients may get tardive dyskinesia from the FGA.

SGA depot injections, on the other hand, may show that they will both prevent relapse and improve function over time. That has been his experience with his patients.

Next, Dr. Nasrallah commented that although there are no new-mechanism drugs (such as those that may work on glutamate or NMDA receptors) yet on the horizon, there are new medications and new formulations of medications expected to soon be available. Mentioned were the following:

  • Seroquel (quetiapine) extended-release (XR): To be taken once per day, rather than twice per day, may help with adherence.
  • bifeprunox: A partial D-2 agonist like aripiprazole has a good metabolic profile with minimal weight gain
  • Invega (paliperidone), or 9-hydroxy risperidone: An active metabolite of risperidone, acts much differently than risperidone. It is safer for patients with liver disease, is released slowly in the intestines resulting in fewer side effects and can be started at the target dosage without the need to titrate.

The interview goes on to discuss the "Measurement and Treatment Research to Improve Cognition in Schizophrenia" (MATRICS) funded by the National Institutes of Mental Health (NIMH), psychosocial treatments, and the issue of weight gain and metabolic syndrome.

Read the Interview: The Cutting Edge of Schizophrenia Treatment: An Expert Interview With Henry A. Nasrallah, MD (free registration required, Medscape)

Related Reading:
Study Suggests Newer Drugs not Better than Older Drugs
Tailored Treatment of Schizophrenia
Schizophrenia Treatment Goal Can Go Beyond Simple Maintenance
MATRICS - Improving cognition


The CATTIE STUDY and CUTLAS studies sem to be having one purpose. somehow to help the drug MNCs either to evergreen the medications or hide the EFFECTIVENESS OF CLOZAPINE. they will never include this drug in these studies because it is way ahead of all these new drugs in pipeline .The scare about agranulocystosis is just that SCARE without any scientific proof.

Posted by: captainjohann at June 3, 2007 01:28 AM

I am on Abilify and function very well. I have schizoaffective disorder. I talk about my illness in my standup act. go to famecast.com and search under skitzobill to see video.

Posted by: Martin Malloy at June 3, 2007 12:58 PM

Hypofunction of glutamatergic neurons has been hypothesized to caused schizophrenia. For example, see conclusions from the symposium entitled, "Not Just Dopamine Any More: Emerging Glutamatergic Therapies for Schizophrenia," (Toronto, 2006) http://www.medscape.com/viewarticle/537385
Calcium deficiency may be a predisposing or causative factor in schizophrenia ?
This concept is based on the demonstration that „NMDA receptor hypofunction“ can be based on calcium-deficiency, potentiated by nutritional hypoproteinemia - see website www.bse-expert.cz ; chapter “Hyperfunction (Alzheimer’s disease and Parkinson disease) and hypofunction (schizophrenia) of glutamatergic neurons”.

Posted by: Josef Hlasny at June 3, 2007 01:20 PM

I have more a question than a comment , my son is 23 years of age and refuses medication, he's in denial of being diagnose with schizoformia .Which he still exhibits signs of schizophrenia, I've even purchase 5htp vitimins for him and he throws them away.He''s not talking to himself as much as he use to just has a habit of constant spiting and afraid of sleeping in his room alone can you give me any advise it's all new new to me as of two months now ,(NEED ADVISE)

Posted by: Janice at June 5, 2007 06:41 AM

Janice, My advice is to join in on the discussion board for Parents: , and to read the book "I Am Not Sick, I Don't Need Help" by Xavier Amador: http://www.vidapress.com/html/iansidnh.html


Posted by: Jeanie at June 8, 2007 11:02 AM

My psychiatrist (I am a schizophrenic) told me that
in the CATIE study by NIMH that the patients on the
first generation antipsychotics were "cherrypicked"
in the sense that if the showed extrapyramidal side
effects they were removed from the study. My
personal experience is that the second generation
antipsychotics that I have used up until now are
vastly superior to the first generation drugs.

Posted by: William O. Romine Jr. at June 16, 2007 06:11 PM

my 28 year old son with schizophrnia dissorder is on enveaga meds..he does not take on his own.i give them daily.when he agrees.and thats not everyday.i do use his ciggerretts to exchange for taking his meds.most of the time it works.he is a heavy smoker.up to 3 packs a day. i feel wrong in suppling so many cigg.for him.slowly making his health worse.and yet he is addicted to niccotene.and can become very difficult to deal with.i try to convince him to slow down.waiting 5 or 10 min. inbetween smokes. etc...i am involved with NAMI.and i am going to a 12 week class to understand the illness.better.we have had 8 years of this illness.its a rollercoaster ride for sure.i love this person very much.and will always be striving for more understanding.and i pray alot.he was a cool person before.and still is.but this illnes is devastating for all and both us.converstation and behaviors from him are making better since to me.now that im learning so much more than i used to know.my patience are getting better.i have read the book,im not sick.it should be read by any family member who is there for there loved one.i whis so much there was a miracle drug.to take it all away.and bring my son back. i miss who he was.but thats not the case right now. we or i know i do.take life one day at time.sometimes even 1 hour at time.and we get thru each day. somedays are better than others.but i try to see and find the joy with him in the most simple things.

Posted by: janetchristison at April 27, 2008 07:56 AM

My nephew has been hearing vices for about a year. It only really come to my attention recently. I am his uncle and am VERY worried about him! He explained to me with tears running down his face that he believed a close family member was giving signal to a hidden camera in order for them to kill him!!! He has come up against a problem with his doctor which has resulted in him walking out and not taking anything for it. He was a heavy canibis user where all these problem started! Firstly can 5HTP help him and i have also heard that he could be lacking in some vitamins? Is there a book that i can get him about drug related schizophrenia?
With his concent i am going to the dotors with him to find out his options, is there any questions your aware of that i should ask the doctor?
Thanks so much

Posted by: Tony Malone at June 17, 2008 12:46 AM

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