Antipsychotics are the treatment of choice in managing schizophrenia and other psychotic disorders. Several major trials have been conducted examining the treatment of schizophrenia, including examining effectiveness, side effect profile, and pharmacoeconomic differences. These major trials have helped guide the way that antipsychotics are utilized.

Essential Questions and References

How do antipsychotics compare in regards to effectiveness?

CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)

  1. Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209-23. [PubMed]
  2. Stroup TS, Lieberman JA, McEvoy JP, et al. Effectiveness of olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia after discontinuing perphenazine: a CATIE study. Am J Psychiatry. 2007;164(3):415-27. [PubMed]
  3. Stroup TS, Lieberman JA, McEvoy JP, et al. Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Am J Psychiatry. 2006;163(4):611-22. [PubMed]
  4. McEvoy JP, Lieberman JA, Stroup TS, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163(4):600-10. [PubMed]
  5. Stroup TS, Lieberman JA, McEvoy JP, et al. Results of phase 3 of the CATIE schizophrenia trial. Schizophr Res. 2009;107(1):1-12. [PubMed]

Is there a clinical difference between typical antipsychotics and atypical antipsychotics?

CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness)

  1. Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209-23. [PubMed]

How do antipsychotics differ as far as side effect profile?

CAFE (Metabolic Profiles of Second-Generation Antipsychotics in Early Psychosis)

  1. Patel JK, Buckley PF, Woolson S, et al. Metabolic profiles of second-generation antipsychotics in early psychosis: findings from the CAFE study. Schizophr Res. 2009 Jun;111(1-3):9-16. [PubMed]

Can antipsychotics be used for other ailments besides schizophrenia?

CATIE-AD (Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer’s Disease)

  1. Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med. 2006;355(15):1525-38. [PubMed]

EUFEST (Effectiveness of Antipsychotics in First-Episode Schizophrenia and Schizophreniform Disorder)

  1. Kahn RS, Fleischhhacker WW, Boter H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet. 2008;371(9618):1085-97. [PubMed]

How does the antipsychotic selection affect quality of life?

CUtLASS 1 (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study)

  1. Jones PB, Barnes TR, Davies L, et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry. 2006 Oct;63(10):1079-87. [PubMed]

SOHO (Schizophrenia Outpatient Health Outcome)

  1. Knapp M, Windmeijer F, Brown J, et al. Cost-utility analysis of treatment with olanzapine compared with other antipsychotic treatments in patients with schizophrenia in the pan-European SOHO study. Pharmacoeconomics. 2008;26(4):341-58. [PubMed]
  2. Haro JM, Novick D, Suarez D, et al. Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study. J Clin Psychopharmacol. 2006;26(6):571-8. [PubMed]

Have any antipsychotics been shown to aid in decreasing suicidality?

InterSePT (International Suicide Prevention Trial)

  1. Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry. 2003;60(1):82-91. [PubMed]

How does schizophrenia impact life expectancy?

InterSePT (International Suicide Prevention Trial)

  1. Gardner-Sood P, Lally J, Smith S, et al. Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychol Med. 2015; 45(12):2619-2629. [Weblink]
  2. Brown S, Inskip H, Barraclough B. Causes of the excess mortality in schizophrenia. Br J Psychiatry. 2000;177:212-217. [Weblink]