Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders

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This paper was based (in part) on results from the study of the Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis by the HGDH Study Group sponsored by Eli Lilly and Company.

Diana O. Perkins, Department of Psychiatry, C. B. #7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA. Tel: [phone]; fax: [phone]; e-mail: [email protected]

Declaration of interest

This work was supported by Lilly Research Laboratories and USPHS grants MH01905-01 (D.O.P.) MH00537, MH33127 (J.A.L.) the UNC Mental Health and Neuroscience Clinical Research Centre, the North Carolina Foundation of Hope, MH52376 and MH62157 (A.I.G.).

Schizophrenia is a heterogeneous disorder with good symptomatic and functional outcomes in some patients although others have a more severe, deteriorating course (Wiersma et al, 1998). This heterogeneity can result from environmental factors as well as differences in the underlying disease biology. Antipsychotic medication treatment might be such an environmental factor, with earlier intervention increasing the likelihood of good response (Loebel et al, 1992). Early age of onset and poor premorbid function are associated with prognosis and could be the behavioural manifestation of brain function impairments indicative of a poor prognosis (Lieberman et al, 2001b ). Such factors could also conceivably lead to treatment delay and therefore confound the relationship of duration of untreated psychosis (DUP) with outcome (McGlashan, 1999). In this study we evaluated the independent contributions of DUP, age at onset and premorbid function to rate of symptom remission, change in psychopathology severity and social and vocational function.

METHOD

Data for this study were collected as part of a 2-year randomised, double-blind clinical trial that compared the efficacy and safety of olanzapine with that of haloperidol in patients experiencing a first-episode of DSM–IV (American Psychiatric Association, 1994) schizophrenia, schizophreniform or schizoaffective disorder. The trial was conducted from March 1997 to July 2001 at 14 academic centres in North America and Western Europe. All study personnel and participants remained masked for the total duration of the study and until the study data-set was completely finalised. A detailed description of the study methods is available in an earlier publication (Lieberman et al, 2003).

Participants

Participants were aged 16–40 years and met DSM–IV diagnostic criteria before age...