[Show abstract][Hide abstract] ABSTRACT: Objectives. To examine the comparative outcomes associated with the antipsychotic treatment of outpatients with schizophrenia and to describe changes in clinical status over the first 6 months of treatment in participating patents from the Middle East and Africa (MEA). Methods. The Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) Study is a 3-year, prospective, observational study of health outcomes associated with antipsychotic medication in outpatients treated for schizophrenia. This article reports the 6-month interim results in the MEA region (N = 1399). Subjects, aged 18 years and over and undergoing treatment for schizophrenia were enrolled if, at the discretion of the treating psychiatrist, they initiated or changed antipsychotic medication. For the primary analyses, two treatment groups were established; viz. olanzapine and other antipsychotics' (non-olanzapine including risperidone) groups. Subanalysis of olanzapine versus risperidone groups was also done as secondary comparison. Measures of treatment effectiveness (Clinical Global Impression of Severity (CGI-S)), and safety (incidence of extrapyramidal symptoms (EPS), tardive dyskinesia (TD), side-effects (sexual dysfunction and weight change)) were taken at baseline and at 3 and 6 months after enrolment. Results. Olanzapine (58.9%) and risperidone (13.8%)) were the most frequently prescribed antipsychotics in this study. Co-prescription of anticholinergics was at least four times more frequent for risperidone-treated patients than for those treated with olanzapine at any time point. Olanzapine was more efficacious in the treatment of overall symptom seven (CGI-S) than other antipsychotics or risperidone. In all other symptom domains (CGI-S), patients responded significantly better to treatment with olanzapine than to treatment with other antipsychotics. EPS significantly declined over the treatment period for patients taking olanzapine. Compared with patients on other antipsychotics, fewer patients receiving olanzapine therapy developed TD post-baseline. In addition, more patients on olanzapine therapy presented with a remission of TD symptoms after 3 and 6 months of treatment compared with patients on other antipsychotics and risperidone. The prevalence of side-effects associated with sexual function (loss of libido, impotence/sexual dysfunction) was significantly reduced (p < 0.001) with olanzapine treatment compared with other antipsychotics. Compared with those patients taking other antipsychotics or risperidone, fewer patients developed loss of libido, and more patients recovered from these symptoms in the course of 6 months of olanzapine treatment. Similarly, fewer olanzapine patients suffered from impotence/sexual dysfunction over the first 3 months of treatment, and more patients had recovered from pre-existing symptoms after 6 months than those taking other antipsychotics or risperidone. Patients taking olanzapine were significantly more likely to gain more than 7% of their baseline weight over a 6-month period. Conclusions. Initial 3- and 6-month findings included in this progress report indicate that patients treated with olanzapine showed greater improvements in terms of effectiveness of treatment, and that this was associated with a more favourable overall safe profile than that of patients treated with other antipsychotics or risperidone.
[Show abstract][Hide abstract] ABSTRACT: Sexual dysfunction in patients with schizophrenia can reduce quality of life and treatment compliance. This report will compare the effects of selected atypical and typical antipsychotics on sexual function in a large, international population of outpatients with schizophrenia who were treated over 1 year.
Outpatients with schizophrenia, who initiated or changed antipsychotic treatment, and entered this 3-year, prospective, observational study were classified according to the monotherapy prescribed at baseline: olanzapine (N=2638), risperidone (N=860), quetiapine (N=142) or haloperidol (N=188).
Based on patient perception, the odds of experiencing sexual dysfunction during 1 year of therapy was significantly lower for patients treated with olanzapine and quetiapine when compared to patients who received risperidone or haloperidol (all P< or =0.001). Females on olanzapine (14%) or quetiapine (8%) experienced a lower rate of menstrual irregularities, compared to females on risperidone (23%) or haloperidol (29%). Significant discordance was evident between patient reports and psychiatrist perception of sexual dysfunction, with psychiatrists underestimating sexual dysfunction (P< or =0.001).
These findings indicate clinically relevant differences exist in the sexual side effect profiles of these selected antipsychotics. These factors should be considered when selecting the most appropriate treatment for outpatients with schizophrenia.
No preview · Article · Jul 2006 · European Psychiatry