Download PDF
Pharmacopsychiatry 2005; 38(5): 206-213
DOI: 10.1055/s-2005-873155
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of Olanzapine and Risperidone in 367 First-Episode Patients with Non-Affective or Affective Psychosis: Results of an Open Retrospective Medical Record Study

M. Lambert1 , P. Conus2 , B. G. Schimmelmann3 , P. Eide4 , J. Ward4 , H. Yuen4 , M. Schacht3 , J. Edwards4 , D. Naber1 , P. D. McGorry4
  • 1Psychosis Early Detection and Intervention Centre (PEDIC) of Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University of Hamburg, Martini Street 52, 20246 Hamburg, Germany
  • 2Département Universitaire de Psychiatrie Adulte, Clinique de Cery, 1008 Prilly, Switzerland
  • 3PEDIC Centre of Psychosocial Medicine, Department of Child- and Adolescent Psychiatry and Psychotherapy, University of Hamburg, Martini Street 52, 20246 Hamburg, Germany
  • 4Orygen Youth Health and Research Centre, Early Psychosis Prevention and Intervention Centre (EPPIC), 35 Poplar Road, Parkville Victoria 3052, Melbourne, Australia
Further Information

Publication History

Received: 29.10.2004 Revised: 24.1.2005

Accepted: 11.4.2005

Publication Date:
14 October 2005 (online)

Also available at
    Permissions and Reprints

Introduction: Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis. Methods: The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level). Results: 367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms (p = .054) and a shorter treatment duration to reach this remission in affective FEP patients (p = .077). More extrapyramidal side effects (p <.001) were related to RIS and more weight gain to OLZ-treatment (p <.001). Discussion: Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

References

  • 1 Allison D B, Casey D E. Antipsychotic-induced weight gain: a review of the literature.  J Clin Psychiatry. 2001;  62 (Suppl 7) 22-31
    PubMedSearch in Google Scholar
  • 2 American Psychiatric Association. Diagnostic Criteria from DSM-IV. Washington; American Psychiatric Press 1994
    Search in Google Scholar
  • 3 Baldwin P A, Scully P J, Quinn J F, Morgan M G, Kinsella A, O"Callaghan E, Owens J M, Waddington J L. First episode bipolar disorder: systematic comparison of incidence with other affective and non-affective psychoses among an epidemiologically complete, rural population.  Bipolar Disord. 2002;  4 (Suppl 1) 39-40
    CrossrefPubMedSearch in Google Scholar
  • 4 Baptista T, Kin N M, Beaulieu S, de Baptista E A. Obesity and related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives.  Pharmacopsychiatry. 2002;  35 205-219
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Bowden C L, Davis J, Morris D, Swann A, Calabrese J, Lambert M, Goodnick P. Effect size of efficacy measures comparing divalproex, lithium and placebo.  Depress Anxiety. 1997;  6 26-30
    CrossrefPubMedSearch in Google Scholar
  • 6 Cohen D. Atypical antipsychotics and new onset diabetes mellitus. An overview of the literature.  Pharmacopsychiatry. 2004;  37 1-11
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Conley R R, Mahmoud R. A randomized double-blind study of risperidone and olanzapine in the treatment of schizophrenia or schizoaffective disorder.  Am J Psychiatry. 2001;  158 765-774
    CrossrefPubMedSearch in Google Scholar
  • 8 Cradock J, Young A S, Sullivan G. The accuracy of medical record documentation in schizophrenia.  J Behav Health Serv Res. 2001;  28 456-465
    PubMedSearch in Google Scholar
  • 9 Edwards J, McGorry P D. Implementing early intervention in psychosis. Martin Dunitz Publisher 2002
    Search in Google Scholar
  • 10 Emsley R A. Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group.  Schizophr Bull.. 1999;  25 721-729
    PubMedSearch in Google Scholar
  • 11 Forrester A, Owens D G, Johnstone E C. Diagnostic stability in subjects with multiple admissions for psychotic illness.  Psychol Med.. 2001;  31 151-158
    CrossrefPubMedSearch in Google Scholar
  • 12 Gureje O, Miles W, Keks N, Grainger D, Lambert T, McGrath J, Tran P, Catts S, Fraser A, Hustig H, Andersen S, Crawford A M. Olanzapine vs Risperidone in the management of schizophrenia: a randomized double-blind trial in Australia and New Zealand.  Schizophr Res. 2003;  61 303-314
    CrossrefPubMedSearch in Google Scholar
  • 13 Gutierrez Fraile M, Segarra Echevarria R, Gonzalez-Pinto Arrillaga A, Martinez Junquera G. Risperidone in the early treatment of first-episode psychosis: a two-year follow-up study.  Actas Esp Psiquiatr. 2002;  30 142-152
    PubMedSearch in Google Scholar
  • 14 Guy W. ECDEU Assessment Manual for Psychopharmacology, revised. DHEW Pub. No. (ADM) 76 - 338. Rockville MD; National Institute of Mental Health 1976
    Search in Google Scholar
  • 15 Hochberg Y, Benjamini Y. More powerful procedures for multiple significance testing.  Stat Med. 1990;  9 811-818
    CrossrefPubMedSearch in Google Scholar
  • 16 Huguelet P, Girardet F. A Swiss retrospective naturalistic outcome study comparing risperidone and olanzapine in the treatment of schizophrenic inpatients.  Schweiz-Arch-Neurol-Psychiatr. 2002;  153 282-288
    PubMedSearch in Google Scholar
  • 17 Kane J M, Leucht S, Carpenter D. Expert Consensus Guidelines for Optimizing Pharmacologic Treatment of Psychotic Disorders. J Clin Psychiatry 2003 64 (Suppl. 12)
    Search in Google Scholar
  • 18 Kopala L C, Good K P, Honer W G. Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low-dose risperidone.  J Clin Psychopharmacol. 1997;  17 308-313
    CrossrefPubMedSearch in Google Scholar
  • 19 Lambert M, Conus P, Eide P, Ward J, Yuen H P, McGorry P D. Treatment of Early Psychosis with Olanzapine or RISperidone (TEPOR study): Methodology and first results of a medical record study in 786 first-episode psychosis patients treated at Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998-2000.  Schizophr Res. 2002;  53 (Suppl 3) B66
    PubMedSearch in Google Scholar
  • 20 Lambert M, Holzbach R, Moritz S, Postel N, Krausz M, Naber D. Objective and subjective efficacy as well as tolerability of Olanzapine in the acute treatment of 120 patients with schizophrenia spectrum disorders.  Int Clin Psychopharmacol. 2003a ;  18 251-260
    PubMedSearch in Google Scholar
  • 21 Lambert M, Conus P, Lambert T, McGorry P D. Pharmacotherapy of first-episode schizophrenia.  Expert Opinion on Pharmacotherapy. 2003b;  Vol 4 717-751
    CrossrefPubMedSearch in Google Scholar
  • 22 Larsen T K, Friis S, Haahr U, Johannessen J O, Melle I, Opjordsmoen S, Rund B R, Simonsen E, Vaglum P V, McGlashan T H. Pre-morbid adjustment in first-episode non-affective psychosis: distinct patterns of pre-onset course.  Br J Psychiatry. 2004;  185 108-115
    CrossrefPubMedSearch in Google Scholar
  • 23 Lieberman J A, Tollefson G, Tohen M, Green A I, Gur R E, Kahn R, McEvoy J, Perkins D, Sharma T, Zipursky R, Wei H, Ramer R M, HGDH study g roup. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: A randomized, double-blind trial of Olanzapine versus Haloperidol.  Am J Psychiatry. 2003;  160 1396-1404
    CrossrefPubMedSearch in Google Scholar
  • 24 Lingjaerde O, Ahlfors U G, Bech P, Dencker S J, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients.  Acta Psychiatr Scand. 1987;  Suppl 334 1-100
    PubMedSearch in Google Scholar
  • 25 Marder S R, Meibach R C. Risperidone in the treatment of schizophrenia.  Am J Psychiatry. 1994;  151 825-835
    PubMedSearch in Google Scholar
  • 26 McGorry P D, Copolov D L, Singh B S. Royal Park Multidiagnostic Instrument for Psychosis: Part I. Rationale and review.  Schizophr Bull. 1990a;  16 501-515
    CrossrefPubMedSearch in Google Scholar
  • 27 McGorry P D, Singh B S, Copolov D L, Kaplan I, Dossetor C R, van Riel R J. Royal Park Multidiagnostic Instrument for Psychosis: Part II. Development, reliability, and validity.  Schizophr Bull. 1990b;  16 517-536
    CrossrefPubMedSearch in Google Scholar
  • 28 Mc Gorry P D. Recommended haloperidol and risperidone doses in first-episode psychosis.  J Clin Psychiatry. 1999;  60 794-795
    PubMedSearch in Google Scholar
  • 29 McGorry P D, Killackey E, Lambert M, Elkins K, Lambert T. Summary Australian and New Zealand Clinical Practice Guidelines for the treatment of schizophrenia.  Australas Psychiatry. 2003;  11 1-13
    CrossrefPubMedSearch in Google Scholar
  • 30 Merlo M C, Hofer H, Gekle W, Berger G, Ventura J, Panhuber I, Latour G, Mardeer S R. Risperidone, 2 mg/day vs. 4 mg/day, in first-episode, acutely psychotic patients: treatment efficacy and effects on fine motor functioning.  J Clin Psychiatry. 2002;  63 885-891
    PubMedSearch in Google Scholar
  • 31 Montes J M, Ciudad A, Gascon J, Gomez J C, EFESO Study Group . Safety, effectiveness, and quality of life of olanzapine in first-episode schizophrenia: a naturalistic study.  Prog Neuropsychopharmacol Biol Psychiatry. 2003;  27 667-674
    CrossrefPubMedSearch in Google Scholar
  • 32 Must A, Spadano J, Coakley E H, Field A E, Colditz G, Dietz W H. The disease burden associated with overweight and obesity.  JAMA. 1999;  282 1523-1529
    CrossrefPubMedSearch in Google Scholar
  • 33 Nasrallah H. A review of the effect of atypical antipsychotics on weight.  Psychoneuroendocrinology. 2003;  28 83-96
    PubMedSearch in Google Scholar
  • 34 Oosthuizen P P, Emsley R A, Maritz J S, Turner J A, Keyter N. Incidence of tardive dyskinesia in first-episode psychosis patients treated with low-dose haloperidol.  J Clin Psychiatry. 2003;  64 1075-1080
    PubMedSearch in Google Scholar
  • 35 Peuskens J. Risperidone in the treatment of patients with chronic schizophrenia: a multi-national, multi-centre, double-blind, parallel-group study versus haloperidol. Risperidone Study Group.  Br J Psychiatry. 1995;  166 712-726
    CrossrefPubMedSearch in Google Scholar
  • 36 Robinson D, Woerner M, Alvir J, Geisler S, Koreen A, Sheitma B, Chakos M, Mayerhoff D, Bilder R, Goldman R, Lieberman J. Predictors of Treatment Response from a first-episode of schizophrenia of schizoaffective disorder.  Am J Psychiatry. 1999;  156 544-549
    PubMedSearch in Google Scholar
  • 37 Sachs G S, Grossman F, Ghaemi S N, Okamoto A, Bowden C L. Combination of a mood-stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety.  Am J Psychiatry. 2002;  159 1146-1154
    CrossrefPubMedSearch in Google Scholar
  • 38 Sanger T M, Lieberman J A, Tohen M, Grundy S, Beasley C J r, Tollefson G D. Olanzapine versus Haloperidol Treatment in First-Episode Psychosis.  Am J Psychiatry. 1999;  156 79-87
    PubMedSearch in Google Scholar
  • 39 Schwartz J E, Fennig S, Tanenberg-Karant M, Carlson G, Craig T, Galambos N, Lavelle J, Bromet E J. Congruence of diagnoses 2 years after a first-admission diagnosis of psychosis.  Arch Gen Psychiatry. 2000;  57 593-600
    CrossrefPubMedSearch in Google Scholar
  • 40 Sernyak M J, Leslie D, Rosenheck R. Use of system-wide outcomes monitoring data to compare the effectiveness of atypical neuroleptic medications.  Am J Psychiatry. 2003;  160 310-315
    CrossrefPubMedSearch in Google Scholar
  • 41 Spearing  M K, Post R M, Leverich G S, Brandt D, Nolen W. Modification of the Clinical Global Impression (CGI) scale for use in bipolar illness (BP): the CGI-BP.  Psychiatry Res. 1997;  73 159-171
    CrossrefPubMedSearch in Google Scholar
  • 42 Tohen M, Jacobs T G, Grundy S L, McElroy S L, Banov M C, Janicak P G, Sanger T, Risser R, Zhang F, Toma V, Francis J, Tollefson G D, Breier A. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. The Olanzipine HGGW Study Group.  Arch Gen Psychiatry. 2000;  57 841-849
    CrossrefPubMedSearch in Google Scholar
  • 43 Tohen M, Chengappa K N, Suppes T, Zarate CA J r, Calabrese J R, Bowden C L, Sachs G S, Kupfer D J, Baker R W, RISser R C, Keeter E L, Feldman P D, Tollefson G D, Breier A. Efficacy of olanzapine in combination with valproate or lithium in the treatment of mania in patients partially nonresponsive to valproate or lithium monotherapy.  Arch Gen Psychiatry. 2002a;  59 62-69
    CrossrefPubMedSearch in Google Scholar
  • 44 Tohen M, Baker R W, Altshuler L L, Zarate C A, Suppes T, Ketter T A, Milton D R, Risser R, Gilmore J A, Breier A, Tollefson G A. Olanzapine versus divalproex in the treatment of acute mania.  Am J Psychiatry. 2002b;  159 1011-1017
    CrossrefPubMedSearch in Google Scholar
  • 45 Tollefson G D, Beasley C M Jr, Tran P V, Street J S, Krueger J A, Tamura R N, Graffeo K A, Thieme M E. Olanzapine versus haloperidol in the treatment of schizophrenia, schizoaffective and schizophreniform disorders: results of an international collaboration study.  Am J Psychiatry. 1997;  154 457-465
    PubMedSearch in Google Scholar
  • 46 Vieta E, Goikolea J M, Corbella B, Benabarre A, Reinares M, Martinez G, Fernandez A, Colom F, Martinez-Aran A, Torrent C. Risperidone safety and efficacy in the treatment of bipolar and schizoaffective disorders: results from a 6-month, multicenter, open study.  J Clin Psychiatry. 2001;  62 818-825
    PubMedSearch in Google Scholar
  • 47 Williams R. Optimal dosing with Risperidone: updated recommendations.  J Clin Psychiatry. 2001;  62 282-289
    CrossrefPubMedSearch in Google Scholar
  • 48 Yap H L, Mahendran R, Lim D, Liow P H, Lee A, Phang S, Tiong A. Risperidone in the treatment of first episode psychosis.  Singapore Med J. 2001;  42 170-173
    PubMedSearch in Google Scholar

Martin Lambert, MD

Centre for Psychosocial Medicine

Department for Psychiatry and Psychotherapy

Psychosis Early Detection and Intervention Centre (PEDIC)

University of Hamburg

Martini Street 52

20246 Hamburg

Germany

Email: lambert@uke.uni-hamburg.de