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. Lambert; P. Conus; B. G. Schimmelmann; P. Eide; J. Ward; H. Yuen; M. Schacht; J. Edwards; D. Naber; P. D. McGorry

doi:10.1055/s-2005-873155

Pharmacopsychiatry 2005; 38(5): 206-213
DOI: 10.1055/s-2005-873155

Original Paper

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

Abstract

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.

Full Text

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
2 American Psychiatric Association. Diagnostic Criteria from DSM-IV. Washington; American Psychiatric Press 1994
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
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
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
6 Cohen D. Atypical antipsychotics and new onset diabetes mellitus. An overview of the literature. Pharmacopsychiatry. 2004; 37 1-11
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
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
9 Edwards J, McGorry P D. Implementing early intervention in psychosis. Martin Dunitz Publisher 2002
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
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
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
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
14 Guy W. ECDEU Assessment Manual for Psychopharmacology, revised. DHEW Pub. No. (ADM) 76 - 338. Rockville MD; National Institute of Mental Health 1976
15 Hochberg Y, Benjamini Y. More powerful procedures for multiple significance testing. Stat Med. 1990; 9 811-818
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
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)
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
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
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
21 Lambert M, Conus P, Lambert T, McGorry P D. Pharmacotherapy of first-episode schizophrenia. Expert Opinion on Pharmacotherapy. 2003b; Vol 4 717-751
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
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
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
25 Marder S R, Meibach R C. Risperidone in the treatment of schizophrenia. Am J Psychiatry. 1994; 151 825-835
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
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
28 Mc Gorry P D. Recommended haloperidol and risperidone doses in first-episode psychosis. J Clin Psychiatry. 1999; 60 794-795
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
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
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
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
33 Nasrallah H. A review of the effect of atypical antipsychotics on weight. Psychoneuroendocrinology. 2003; 28 83-96
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
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
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
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
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
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
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
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
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
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
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
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
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
47 Williams R. Optimal dosing with Risperidone: updated recommendations. J Clin Psychiatry. 2001; 62 282-289
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

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