Little Improvement in Psychosocial Functioning in Patients Receiving Atypicals

Treatment with second-generation antipsychotic medications produced only modest improvement in the psychosocial functioning of patients with schizophrenia, a follow-up report from investigators of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) concluded.

In the report published in the March issue of the American Journal of Psychiatry, investigators assessed the psychosocial functioning of patients with schizophrenia who were receiving atypical antipsychotics at 6, 12, and 18 months, using the quality of life (QOL) scale.

CATIE randomized patients to receive olanzapine, perphenazine, quetiapine, risperidone, or ziprasidone. Patients who discontinued medication received double-blind treatment with an alternative atypical. Dosages were flexible, ranging from 1 to 4 capsules per day, at the discretion of the treating physician. A total of 455 patients completed the QOL assessment at baseline and were available 12 months later for follow-up. (The scale contains 21 items with 4 subscales, each of which is rated on a 7-point scale; the overall score is calculated by taking the mean of these items.)

Although investigators noted that patients who were treated with atypical antipsychotics in all groups demonstrated modest improvement in psychosocial function, there were no significant differences found among the treatments at 6-, 12-, and 18-month follow-up. Among the patients studied, women were more likely to improve, whereas patients taking illicit drugs and those in urban communities fared worse.

Overall, at 12 months, patients with a baseline score of less than 2.0 on the QOL scale made the largest gains (P < .01), those with scores ranging from 2.0 to less than 3.0 made modest gains (P < .01), and those who scored 3.0 or above made no gains on average and even showed a decline in function.

The authors hypothesized that producing substantial improvement would require intensive adjunctive psychosocial rehabilitation interventions. They also noted that patients who completed the study were higher functioning, which could suggest a "ceiling effect" that limited improvement.