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Newer Antipsychotic Drug Better for Schizophrenia

Fewer relapses, motor side effects with modern pill, study shows

THURSDAY, Jan. 3, 2002 (HealthDayNews) -- Newer really is better, at least when it comes to drugs to treat schizophrenia.

A modern antipsychotic medication called risperidone is roughly twice as effective as its older cousin haloperidol at preventing relapses, according to a study appearing this week in the New England Journal of Medicine. Relapses are not only traumatic for patients and their families, but they also lead to wounded or broken relationships, lost productivity and costly hospitalizations, experts say.

The newer drug is also better than haloperidol at controlling symptoms of the mental illness, and it causes fewer of the motor side effects that often bedevil schizophrenics who take antipsychotics, the study shows.

Doctors caution that the latest findings apply only to risperidone and not necessarily to other "atypical" antipsychotic drugs. Even so, Dr. John Davis, a psychiatrist at the University of Illinois in Chicago, calls the research "one of the most important studies on the atypicals to be done so far. Most have been shorter looks, so this makes an increment in our knowledge."

A recent report on mental illness from the U.S. Surgeon General says there are roughly 2.2 million Americans with schizophrenia, split evenly between men and women.

Haloperidol, introduced in the 1950s, was long the treatment of choice for controlling the psychosis of schizophrenia. The drug and its near relatives muzzle the action of brain receptors that process dopamine, a messenger molecule vital to sending and receiving nerve signals. While the precise role of the chemical in schizophrenia isn't clear, some experts believe that patients with the mental disease have an overactive dopamine system.

Newer antipsychotics inhibit dopamine, but for extra effect they also interfere with serotonin and other messenger chemicals believed to run amok in schizophrenia.

A research team led by Dr. John G. Csernansky of Washington University School of Medicine in St. Louis, compared haloperidol with risperidone in several hundred psychotic patients -- diagnosed with either schizophrenia or a related condition called schizoaffective disorder -- at 40 clinics nationwide. All of the patients, who were between 18 and 65 years old, had suffered a relapse of psychotic symptoms within two years of beginning the trial, which started in 1996.

Roughly 44 percent of those taking risperidone, and 52 percent of those on haloperidol, dropped out of the study, the researchers say. Over a year of follow-up, the risk of relapse was 34 percent in the risperidone group, vs. 60 percent in the group taking haloperidol.

When they did relapse, those receiving risperidone tended to have less severe psychosis. They also suffered fewer "extrapyramidal" side effects -- movement trouble like Parkinsonism or jerky motion -- than did patients taking the other drug.

Although risperidone is many times more expensive per dose than haloperidol -- costing dollars a day vs. pennies -- Csernansky says the lower relapse rate makes up for the difference.

"This study really should settle the argument whether the second-generation atypical antipsychotics, and particularly risperidone, are cost-effective and superior to" the older drugs. Atypical antipsychotics are generally defined as those that cause fewer side effects to a person's motor system.

Dr. John Geddes, a University of Oxford, England, psychiatrist who wrote the editorial accompanying the journal article, says the latest work carries several important caveats. The patients had stable symptoms and were highly faithful to their treatment. As a result, he says, the advantage of prescribing risperidone "would probably be smaller in routine clinical practice."

On the other hand, Geddes writes, the new drug "is most likely as effective as conventional drugs" at controlling symptoms of psychosis and probably better than haloperidol at preventing relapses.

The study was sponsored by Janssen Research Foundation, of Titusville, N.J., the drug research arm of Janssen Pharmaceutica, Inc., which makes risperidone under the brand name Risperdal.

What To Do

Although atypical antipsychotics may work as well, if not better, than older drugs, they're not necessarily benign. The U.S. Food and Drug Administration recently cautioned doctors to be alert to dangerous and potentially deadly spikes in blood sugar in their patients who take the medications. They can also cause sharp weight gain.

To find out more about the disease, visit The Schizophrenia Homepage or Scientific American.

You can also try NARSAD, the National Alliance for Research on Schizophrenia and Depression or the National Institute of Mental Health.

To learn more about atypical antipsychotics, try About.com.

SOURCES: Interviews with John M. Davis, M.D., professor of psychiatry, University of Illinois at Chicago; John G. Csernansky, M.D., professor of psychiatry, Washington University School of Medicine in St. Louis; Jan. 3, 2002, New England Journal of Medicine
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