A randomized, controlled comparison of the efficacy and tolerability of low and high doses of haloperidol in the treatment of first-episode psychosis.

While haloperidol is still widely used in the treatment of psychoses, the optimal daily dose remains a topic of controversy, particularly in first-episode psychosis. Previous studies have suggested that doses as low as 2 mg/d may be effective, whereas others have indicated superiority for higher over lower doses. This double-blinded, randomized controlled study compared the efficacy and tolerability of 2 vs. 8 mg/d of haloperidol over 6 wk in 40 subjects with first-episode psychosis. Both treatments were equally effective in reducing the PANSS Total and subscale scores. The low dose of haloperidol was better tolerated, with fewer extrapyramidal side-effects, less frequent use of anticholinergic medication and smaller elevations in prolactin levels. Using a low dose of haloperidol is at least as effective as, and better tolerated than a high dose of haloperidol in the treatment of first-episode psychosis.

Depressive symptoms at baseline predict fewer negative symptoms at follow-up in patients with first-episode schizophrenia.

There is uncertainty regarding the prognostic value of depressive symptoms in schizophrenia, having previously been associated with both favourable and poor outcome. This study investigated the relationship between baseline depressive symptoms and treatment outcome at 6, 12 and 24 weeks in 80 subjects with first-episode schizophrenia or schizophreniform disorder in terms of PANSS total and subscale score changes. No significant association was found between baseline PANSS depression factor scores and PANSS total and subscore changes. However, a significant inverse correlation between baseline depression scores and negative scores at 6, 12 and 24 weeks was found (p=0.044, 0.023 and 0.012, respectively). Multiple regression analysis indicated that this finding could not be explained on the basis of age, gender or duration of untreated psychosis. These findings support previous work suggesting that high baseline depressive scores predict favourable outcome.

Ethnicity and treatment response in schizophrenia: a comparison of 3 ethnic groups.

BACKGROUND: Numerous cultural and ethnic factors may directly and indirectly influence treatment outcome in schizophrenia. The present study compared the response to antipsychotic treatment in 3 ethnic groups of patients with schizophrenia. METHOD: Fifty black, 63 mixed descent, and 79 white patients with DSM-IV-diagnosed schizophrenia or schizophreniform disorder who were participants in multinational clinical drug trials were assessed by means of the Positive and Negative Syndrome Scale (PANSS). Treatment response was measured by the change in PANSS total scores and the change in positive, negative, and general psychopathology subscale scores from baseline to 6 weeks. Also, the percentage of responders (defined as > or = 40% reduction in PANSS total scores) was calculated for each group. RESULTS: Baseline PANSS scores differed significantly, being higher for black and mixed descent patients. Mixed descent patients showed the greatest mean +/- SD percentage reduction in PANSS total score (29.4 +/- 21.6) followed by black (28.4 +/- 14.7) and white (11.4 +/- 27.6) patients. Analysis of covariance revealed a significant effect of ethnicity on the reduction in PANSS total scores (p < .0001). The numbers of responders were 20 mixed descent (32%), 12 black (24%), and 7 white (9%) patients (p = .002). CONCLUSION: Significant ethnic differences in acute antipsychotic treatment response are demonstrated by this study. Factors such as diet, nutritional status, body mass, and substance use could be important, as well as genetically determined ethnospecific pharmacokinetic and pharmacodynamic differences. Delayed help-seeking may account for the higher baseline scores in the black and mixed descent patients.