[Atypical antipsychotics in first-episode psychosis: a review].
L'Encéphale. 2008-04-01; 34(2): 194-204
DOI: 10.1016/j.encep.2007.07.003
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1. Encephale. 2008 Apr;34(2):194-204. doi: 10.1016/j.encep.2007.07.003. Epub 2007
Oct 24.
[Atypical antipsychotics in first-episode psychosis: a review].
[Article in French]
Rotgé JY(1), Aouizerate B, Tignol J.
Author information:
(1)Service de psychiatrie d’adultes, centre hospitalier Charles-Perrens, centre
Carreire, université Bordeaux-2, 121, rue de la Béchade, 33076 Bordeaux, France.
BACKGROUND: The management of patients with first-episode psychosis (FEP) is a
difficult, but challenging task. Early and efficient treatment may influence
long-term clinical outcome. Atypical antipsychotics (A-AP) are commonly
prescribed in this population, but few data exist to establish their appropriate
usage in the management of FEP. Our purpose is to review the literature and to
summarize current data on the prescription of A-AP in FEP.
METHODS: Studies assessing efficacy or safety of A-AP in FEP were identified by
searches in Medline (up to April 2006). The following nine drugs were considered
for this review: clozapine, olanzapine, risperidone, amisulpride, aripiprazole,
quetiapine, ziprasidone, zotepine, and sertindole.
RESULTS: Only four A-AP (clozapine, quetiapine, olanzapine, and risperidone)
were evaluated as treatment of FEP. All of them show the same efficacy as
conventional antipsychotics (C-AP). Clozapine has no benefit over C-AP in the
treatment of naive patients. It entails a high rate of treatment discontinuation
because of the need for regular white blood cell monitoring explained by the
risk of agranulocytosis. Hence, clozapine may not be a first-line treatment of
FEP. Tolerance to quetiapine and olanzapine is better than C-AP regarding
extrapyramidal side effects, but weight gain induced by these two A-AP may be
very disabling in a young population. Considering results from head-to-head
comparative studies, olanzapine may be more effective than risperidone when an
affective component is associated with the FEP symptomatology, but more data are
needed to demonstrate this point. Risperidone is a relatively well-tolerated
compound when it is prescribed at doses lower than 4 mg/d. It is the only A-AP
that showed greater efficacy than C-AP to prevent relapse in patients with FEP.
Unfortunately, information regarding the preventive efficacy of the other A-AP
are lacking.
CONCLUSIONS: Further studies, particularly longer-term studies, are needed to
explore the impact of A-AP prescription in FEP on the course of psychotic
disorders. The common use of A-AP as treatment of FEP is justified by a
relatively better tolerance compared to C-AP, and by the hypothesis-not
demonstrated-of a better effect on long-term outcome.
DOI: 10.1016/j.encep.2007.07.003
PMID: 18597729 [Indexed for MEDLINE]