Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder.

Full Abstract

OBJECTIVE:
Newer antipsychotic drugs have shown promise in ameliorating neurocognitive deficits in patients with schizophrenia, but few studies have compared newer antipsychotic drugs with both clozapine and conventional agents, particularly in patients who have had suboptimal response to prior treatments.

METHOD:
The authors examined the effects of clozapine, olanzapine, risperidone, and haloperidol on 16 measures of neurocognitive functioning in a double-blind, 14-week trial involving 101 patients. A global score was computed along with scores in four neurocognitive domains:
memory, attention, motor function, and general executive and perceptual organization.

RESULTS:
Global neurocognitive function improved with olanzapine and risperidone treatment, and these improvements were superior to those seen with haloperidol. Patients treated with olanzapine exhibited improvement in the general and attention domains but not more than that observed with other treatments. Patients treated with risperidone exhibited improvement in memory that was superior to that of both clozapine and haloperidol. Clozapine yielded improvement in motor function but not more than in other groups. Average effect sizes for change were in the small to medium range. More than half of the patients treated with olanzapine and risperidone experienced "clinically significant" improvement (changes in score of at least one-half standard deviation relative to baseline). These findings did not appear to be mediated by changes in symptoms, side effects, or blood levels of medications.

CONCLUSIONS:
Patients with a history of suboptimal response to conventional treatments may show cognitive benefits from newer antipsychotic drugs, and there may be differences between atypical antipsychotic drugs in their patterns of cognitive effects.

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Author information

Author/s: Bilder, Robert M (RM); Goldman, Robert S (RS); Volavka, Jan (J); Czobor, Pal (P); Hoptman, Matthew (M); Sheitman, Brian (B); Lindenmayer, Jean-Pierre (JP); Citrome, Leslie (L); McEvoy, Joseph (J); Kunz, Michal (M); Chakos, Miranda (M); Cooper, Thomas B (TB); Horowitz, Terri L (TL); Lieberman, Jeffrey A (JA);

Affiliation: Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA. bilder(-atsign-)nki.rfmh.org

Grants: MH-53550 (Agency:NIMH NIH HHS)

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: The American journal of psychiatry (Am J Psychiatry), published in United States. (Language: eng)

Reference: 2002-Jun; vol 159 (issue 6) : pp 1018-28

Dates: Created 2002/06/03; Completed 2002/06/21; Revised 2008/11/21;

PMID: 12042192, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Am J Psychiatry. 2002 Dec;159(12):2118; author reply 2118-9. (PMID: 12450982)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Antipsychotic Agents - therapeutic use
Benzodiazepines
Clozapine - therapeutic use
Cognition - drug effects
Double-Blind Method
Female
Haloperidol - therapeutic use
Humans

Humans
Male
Neuropsychological Tests - statistics & numerical data
Pirenzepine - analogs & derivatives; therapeutic use
Psychotic Disorders - drug therapy
Risperidone - therapeutic use
Schizophrenia - drug therapy
Schizophrenic Psychology
Treatment Outcome

Associated Chemicals: Antipsychotic Agents (0) ; Risperidone (106266-06-2) ; Benzodiazepines (12794-10-4) ; olanzapine (132539-06-1) ; Pirenzepine (28797-61-7) ; Haloperidol (52-86-8) ; Clozapine (5786-21-0)

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