EBM-style Journal Reading R1 Email: [email protected] /
11/19/2009 Slide 2 2 Clinical Scenario 19 Psychotic disorder, NOS,
suspect schizophrenia. paliperidone 9mg/day 12mg/day olanzapine
15mg/day Slide 3 3 Clinical Uncertainty PICO For first-episode
psychosis, which antipsychotics would significantly reduce the
severity of psychotic symptoms? Slide 4 4 PICO Patient / Problem
First-episode psychosis Intervention Antipsychotics Comparison
Placebo Outcome Improvement of PANSS score Type of Question:
Treatment Slide 5 5 Search Terms & Strategy: Pubmed 11/01/2009
#1 (Schizophrenia AND first episode patient) AND
((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical
trials[MeSH Terms] OR clinical trial[Publication Type] OR
random*[Title/Abstract] OR random allocation[MeSH Terms] OR
therapeutic use[MeSH Subheading]) Slide 6 6 Best available
evidence: Citation/s: Effectiveness of antipsychotics in
first-episode schizophrenia and schizophreniform disorder on
response and remission: An open randomized clinical trial (EUFEST)
Schizophrenia Research, Volume 115, Issue 2, Pages 97-103, Sep 2009
Lead author's name : H. Boter, J. Peuskens, J. Libiger, W.
Fleischhacker, M. Davidson, S. Galderisi, R. Kahn Slide 7 7 The
Study: - 1 A total of 50 centers participated in 13 European
countries and Israel. Eligible patients were 1840 years of age and
met DSM-IV criteria for schizophrenia, schizophreniform, or
schizoaffective disorder conrmed by the Mini International
Neuropsychiatric Interview Plus. Patients were excluded if: 1.more
than 2 years had passed since the onset of positive symptoms 2.any
antipsychotic had been used exceeding 2 weeks in the previous year
or 6 weeks lifetime 3.patients had a known intolerance to one of
the study drugs 4.patients met any of the contraindications for any
of the study drugs as mentioned in the (local) package insert
texts. Slide 8 8 The Study: - 2 Patients were randomized by a
dedicated web based online system to: haloperidol 14 mg/d,
amisulpride 200 800 mg/d, olanzapine 520 mg/d, quetiapine 200750
mg/d, or ziprasidone 40160 mg/d. All study medications were
administered orally within the dose ranges at the treating
physician's discretion. The use of mood stabilizers,
benzodiazepines, antidepressants, and anticholinergics was allowed
and documented. Slide 9 9 The Study: - 3 The following formula was
used to calculate response rates: ((PANSS baseline 30)(PANSS
follow-up30))100/ (PANSSbaseline30) Remission was defined as a
score of mild or less(3) on eight predefined PANSS items each
maintained for at least 6 months: delusions (P1), conceptual
disorganization (P2), hallucinatory behavior (P3), blunted affect
(N1), social withdrawal (N4), lack of spontaneity (N6), mannerisms/
posturing (G5), and unusual thought content(G9) Slide 10 10 The
Study: - 2 Level of Evidence: 1b (multicenter, open randomized
clinical trial) Slide 11 11 The Study: - 3 PICO (T) Patient /
Problem Patients of first episode schizophrenia and
schizophreniform disorder InterventionAtypical antipsychotics
ComparisonHaloperidol OutcomeResponse and remission on PANSS score
Time 12 months Slide 12 12 The Evidence: - 1 Of the 498 patients
enrolled, 200 (40%) were female, 162 (33%) were antipsychotic nave,
198 (40%) had schizophreniform disorder, 35 (7%) had
schizoaffective disorder, and 265 (53%) had schizophrenia. Higher
proportions of patients on haloperidol or amisulpride used
anticholinergic drugs (overall p
