Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode

Strakowski, Stephen M.; Johnson, Jacqueline L.; DelBello, Melissa P.; Hamer, Robert M.; Green, Alan I.; Tohen, Mauricio; Lieberman, Jeffrey A.; Glick, Ira; Patel, Jayendra K.; HGDH Research Group,

doi:10.1016/j.schres.2005.04.017

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Volume 78, Issue 2 , Pages 161-169, 15 October 2005

Quality of life during treatment with haloperidol or olanzapine in the year following a first psychotic episode

Stephen M. Strakowski
- Center for Imaging Research and Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML0583), Cincinnati, OH 45267-0583, USA
- Corresponding author. Tel.: +1 513 558 2958; fax: +1 513 558 7164.
Jacqueline L. Johnson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Melissa P. DelBello
- Center for Imaging Research and Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, 231 Albert Sabin Way (ML0583), Cincinnati, OH 45267-0583, USA
Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Alan I. Green
- Dartmouth Medical School, Lebanon, NH, USA
Mauricio Tohen
- Eli Lilly and Co., Lilly Research Laboratories, Indianapolis, IN, USA
- McLean Hospital, Harvard Medical School, Belmont, MA, USA
Jeffrey A. Lieberman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Columbia University, School of Medicine, New York, NY, USA
Ira Glick
- Stanford University School of Medicine, CA, USA
Jayendra K. Patel
- University of Massachusetts Medical Center, MA, USA
HGDH Research Group
- This paper was based in part on results from the study of the Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis by the HGDH Study Group sponsored by Eli Lilly and Company. The HGDH research group consists of Drs. Jeffrey Lieberman and Diana Perkins, Dept. of Psychiatry, Univ. of North Carolina School of Medicine, NC, USA; Drs. Joseph P. McEvoy, Cecil Charles and Richard Keefe, John Ulmstead Hospital, Duke University Health System, NC, USA; Drs. Robert B. Zipursky and Zafiris J. Daskalakis, Dept. of Psychiatry, University of Toronto School of Medicine, Ontario, Canada; Dr. Alan I. Green, Massachusetts Mental Health Center, Harvard Medical School, MA, USA; Dr. Charles B. Nemeroff, Dept. of Psychiatry, Emory University School of Medicine, GA, USA; Prof. Robin Murray and Dr. Tonmoy Sharma, Institute of Psychiatry, UK; Dr. Raquel E. Gur, Dept of Psychiatry, Univ. of Pennsylvania Medical Center, PA, USA; Drs. Bruce Cohen and Franca Centorrino, McLean Hospital, Harvard Medical School, Belmont, MA, USA; Prof. Dr. R.S. Kahn, University Hospital, Utrecht, The Netherlands; Drs. Wayne Goodman and John Kuldau, Dept. of Psychiatry, Univ. of Florida, FL, USA; Drs. Anthony J. Rothschild and Jayendra K. Patel, Dept. of Psychiatry, Univ. of Massachusetts Medical Center, MA, USA; Dr. Stephen M. Strakowski, Dept. of Psychiatry, Univ. of Cincinnati, OH, USA; Dr. Ira Glick, Dept. of Psychiatry, Stanford University School of Medicine, CA, USA; Dr. John De Quardo, Dept. of Psychiatry, Univ. of Michigan Medical Center, MI, USA; Drs. Gary Tollefson, Todd Sanger, Mauricio Tohen, Lilly Research Laboratories, IN, USA.

Received 12 January 2005; received in revised form 13 April 2005; accepted 15 April 2005.

Abstract

Objectives

Schizophrenia causes significant impairments of quality of life. As treatment approaches have advanced, more attention has been given to re-integrating patients into their psychosocial environments, rather than simply monitoring psychotic symptoms. The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics. This improvement is particularly relevant early in the course of schizophrenia.

Methods

To address these considerations, improvements in measures of general health and social function (determined using the SF-36) were assessed in 195 patients with first-episode schizophrenia for up to one year following randomization to either olanzapine or haloperidol in a double blind clinical trial. We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol. In order to test this hypothesis, we used a repeated measure model with SF-36 scores as the outcome, and treatment group, time, time², time-by-treatment group interaction, and time²-by-treatment group interaction as fixed effects.

Results

Both treatments demonstrated similar changes on the SF-36. Independent of treatment, patients demonstrated significant improvements in most of the SF-36 subscales, which approached normative scores by the end of one year of treatment. Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study (p<.4).

Conclusions

These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders, namely that they can expect to recover significant quality of life and social function at least initially in treatment.

Keywords: Functional outcome, SF-26, First-episode psychosis, Schizophrenia