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Naturalistic, Retrospective Comparison Between Second-Generation Antipsychotics and Depot Neuroleptics in Patients Affected by Schizophrenia

J Clin Psychiatry 2005;66(11):1423-1431

Objective: Data in the literature comparing second-generation antipsychotics (SGAs) and depot neuroleptics are scarce. The aim of this retrospective, naturalistic study is to examine the relative effectiveness of SGAs and depot neuroleptics in 2 matched groups of patients affected by schizophrenia.

Method: Between July 2004 and September 2004, we collected data from 2 groups of 30 DSM-IV-TR schizophrenia outpatients, matched for a number of demographic and clinical characteristics, who received a 2-year treatment with depot neuroleptics or SGAs. Treatments were compared through the Clinical Global Impressions-Severity of Illness scale (CGI-S), performed on several symptom domains of schizophrenia. Other outcomes included 1- and 2-year readmission rates, the number of self-injuries during the treatment period, and anticholinergic drug prescription, considered as an index of extrapyramidal symptoms.

Results: Treatment with both drug classes produced broadly comparable clinical effects. Clinician-assessed effectiveness was similar for SGA and depot recipients, with significant decreases over baseline in all CGI-S symptom domain scores. The percentages of patients readmitted during the follow-up period were similar among drug groups. After 1 year, 6 SGA patients (20%) were readmitted compared with 7 depot patients (23%); after 2 years, 9 SGA patients (30%) were rehospitalized compared with 11 depot patients (37%). Also, no between-group differences were detected with respect to the number of self-injuries. Anticholinergic drug prescription was significantly less common in SGA patients compared with depot recipients (p = .0112).

Conclusion: These findings confirm at least equal long-term effectiveness of depot neuroleptics and SGAs, but a possible advantage for SGAs in decreased use of anticholinergic drugs.