Early Prediction of Antipsychotic Nonresponse Among Patients With Schizophrenia. [CME]
J Clin Psychiatry 2007;68(3):352-360
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Objective: Schizophrenia guidelines recommend waiting several weeks before major changes in antipsychotic treatment are implemented. If, however, nonresponders could be identified shortly after treatment initiation, considerable time could be saved by rapidly switching such patients to potentially more effective alternatives. We therefore attempted to identify what degree of nonresponse shortly after initiation of antipsychotic drug treatment predicts nonresponse at 4 weeks.
Method: Individual patient data from 7 randomized, controlled antipsychotic drug trials including 1708 patients with schizophrenia or schizophreniform disorder according to DSM-III-R or DSM-IV criteria and positive symptoms (mean ± SD age of 36.0 ± 10.9 years; 1054 men and 654 women) were pooled. Receiver-operator curves and logistic regression analyses were used to predict nonresponse at week 4 from the percentage Brief Psychiatric Rating Scale (BPRS) score change at weeks 1 and 2. Three criteria for nonresponse at week 4 were examined: less than 25% BPRS score reduction, less than 50% BPRS score reduction, and "no remission."
Results: Cutoffs predicting nonresponse at 4 weeks with 90% specificity were virtually no response at week 1 (less than 3%-7% BPRS score reduction) and less than 15%, 25%, and 20% at week 2 for the 3 nonresponse criteria described above, respectively. However, to predict less than 25% BPRS score reduction with a positive predictive value of 80%, the cutoff needed was 0% BPRS score reduction at week 2. When the cutoffs identified were entered in logistic regression analyses together with other parameters, they remained the strongest predictors of nonresponse.
Conclusions: Patients with no improvement of symptoms during the first 2 weeks of treatment are unlikely to respond at week 4 and may benefit from a change of treatment.