Background: Schizophrenia is a chronic disease of global importance. The second-generation antipsychotic quetiapine\r\nhas a favorable side-effect profile, however, its clinical effectiveness has been called into question when compared with\r\nfirst-generation antipsychotics such as haloperidol. This study evaluates the efficacy and tolerability of quetiapine versus\r\nhaloperidol for first-episode schizophrenia in the outpatient setting.\r\nMethods: 156 adult patients with first-episode schizophrenia participated in an outpatient clinical trial and were\r\nrandomized to quetiapine (200 mg/d; n = 78) or haloperidol (5 mg/d; n = 78). The study medications were titrated\r\nto a mean daily dose of 705 mg for quetiapeine and 14 mg for haloperidol. The patients were assessed at baseline, six\r\nweeks, and twelve weeks. The primary outcome measures were positive and negative scores of the Positive and\r\nNegative Syndrome Scale (PANSS). Secondary measures were Global Assessment of Functioning (GAF) scale for\r\noverall psychosocial functioning, and Simpson-Angus Scale (SAS) for extra-pyramidal symptoms.\r\nResults: At twelve weeks, the quetiapine group had a greater decrease in PANSS positive (18.9 vs. 15.3, p = 0.013) and\r\nnegative scores (15.5 vs. 11.6, p = 0.012), however, haloperidol showed a greater decrease in general psychopathology\r\nscore (23.8 vs. 27.7, p = 0.012). No significant difference between groups were found for total PANSS (58.3 vs.\r\n54.8, p = 0.24) and GAF (45.7 vs. 46.2, p = 0.79).\r\nANOVA identified significant group interactions on PANSS positive (F = 18.72, df = 1.6,52.4, p < 0.0001), negative\r\n(F = 5.20, df = 1.1,35.7, p < 0.0001), depression/anxiety (F = 106.49, df = 1.14,37.8, p < 0.0001), and total scores\r\n(F = 7.51, df = 1.4,45.6, p = 0.001).\r\nSAS (8.62 vs. 0.26, p < 0.0001) and adverse events of akathisia (78% vs. 0%, p = 0.000), parkinsonism (66.6% vs.\r\n0%, p < 0.0001), and fatigue (84.6% vs. 66.6%, p = 0.009) were greater in haloperidol compared to quetiapine,\r\nwhereas headache was more common in quetiapine treated patients (11.5% vs. 35.9%, p < 0.0001).\r\nConclusions: Quetiapine has greater efficacy for positive and negative symptoms with less extra-pyramidal\r\nsymptoms than haloperidol when used for first-episode schizophrenia in the outpatient setting.
Loading....