Response at 2 Weeks in Treatment-Naive Schizophrenia Associates With Outcomes

Early nonresponse in schizophrenia associated with lower short-term remission rates and increased risk for abnormal metabolic outcomes. These findings were published in the Annals of General Psychiatry.

Patients (N=143) with treatment-naive schizophrenia who were admitted to Wuhan Mental Health Center in China between 2019 and 2020 were included in this study. All participants received a single antipsychotic treatment for 6 weeks. Changes to Positive and Negative Symptom Scale (PANSS) scores and metabolic markers at 6 weeks were evaluated on the basis of whether the patient achieved early response at 2 weeks. Response to treatment was defined as a PANSS score reduction greater than 20% of baseline.

Patients had a mean age of 29.37 (SD, 7.30) years, 55.94% were women, 54.54% lived with their parents, 48.25% had a junior high school education, and 24.48% had a family history of psychosis.

The most common antipsychotic drug was risperidone (19.58%), followed by olanzapine (18.88%), aripiprazole (16.78%), quetiapine (15.38%), ziprasidone (14.69%), haloperidol (8.39%), and perphenazine (6.29%).

Overall, PANSS scores decreased from an average of 89.15±11.19 points at baseline to 76.14±14.61 points at week 2 or a reduction of 22.62%. Nearly half of the cohort (48.95%) were early responders. Stratified by early response, the improvement in PANSS scores at 2 weeks was 37.07% among responders and 8.77% among nonresponders.

Responders and nonresponders did not differ significantly for any sociodemographic or clinical characteristics.

At week 6, the early responders had significantly lower PANSS total (P <.001) scores, Positive Symptom Scale (P =.001) scores, General Pathological Scale (P <.001) scores, and Negative Symptom Scale (P <.001) scores compared with nonresponders.

The remission rates were 42.86% and 10.96% at week 6 among the early response and nonresponse cohorts, respectively.

Overall, significant changes in triglyceride (t, -9.27; P <.001), fasting blood glucose (t, -8.53; P <.001), total cholesterol (t, -7.72; P <.001), prolactin (t, -5.89; P <.001), blood creatinine (t, -4.54; P <.001), low-density lipoprotein cholesterol (t, -3.22; P =.002), uric acid (t, -2.60; P =.010), BMI (t, -2.59; P =.011), bodyweight (t, -2.53; P =.013), and high-density lipoprotein cholesterol (t, 8.100; P <.001) levels were observed from baseline to week 6.

Stratified by response, significant group effects were observed for fasting blood glucose (F, 16.39; P <.001), abdominal circumference (F, 8.67; P =.004), triglyceride (F, 7.88; P =.005), blood creatinine (F, 6.84; P =.009), and body weight (F, 4.08; P =.044), generally favoring early response.

This study may have been limited, as it could have been difficult for patients to control metabolic outcomes in an inpatient setting.

This study found that early response at 2 weeks after first-time treatment for schizophrenia with a single antipsychotic had significant implications on short-term response and metabolic outcomes. The study authors concluded, “In clinical practice, patients with poor early response should be given a targeted management strategy, antipsychotic drugs should be switched on time, and active and effective interventions for their metabolic disorders should be given.”

This article originally appeared on Psychiatry Advisor