Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST)

Jan Volavka, P. Czobor, Eske M. Derks, I. Bitter, Jan Libiger, René S. Kahn, W. Wolfgang Fleischhacker

Research output: Contribution to journalArticle

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Abstract

Objective: To compare the effects of haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on hostility in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. Method: We used the data acquired in the European First-Episode Schizophrenia Trial, an open, randomized trial (conducted in 14 countries) comparing 5 antipsychotic drugs in 498 patients aged 18-40 years with first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. DSM-IV diagnostic criteria were used. Patients were assessed between December 23, 2002 and January 14, 2006. Most subjects joined the study as inpatients and then continued with follow-ups in outpatient clinic visits. The Positive and Negative Syndrome Scale (PANSS) was administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. We analyzed the scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility (a score > 1) at baseline. We hypothesized (1) that the treatments would differ in their efficacy for hostility and (2) that olanzapine would be superior to haloperidol. Our primary statistical analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time. Secondary analysis addressed the question of whether the effects on hostility found in the primary analysis were specific to this item. All our analyses were post hoc. Results: The primary analysis of hostility indicated an effect of differences between treatments (F 4,889 = 4.02, P = .0031). Post hoc treatment-group contrasts for hostility change showed that, at months 1 and 3, olanzapine was significantly superior (P <.05) to haloperidol, quetiapine, and amisulpride in reducing hostility. Secondary analyses demonstrated that these results were at least partly specific to hostility. Conclusions: Both hypotheses were supported. Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia, schizoaffective disorder, and schizophreniform disorder. This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects and propensity to cause weight gain. Trial Registration: ISRCTN Register Identifier: ISRCTN68736636

Original languageEnglish
Pages (from-to)955-961
Number of pages7
JournalJournal of Clinical Psychiatry
Volume72
Issue number7
DOIs
Publication statusPublished - Jul 2011

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Hostility
olanzapine
Antipsychotic Agents
Schizophrenia
Psychotic Disorders
Haloperidol
Therapeutics
Ambulatory Care
Random Allocation
Secondary Prevention
Ambulatory Care Facilities
Diagnostic and Statistical Manual of Mental Disorders
Weight Gain
Inpatients

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). / Volavka, Jan; Czobor, P.; Derks, Eske M.; Bitter, I.; Libiger, Jan; Kahn, René S.; Fleischhacker, W. Wolfgang.

In: Journal of Clinical Psychiatry, Vol. 72, No. 7, 07.2011, p. 955-961.

Research output: Contribution to journalArticle

Volavka, Jan ; Czobor, P. ; Derks, Eske M. ; Bitter, I. ; Libiger, Jan ; Kahn, René S. ; Fleischhacker, W. Wolfgang. / Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). In: Journal of Clinical Psychiatry. 2011 ; Vol. 72, No. 7. pp. 955-961.
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AU - Libiger, Jan

AU - Kahn, René S.

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