Featured Research

from universities, journals, and other organizations

Newer Antipsychotics No Better Than Older Drug In Treating Child And Adolescent Schizophrenia, Study Finds

Date:
September 15, 2008
Source:
University of North Carolina School of Medicine
Summary:
Nearly every child who receives an antipsychotic medicine is first prescribed a second-generation, or "atypical" drugs. However, there has never been evidence that these drugs are more effective or safer than the older, first-generation medications. Now a UNC Chapel Hill School of Medicine study suggests that first-generation drugs are as effective as the newer ones and should be used as a first line of therapy in some children.

Nearly every child who receives an antipsychotic medicine is first prescribed one of the second-generation, or “atypical” drugs, such as olanzapine and risperidone. However, there has never been evidence that these drugs are more effective than the older, first-generation medications.

Related Articles


Now a study from the University of North Carolina at Chapel Hill School of Medicine suggests that molindone, a first-generation drug, is as effective as the newer ones and should be used as a first line of therapy in some children with schizophrenia or schizoaffective disorder.

“People thought the second-generation drugs were superior because they had no side effects. We found that molindone works as well as newer drugs, and in some cases it’s safer,” said Lin Sikich, M.D., associate professor in the department of psychiatry at UNC and lead author of the study, titled the Treatment of Early-Onset Schizophrenia Spectrum Disorders Study.

“The guidelines are going to have to be rewritten because of this study,” Sikich said. A report of the study is published Monday in the Sept. 15, 2008 edition of the American Journal of Psychiatry. Co-author Jeffrey Lieberman, M.D., led the earlier CATIE trial at UNC, a landmark study that compared antipsychotic medications in adults. Lieberman is now at Columbia University Medical Center.

The study is the largest head-to-head trial comparing the newer drugs, which became available in the 1990s, to the older ones, which have been around since the 1950s.

Between 2002 and 2006 the study randomly assigned 119 people aged 8 to 19 years to receive molindone, olanzapine or risperidone over an eight-week period at four sites: UNC; McLean Hospital and Cambridge Health Alliance at Harvard Medical School; Seattle Children’s Hospital and the University of Washington; and Case Western Reserve University.

A decline in symptoms was similar across the three medications. But the drugs caused very different types of side effects, Sikich said. Both olanzapine and risperidone were associated with significant weight gain and could put young patients at risk of developing heart disease and diabetes. In fact, the National Institute of Mental Health, which sponsored the study, halted recruitment into the olanzapine arm of the study because of the weight gain problem and the resulting increase in cholesterol and glucose levels.

“Olanzapine should not be a first-line therapy in adolescents,” Sikich said.

Both the older “typical” antipsychotics and newer “atypical” ones block dopamine receptors in the brain, but the newer drugs also interact with serotonin receptors and cause fewer muscle side effects, including stiffness, muscle cramps, restlessness and involuntary movements. With some older drugs, the involuntary movements can lead to permanent physical disabilities.

There were more reported cases of restlessness with molindone treatment than with either of the two newer treatments. Participants treated with molindone were also required to receive another drug, benztropine, to decrease muscle cramps and stiffness.

Brandon Constantineau, 18, of Wilmington, N.C., enrolled in the TEOSS study about four years ago. He was initially prescribed olanzapine but quickly began gaining weight, ultimately adding more than 45 pounds over 36 weeks. He was switched to molindone and gained about 8 pounds over the next 31 weeks and saw improvements similar to those with olanzapine. But, probably as a result of being on olanzapine, Sikich said, Brandon developed fatty liver disease and was ultimately prescribed two other medications.

Brandon’s case also highlights two other points Sikich makes in the study: the benefits of proper diagnosis and the need for more effective medications.

“He was treated when he was very young, about 3, for ADHD,” said Brandon’s father, Richard Constantineau. But medications and other therapies didn’t help, and Brandon grew violent.

“At the point when we went to see Dr. Sikich, when Brandon was 14, I was getting phone calls from the school because he was making threats against teachers,” said Brandon’s mother, Darlene Wilson. This coincided with violent threats against his parents and, Brandon said, “at one point in time I thought I was seeing angels with halos and wings, like in the Bible.”

A psychiatrist Brandon had been seeing was not helpful, Wilson said, so a pediatrician referred them to Sikich.

Late diagnosis is a common problem with many children who develop early onset schizophrenia or schizoaffective disorder, and the diseases usually develop more severely when they begin in childhood, Sikich said.

Brandon is now doing well on an even newer drug, ziprasidone. But in the TEOSS trial only half of all of the participants responded to any medication.

“Medications make a vast difference in peoples’ lives, but we need better treatment options,” Sikich said. The trial will next compare outcomes after a one-year course of treatment.

Brandon and his family appreciate first-hand the challenges and advances.

“It’s working well for him and we need to enjoy the good times, because it’s not always good times,” Wilson said. “We just have to enjoy what we have right now.”


Story Source:

The above story is based on materials provided by University of North Carolina School of Medicine. Note: Materials may be edited for content and length.


Cite This Page:

University of North Carolina School of Medicine. "Newer Antipsychotics No Better Than Older Drug In Treating Child And Adolescent Schizophrenia, Study Finds." ScienceDaily. ScienceDaily, 15 September 2008. <www.sciencedaily.com/releases/2008/09/080915083353.htm>.
University of North Carolina School of Medicine. (2008, September 15). Newer Antipsychotics No Better Than Older Drug In Treating Child And Adolescent Schizophrenia, Study Finds. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2008/09/080915083353.htm
University of North Carolina School of Medicine. "Newer Antipsychotics No Better Than Older Drug In Treating Child And Adolescent Schizophrenia, Study Finds." ScienceDaily. www.sciencedaily.com/releases/2008/09/080915083353.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) — The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Experimental Ebola Vaccine Shows Promise In Human Trial

Experimental Ebola Vaccine Shows Promise In Human Trial

Newsy (Nov. 27, 2014) — A recent test of a prototype Ebola vaccine generated an immune response to the disease in subjects. Video provided by Newsy
Powered by NewsLook.com
Pet Dogs to Be Used in Anti-Ageing Trial

Pet Dogs to Be Used in Anti-Ageing Trial

Reuters - Innovations Video Online (Nov. 26, 2014) — Researchers in the United States are preparing to discover whether a drug commonly used in human organ transplants can extend the lifespan and health quality of pet dogs. Video provided by Reuters
Powered by NewsLook.com
Today's Prostheses Are More Capable Than Ever

Today's Prostheses Are More Capable Than Ever

Newsy (Nov. 26, 2014) — Advances in prosthetics are making replacement body parts stronger and more lifelike than they’ve ever been. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins