The impact upon extra-pyramidal side effects, clinical symptoms and quality of life of a switch from conventional to atypical antipsychotics (risperidone or olanzapine) in elderly patients with schizophrenia

• Published in: International journal of geriatric psychiatry 2003-05, Vol.18 (5), p.432-440
• Main Authors: Ritchie, C. W., Chiu, E., Harrigan, S., Hall, K., Hassett, A., Macfarlane, S., Mastwyk, M., O'Connor, D. W., Opie, J., Ames, D.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Aged, 80 and over; Antipsychotic Agents - adverse effects; Benzodiazepines; Biological and medical sciences; elderly; extra-pyramidal side-effects; Female; Humans; Male; Medical sciences; Middle Aged; Neuropharmacology; olanzapine; Pharmacology. Drug treatments; Pirenzepine - adverse effects; Pirenzepine - analogs & derivatives; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychomotor Disorders - chemically induced; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Quality of Life; risperidone; Risperidone - adverse effects; Schizophrenia; Schizophrenia - drug therapy; switching
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.862

Background Atypical antipsychotics are commonly used in the management of schizophrenia in late life with evidence suggesting they induce lower rates of motor disturbance, but have similar efficacy to conventional antipsychotics. Trials in the elderly have been either retrospective, small, of short duration or of a single‐arm design. Aims To demonstrate the effects upon motor side‐effects, efficacy, safety and quality of life (QOL) of switching elderly patients with schizophrenia from conventional antipsychotics to olanzapine or risperidone. Methods Elderly patients with schizophrenia were randomly allocated to olanzapine or risperidone and followed through an open‐label crossover period. Between and within group intention to treat analyses were conducted. Results 66 patients were randomised (mean age 69.6 [SD ± 6.2]). Four (11.8%) patients on olanzapine and 8 (26.7%) patients on risperidone failed to complete the crossover because of treatment failure [Odds Ratio (OR) = 2.73[0.73–10.2] p = 0.14]. The mean doses upon completion of switching in each arm were 9.9 mg (SD = 4.2) and 1.7 mg (SD = 1.2) for olanzapine and risperidone respectively. In both arms there was improvement in Parkinsonism, though only olanzapine was associated with a reduction in dyskinetic symptoms. The Brief Psychiatric Rating Scale, Scale for the assessment of Negative Symptoms and Montgomery and Asberg Depression Rating Scale scores all improved through the crossover period in both arms with no between group differences. Treatment with olanzapine was associated with a better response over risperidone on the psychological domain of the World Health Organisation—Quality Of Life [Brief] (WHO‐QOL‐BREF) scale ( p = 0.02). Patients in the olanzapine arm also demonstrated improvement from baseline in the WHO‐QOL‐BREF physical, psychological and health satisfaction domains, but risperidone had no effect on any Quality of Life (QOL) measure. Conclusions After switching from a conventional antipsychotic, olanzapine and risperidone were associated with improvement in core symptoms of schizophrenia and motor side effects. Subjects switched to olanzapine were more likely to complete the switching process and show an improvement in psychological QOL. Copyright © 2003 John Wiley & Sons, Ltd.