The CATIE Schizophrenia Trial: Results, Impact, Controversy

The CATIE Schizophrenia Trial: Results, Impact, Controversy
Harvard Review of Psychiatry, 03/13/09

Manschreck TC et al. - Cost-effectiveness analysis revealed a significant advantage for perphenazine, due to the impact of the high-priced, brand-name SGAs on overall health care costs. Methods

• Examine fundamental issues about second-generation antipsychotic (SGA) medications (olanzapine, risperidone, quetiapine, and ziprasidone)
• Their relative effectiveness and their effectiveness compared to a first-generation antipsychotic (FGA), perphenazine.

Results

• The primary outcome measure, time to discontinuation, served as an index of effectiveness and was remarkably short; only 26% of subjects completed the 18-month trial on the medicine to which they were initially randomized.
• Subjects receiving olanzapine experienced a slightly longer time to discontinuation. Based on this single criterion, olanzapine showed greater effectiveness than the other agents despite its association with significant metabolic disturbance, especially weight gain.
• Perphenazine unexpectedly showed comparable levels of effectiveness and produced no more extrapyramidal side effects than the other agents.
• Despite modest prolactin elevation, risperidone was the best-tolerated medication.
• Ziprasidone was associated with weight loss and with positive impact on lipids and blood glucose.
• In Phase 2, clozapine demonstrated better effectiveness compared to other SGAs for subjects who discontinued their Phase 1 medication because of efficacy.
• Olanzapine and risperidone showed greater effectiveness in the tolerability pathway.

 

 

 

 

The Effectiveness of Long-Term Psychoanalytic Therapy: A Systematic Review of Empirical Studies
Harvard Review of Psychiatry, 03/12/09

Maat S et al. - This study suggests that Long-Term Psychoanalytic Therapy is an effective treatment for a large range of pathologies, with moderate to large effects. Methods

• A systematic literature search for studies dealing with the effectiveness of individual LPT in ambulatory, adult patients.
• Data about the overall effectiveness of LPT, its impact on symptom reduction, and its effect on personality changes were pooled both at treatment termination and at follow-up, using effect sizes (ESs) and success rates.

Results

• We found 27 studies (n = 5063).
• Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow-up) and high mean overall success rates (64% at termination; 55% at follow-up) in moderate/mixed pathology.
• The mean ES was larger for symptom reduction (1.03) than for personality change (0.54). In severe pathology, the results were similar.
• Psychoanalysis achieved large mean ESs (0.87 at termination; 1.18 at follow-up) and high mean overall success rates (71% at termination; 54% at follow-up) in moderate pathology.
• The mean ES for symptom reduction was larger (1.38) than for personality change (0.76)

 

 

 

Effects of memantine on cognition in patients with moderate to severe Alzheimers disease: post-hoc analyses of ADAS-cog and SIB total and single-item scores from six randomized, double-blind, placebo-controlled studies
International Journal of Geriatric Psychiatry, 03/12/09

Patrizia Mecocci et al. - Memantine shows significant benefits on overall cognitive abilities as well as on specific key cognitive domains for patients with moderate to severe Alzheimer's Disease. Methods

• Data from six multicentre, randomised, placebo-controlled, parallel-group, double-blind, 6-month studies were used as the basis for these post-hoc analyses.
• All patients with a Mini-Mental State Examination (MMSE) score of less than 20 were included.
• Analyses of patients with moderate AD (MMSE: 10-19), evaluated with the Alzheimer's disease Assessment Scale (ADAS-cog) and analyses of patients with moderate to severe AD (MMSE: 3-14), evaluated using the Severe Impairment Battery (SIB), were performed separately.

Results

• The mean change from baseline showed a significant benefit of memantine treatment on both the ADAS-cog (p < 0.01) and the SIB (p < 0.001) total score at study end.
• The ADAS-cog single-item analyses showed significant benefits of memantine treatment, compared to placebo, for mean change from baseline for commands (p < 0.001), ideational praxis (p < 0.05), orientation (p < 0.01), comprehension (p < 0.05), and remembering test instructions (p < 0.05) for observed cases (OC).
• The SIB subscale analyses showed significant benefits of memantine, compared to placebo, for mean change from baseline for language (p < 0.05), memory (p < 0.05), orientation (p < 0.01), praxis (p < 0.001), and visuospatial ability (p < 0.01) for OC.