Safety and effectiveness of olanzapine versus conventional antipsychotics in the acute treatment of first-episode schizophrenic inpatients

Objective: To assess the safety and effectiveness of olanzapine compared to typical antipsychotics in the treatment of first-episode schizophrenics in acute psychiatric inpatient wards. Methods: Data were collected from a prospective, comparative, nonrandomized, open, observational study of 904 inpatients with schizophrenia. One hundred and fifty-eight patients fulfilled the criteria for first-episode schizophrenia, defined as (1) the International Classification of Diseases: Mental and Behavioral Disorders, 10th ed. (ICD-10) diagnosis of schizophrenia, (2) antipsychotic naive; and (3) a course of illness of less than 5 years. Eighty-nine (56.3%) of these patients were assigned to the olanzapine treatment group (OLZ) and 69 (43.7%) to the control group that received treatment with conventional antipsychotics (CON). Safety was evaluated in terms of the spontaneous adverse events reported and a specific questionnaire for extrapyramidal symptoms (EPS). Clinical status was measured by means of the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Severity (CGI-S). Clinical response was defined as the baseline-endpoint decrease in BPRS > 40% plus an endpoint BPRS < 18 or an endpoint CGI less than or equal to 3. Results: The rate of clinical response to treatment in the OLZ was 76.7%, compared to 54.4% in the CON (chi(2) = 8.48; P = .003). Olanzapine was significantly more effective than conventional antipsychotics in lowering the total BPRS score (P = .0003), as well as each of the following BPRS subscales: positive symptoms (P = .0019), negative symptoms (P < .0001), depression (P = .018), and agitation (P = .007), even after mean scores were adjusted for their baseline value and disease duration. Olanzapine also proved to be significantly superior to conventional antipsychotics in lowering mean CGI scores (P = .013). The frequency with which new EPS appeared, or previously existing ones worsened, was significantly greater in the CON than in the OLZ (55.1% vs. 13.5%; P < .001). Anticholinergics were needed more frequently in the CON than in the OLZ (58.0% vs. 6.7%; P < .0001). Conclusions: The results of this observational, naturalistic study show that olanzapine is safe and effective in a nonselected sample of acute, first-episode schizophrenic inpatients. (C) 2003 Elsevier Science Inc. All rights reserved.