The most valuable message from this direct comparison of five antipsychotics might be that psychiatrists need to use a spectrum of strategies.
Efficacy trials have suggested the superiority of atypical antipsychotic drugs over older agents, but these trials have not been conducted under real-world conditions. In an 18-month, double-blind, randomized, multisite trial, researchers used minimal inclusion criteria to enroll 1493 patients with schizophrenia in a comparison study of the neuroleptic perphenazine and four newer antipsychotics: olanzapine, quetiapine, risperidone, and ziprasidone.
Olanzapine recipients were less likely than recipients of the other drugs to discontinue medication for any reason (64% vs. 74%–82%), and they continued treatment significantly longer as well (median, 9.2 months vs. 3.5–5.6 months). Secondary analyses of symptom-rating scales showed a similar tren…