Harvard Mental Health Letter

In brief: Antipsychotic choice in early-onset schizophrenia

In brief

Antipsychotic choice in early-onset schizophrenia

Another study raises questions about the relative efficacy of first- and second-generation antipsychotics.

In the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) study, investigators randomly assigned 119 patients, ages 8 to 19, diagnosed with early-onset schizophrenia or schizoaffective disorder to treatment with the first-generation drug molindone (Moban) or one of two second-generation drugs, olanzapine (Zyprexa) or risperidone (Risperdal). Some patients were just diagnosed or "first episode," while others had chronic illness. Medications were prescribed at moderate doses.

At the end of eight weeks, investigators assessed treatment response rates, based on a standard instrument (the Positive and Negative Syndrome Scale), for 116 patients who received at least one dose of medication. Response to treatment was about the same no matter what drug the young patients took. Half of patients assigned to take molindone responded to treatment (defined in the study as a 20% or greater reduction in symptom severity), compared with 34% of those taking olanzapine and 46% of those taking risperidone. The differences are not statistically significant.

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