Farmacotherapeutische overwegingen bij eerste psychose

Objective

Although antipsychotic medication is often used for the treatment of patients with a first-episode psychosis, there is a lack of clarity concerning their optimal use. The aim of this study was to assess an algorithm for treatment involving antipsychotics.

Design

A medication trial with three phases: phase one and three were open-label, phase two was a randomized, double-blind design.

Method

The study ran in 27 centres in 14 European countries and Israel. All patients were commenced on amisulpride for 4 weeks (phase 1). After 4 weeks non-remitters were randomized, double blind, to either continue on amisulpride for a further 6 weeks or switch to olanzapine for 6 weeks (phase 2). Patients who were still not in remission at the end of phase 2, were treated for 12 weeks with clozapine (phase 3).

Results

A total of 466 patients were included. Of the 371 patients who completed phase 1 (83%), 250 (56%) met remission criteria at the end of this phase. At the end of phase 2, 45% of patients on amisulpride and 44% of patients on olanzapine met remission criteria (statistically non-significant difference). Of the 18 patients who completed phase 3, 5 (28%) reached remission.

Conclusion

Switching non-remitters after 4 weeks of amisulpride treatment to olanzapine provides no improvement for the patient. Amisulpride appears to be a good first choice antipsychotic for patients with first-episode psychosis, followed by clozapine if remission has not been achieved following 10 weeks of amisulpride therapy.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.