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Schizophrenia Bulletin 2003 29(3):519-530;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Atypical Antipsychotics in First Admission Schizophrenia: Medication Continuation and Outcomes

Ramin Mojtabai, M.D., Ph.D., Janet Lavelle, M.S.W., P. Joseph Gibson, Ph.D., M.P.H. and Evelyn J. Bromet, Ph.D.
Assistant Professor of Clinical Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute New York, NY
Clinical Research Coordinator, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute New York, NY
Director of Epidemiology, Health and Hospital Corporation of Marion County Indianapolis, IN
Professor of Psychiatry, Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook Stony Brook, NY

Send reprint requests to Dr. Ramin Mojtabai, 2600 Netherland Ave., Apt. #805, Bronx, NY 10463; e-mail: rm322{at}columbia.edu

This study compares the effects of atypical and conventional antipsychotic medications on treatment continuation and outcomes in a first admission sample of patients with schizophrenia treated in usual practice settings. In a sample of 189 participants with a research diagnosis of DSM-IV schizophrenia drawn from the Suffolk County Mental Health Project, we compared the effects of atypical and conventional agents on change of medication, medication gaps, and rehospitalization. For these analyses we used the method of survival analysis for recurrent events, in which the episodes of treatment rather than individual subjects are the units of analysis. In addition, we compared improvement in positive and negative symptoms from intake to 24- or 48-month followups for subjects who stayed on one type of medication or changed to atypicals from conventional antipsychotics. Atypical agents were associated with lower risk of medication change, medication gaps, and rehospitalization. Both conventional and atypical agents were associated with improvement of positive symptoms at followup, but only subjects on atypical agents at followup experienced a significant improvement in negative symptoms. We conclude that in usual practice settings, as in randomized clinical trials, atypical agents are associated with improved treatment continuation and outcomes.

Keywords: Antipsychotic medication / atypical antipsychotic medication / schizophrenia / first admission / continuity of care


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