The PAFIP group (Initial Psychosis Care Program) that is part of the IDIVAL Psychiatry group has published in the International Journal of Neuropsychopharmacology the article “Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone” in which six of the most widely used antipsychotics in clinical practice in patients with schizophrenia are analyzed.
Traditionally, schizophrenia has been attributed the qualities of being a chronic and highly disabling disease. However, thanks to advances in pharmacological treatment and the participation of specific programs from the early stages of the disease, a much more optimistic vision can be transmitted.
To prevent a negative progression of schizophrenia, the first phase of the disease, between the three and the first five years from the beginning of the disease, is especially critical. Effective interventions in this phase are decisive for modifying the long-term course of the disease. In this sense, it is necessary not only to intervene effectively in the acute episode but critically to prevent relapse. Relapses are linked to an increased risk of developing resistance to treatment in subsequent relapses, requiring higher treatment doses with a higher risk for the development of side effects and greater neurotoxicity with hardly reversible cognitive and functional sequelae; all this, ultimately, conditions a worse prognosis.
Antipsychotics have been shown to be effective in both treating acute episodes and preventing relapses. However, there are still high relapse rates in the long-term follow-up of the patients (above 70% at three years). Based on the experience of the work team, there are wide differences depending on the treatment. Thus, it was hypothesized that the differences regarding efficacy, tolerability and adherence between the different antipsychotics will result in substantial differences in terms of effectiveness in making a potentially critical decision for the long-term prognosis of a patient with a first psychotic episode how is the choice of your first treatment.
This work provides evidence on the differences in terms of long-term effectiveness between six of the most widely used antipsychotics in clinical practice. The results show strikingly a distinction between a highly effective group and a less effective group. Thus, the group consisting of olanzapine, risperidone and aripiprazole have clear advantages for the initial treatment of patients with psychosis due to its impact on the long-term prognosis based on its superior effectiveness.
The aim of this study is to help guide the long-term treatment of patients with schizophrenia based on the best possible evidence. In fact, its results have had a direct impact on our intervention program in first episodes of psychosis (ITPCAN- Early Intervention in Psychosis Cantabria), so that the first lines of treatment are oriented towards the most effective treatments mentioned.
This work has been carried out by the PAFIP group (Program of Attention in Initial Phases of Psychosis), which is part of the IDIVAL Psychiatry group, currently led by Dr. Rosa Ayesa, and a prominent group within the national structure of CIBERSAM. The work is part of the doctoral thesis carried out by Dr. Marcos Gómez directed by Drs. Crespo Facorro and Pelayo-Terán, and with the collaboration of Dr. Vázquez-Bourgon, Dr. Juncal and Víctor Ortiz.
Currently, we are working on new personalized studies (with the participation of Dr. Gómez, Dr. Vázquez and Dr. Juncal) aimed at characterizing response phenotypes, so that we are able to identify profiles of “good” and ” poor ”responders that allow us to implement personalized treatments and interventions aimed at optimizing the patient's overall long-term prognosis.
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