How antipsychotics impact the different dimensions of Schizophrenia: A test of competing hypotheses

Tiago Reis Marques, Stephen Z. Levine, Avi Reichenberg, Rene Kahn, Eske M. Derks, Wolfgang W. Fleischhacker, Jonathan Rabinowitz, Shitij Kapur*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

The clinical expression of schizophrenia is generally reported to be expressed by three to five different factors (i.e. positive, negative, disorganization, excitability, anxiety-depression symptoms). It is often claimed that antipsychotic medications are particularly helpful for positive symptoms, but not for the others, suggesting a differential efficacy for different aspects of the disorder. We formally tested this claim. Using Structural Equation Modeling in two large [1884 patients] clinical trials in schizophrenia, we compared the model of a common general effect of antipsychotics to models whereby the antipsychotics have multiple and differential effects on the different factors of the illness. We validated the generalizability of the model in further trials involving antipsychotics in chronic [1460 patients] and first-episode patients [1053 patients]. Across different populations, different trials and different antipsychotics - the best-fitting model suggests that symptom response in schizophrenia is underpinned by a single general effect with secondary and minor lower-order effects on specific symptom domains. This single-factor model explained nearly 80% of the variance, was superior to the assumption of unique efficacy for specific domains; and replicated across antipsychotics and illness stages. Despite theoretical and pharmacological claims the differential efficacy of antipsychotics on the various dimensions of schizophrenia is not supported in the prevailing data. The implication of this finding for the measurement of treatment response and our understanding of the neurobiology of antipsychotic action, for clinical practice and for future drug development are discussed.

Original languageEnglish
Pages (from-to)1279-1288
Number of pages10
JournalEuropean Neuropsychopharmacology
Volume24
Issue number8
DOIs
Publication statusPublished - Aug 2014

Keywords

  • Antipsychotics
  • Antipsychotic response
  • Factor analysis
  • Schizophrenia
  • Symptom dimensions
  • NEGATIVE SYNDROME SCALE
  • SYMPTOM DIMENSIONS
  • DRUGS
  • RISPERIDONE
  • TRIALS
  • MODEL
  • 2ND-GENERATION
  • METAANALYSIS
  • HALOPERIDOL
  • DISORDERS

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