Psychopharmacology

, Volume 227, Issue 4, pp 615–625

Long-term (3-year) neurocognitive effectiveness of antipsychotic medications in first-episode non-affective psychosis: a randomized comparison of haloperidol, olanzapine, and risperidone

  • Rosa Ayesa-Arriola
  • Jose Manuel Rodríguez-Sánchez
  • Rocío Pérez-Iglesias
  • Roberto Roiz-Santiáñez
  • Obdulia Martínez-García
  • Jose Sánchez-Moreno
  • Rafael Tabarés-Seisdedos
  • Jose L. Vázquez-Barquero
  • Benedicto Crespo-Facorro
Original Investigation

DOI: 10.1007/s00213-013-2994-z

Cite this article as:
Ayesa-Arriola, R., Rodríguez-Sánchez, J.M., Pérez-Iglesias, R. et al. Psychopharmacology (2013) 227: 615. doi:10.1007/s00213-013-2994-z

Abstract

Introduction

The initially postulated superior neurocognitive effectiveness of second-generation antipsychotics is currently under debate.

Methods

A prospective, randomized, open-label study was carried out to compare the long-term neurocognitive effectiveness of haloperidol, olanzapine, and risperidone in the first episode of schizophrenia spectrum disorders. A final sample of 79 patients randomized to haloperidol (N = 28), olanzapine (N = 23), or risperidone (N = 28) who completed clinical and cognitive evaluations at baseline and 3-year follow-up was included in the final analysis. Forty-one healthy individuals were also included in the final analysis. The main outcome measure was cognitive changes at 3-year follow-up. Due to the fact that some of the patients had switched their initially prescribed antipsychotic medication during the course of the study (6 out of 28 in haloperidol group, 18 out of 23 in olanzapine group, and 24 out of 28 in risperidone group continued with the initial study drug at 3-year assessment), we have also conducted a per protocol analysis.

Results

Overall, cognitive changes were similar in the three treatment groups and controls, although a greater improvement in Rey Auditory Verbal Learning Test, Digit Symbol, and Iowa Gambling Test was found in the treatment groups. The better performance observed on Rey Auditory Verbal Learning Test and Digit Symbol in olanzapine treatment group was likely explained by the lower prevalence of use of antimuscarinic drugs. These results were essentially similar to those found in the intention-to-treat analysis.

Conclusions

The major conclusion of this study is that haloperidol, olanzapine, and risperidone have not demonstrated substantial neurocognitive effectiveness, improving cognitive deficits present in the early phases of the illness. The study also underscores the importance of exploring new drugs for the treatment of cognitive impairments and associated functional disabilities in schizophrenia.

Keywords

Schizophrenia Neurocognition Antipsychotic treatments 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rosa Ayesa-Arriola
    • 1
    • 2
  • Jose Manuel Rodríguez-Sánchez
    • 1
    • 2
  • Rocío Pérez-Iglesias
    • 1
    • 2
    • 3
  • Roberto Roiz-Santiáñez
    • 1
    • 2
  • Obdulia Martínez-García
    • 1
  • Jose Sánchez-Moreno
    • 2
    • 4
  • Rafael Tabarés-Seisdedos
    • 2
    • 5
  • Jose L. Vázquez-Barquero
    • 1
    • 2
  • Benedicto Crespo-Facorro
    • 1
    • 2
  1. 1.Department of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of MedicineUniversity of CantabriaSantanderSpain
  2. 2.Centro Investigación Biomédica en Red Salud Mental (CIBERSAM)MadridSpain
  3. 3.Psychosis Studies DepartmentInstitute of PsychiatryLondonUK
  4. 4.Bipolar Disorders Unit, Hospital ClínicUniversity of BarcelonaBarcelonaSpain
  5. 5.Department of MedicineUniversity of ValenciaValenciaSpain