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Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups

Published online by Cambridge University Press:  16 April 2020

C.U. Correll ,
F. Cañas ,
I. Larmo ,
P. Levy ,
J.-M. Montes ,
A. Fagiolini ,
G. Papageorgiou ,
A. Rossi ,
R. Sturlason  and
M. Zink
C.U. Correll*
Affiliation:
The Zucker Hillside Hospital Center for Translational Psychiatry, The Feinstein Institute for Medical Research, Glen Oaks, USA and Department of Psychiatry, Albert Einstein College of Medicine, New York, USA
F. Cañas
Affiliation:
Department of Psychiatry, Hospital Dr R Lafora, Madrid, Spain
I. Larmo
Affiliation:
Aurora Psychiatric Hospital, Helsinki, Finland
P. Levy
Affiliation:
Psychiatry Department, Hospital Santa Maria, Lisbon, Portugal
J.-M. Montes
Affiliation:
Psychiatric Section, Hospital del Sureste, Madrid, Spain
A. Fagiolini
Affiliation:
Department of Neuroscience, School of Medicine, University of Siena, Siena, Italy
G. Papageorgiou
Affiliation:
Department of Psychiatry, Evangelismos General Hospital, Athens, Greece
A. Rossi
Affiliation:
Department of Experimental Medicine, University of L’Aquila, L’Aquila, Italy
R. Sturlason
Affiliation:
Psychiatry Department, University Hospital of Aarhus Risskov, Århus, Denmark
M. Zink
Affiliation:
Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
*
*Corresponding author. Tel.: ++1-718 470-4812; fax: ++1-718 343-1659. E-mail address:[email protected] (C. Correll).
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Abstract

Treatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.

Keywords

SchizophreniaAntipsychoticsFactor analysisPatient subgroupsPatient characteristicsTreatment selectionTreatment outcomeComorbidities
Type
Research Article
Information
European Psychiatry , Volume 26 , Issue S1: Patients with schizophrenia: Results of a physician-based survey conducted in four European countries (Germany, Greece, Italy and Spain) , March 2011 , pp. 3 - 16
Copyright
Copyright © European Psychiatric Association 2011

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References

Bleuler, E.Dementia praecox oder Gruppe der Schizophrenien 1911 F. Deuticke Leipzig and Vienna Google Scholar
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 4th edn. 2000 American Psychiatric Association Washington DC Text RevisionGoogle Scholar
Allardyce, J.Suppes, T.Van Os, J.Dimensions and the psychosis phenotype Int J Methods Psychiatr Res 16 Suppl 1 2007 S34–S40CrossRefGoogle ScholarPubMed
Kane, J.M.Correll, C.U.Past and present progress in the pharmacologic treatment of schizophrenia J Clin Psychiatry 71 2010 1115–1124CrossRefGoogle ScholarPubMed
Nose, M.Barbui, C.Tansella, M.How often do patients with psychosis fail to adhere to treatment programmes? A systematic review Psychol Med 33 2003 1149–1160CrossRefGoogle ScholarPubMed
Ayuso-Gutierrez, J.L.del Rio Vega, J.M.Factors influencing relapse in the long-term course of schizophrenia Schizophr Res 28 1997 199–206CrossRefGoogle ScholarPubMed
Weiden, P.J. Switching in the era of atypical antipsychotics. An updated review Postgrad Med 2006 27–44 Spec NoGoogle Scholar
Lieberman, J.A.Stroup, T.S.McEvoy, J.P.Swartz, M.S.Rosenheck, R.A.Perkins, D.O.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia N Engl J Med 353 2005 1209–1223CrossRefGoogle ScholarPubMed
Kahn, R.S.Fleischhacker, W.W.Boter, H.Davidson, M.Vergouwe, Y.Keet, I.P.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial Lancet 371 2008 1085–1097CrossRefGoogle ScholarPubMed
Novick, D.Haro, J.M.Suarez, D.Vieta, E.Naber, D.Recovery in the outpatient setting: 36-month results from the Schizophrenia Outpatients Health Outcomes (SOHO) study Schizophr Res 108 2009 223–230CrossRefGoogle ScholarPubMed
Perkins, D.Lieberman, J.Gu, H.Tohen, M.McEvoy, J.Green, A.Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders Br J Psychiatry 185 2004 18–24CrossRefGoogle ScholarPubMed
Robinson, D.Woerner, M.G.Alvir, J.M.Bilder, R.Goldman, R.Geisler, S.Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder Arch Gen Psychiatry 56 1999 241–247CrossRefGoogle ScholarPubMed
Robinson, D.G.Woerner, M.G.Alvir, J.M.Bilder, R.M.Hinrichsen, G.A.Lieberman, J.A.Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder Schizophr Res 57 2002 209–219CrossRefGoogle ScholarPubMed
Chatterjee, A.Chakos, M.Koreen, A.Geisler, S.Sheitman, B.Woerner, M.K.Prevalence and clinical correlates of extrapyramidal signs and spontaneous dyskinesia in never-medicated schizophrenic patients Am J Psychiatry 152 1995 1724–1729Google ScholarPubMed
Ascher-Svanum, H.Zhu, B.Faries, D.Peng, X.Kinon, B.J.Tohen, M.Tardive dyskinesia and the 3-year course of schizophrenia: results from a large, prospective, naturalistic study J Clin Psychiatry 69 2008 1580–1588CrossRefGoogle ScholarPubMed
Leucht, S.Busch, R.Kissling, W.Kane, J.M.Early prediction of antipsychotic nonresponse among patients with schizophrenia J Clin Psychiatrys 68 2007 352–360CrossRefGoogle ScholarPubMed
Kinon, B.J.Chen, L.Ascher-Svanum, H.Stauffer, V.L.Kollack-Walker, S.Zhou, W.Early response to antipsychotic drug therapy as a clinical marker of subsequent response in the treatment of schizophrenia Neuropsychopharmacology 35 2010 581–590CrossRefGoogle ScholarPubMed
Correll, C.U.Malhotra, A.K.Kaushik, S.McMeniman, M.Kane, J.M.Early prediction of antipsychotic response in schizophrenia Am J Psychiatry 160 2003 2063–2065CrossRefGoogle Scholar
Davis, J.M.Casper, R.Antipsychotic drugs: clinical pharmacology and therapeutic use Drugs 4 1977 260–282CrossRefGoogle Scholar
Deniker, P.Principles of French pharmaco-clinical classification Prog Neuropsychopharmacol 4 1980 455–468CrossRefGoogle ScholarPubMed
Fischer-Barnicol, D.Lanquillon, S.Haen, E.Zofel, P.Koch, H.J.Dose, M.Typical and atypical antipsychotics – the misleading dichotomy. Results from the Working Group ‘Drugs in Psychiatry’ (AGATE) Neuropsychobiology 57 2008 80–87CrossRefGoogle Scholar
Correll, C.U.Leucht, S.Kane, J.M.Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies Am J Psychiatry 161 2004 414–425CrossRefGoogle ScholarPubMed
Leucht, S.Corves, C.Arbter, D.Engel, R.R.Li, C.Davis, J.M.Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis Lancet 373 2009 31–41CrossRefGoogle ScholarPubMed
Woodward, N.D.Purdon, S.E.Meltzer, H.Y.Zald, D.H.A meta-analysis of neuropsychological change to clozapine, olanzapine, quetiapine, and risperidone in schizophrenia Int J Neuropsychopharmacol 8 2005 457–472CrossRefGoogle Scholar
Kane, J.M. Clinical efficacy of clozapine in treatment-refractory schizophrenia: an overview Br J Psychiatry 1992 41–45CrossRefGoogle Scholar
merican Psychiatric Association Practice guideline for the treatment of patients with schizophrenia Second edition 2004 American Psychiatric Association Washington DCGoogle Scholar
Mortimer, A.M.Singh, P.Shepherd, C.J.Puthiryackal, J.Clozapine for treatment-resistant schizophrenia: National Institute of Clinical Excellence (NICE) guidance in the real world Clin Schizophr Relat Psychoses 4 2010 49–55CrossRefGoogle ScholarPubMed
Thaker, G.K.Schizophrenia endophenotypes as treatment targets Expert Opin Ther Targets 11 2007 1189–1206CrossRefGoogle ScholarPubMed
Weiden, P.J.Preskorn, S.H.Fahnestock, P.A.Carpenter, D.Ross, R.Docherty, J.P.Translating the psychopharmacology of antipsychotics to individualized treatment for severe mental illness: a Roadmap J Clin Psychiatry 68 Suppl 7 2007 1–48Google ScholarPubMed
Jolliffe, I.T.Principal Component Analysis 2002 Springer Verlag New York New YorkGoogle Scholar
Ramsay, J.O.Silverman, B.W.Functional Data Analysis 1997 Springer Verlag New York New YorkCrossRefGoogle Scholar
Papageorgiou, G.Cañas, F.Zink, M.Rossi, A.Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe Eur Psychiatry 26 2011 17–28CrossRefGoogle ScholarPubMed
De Hert, M.Mauri, M.Shaw, K.Wetterling, T.Doble, A.Giudicelli, A.The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology Int J Methods Psychiatr Res 19 2010 195–210CrossRefGoogle ScholarPubMed
Correll, C.U.Druss, B.G.Lombardo, I.O’Gorman, C.Harnett, J.P.Sanders, K.N.Findings of a U.S. national cardiometabolic screening program among 10,084 psychiatric outpatients Psychiatr Serv 61 2010 892–898CrossRefGoogle Scholar
Correll, C.U.Balancing efficacy and safety in treatment with antipsychotics CNS Spectr 12 2007 12–20CrossRefGoogle ScholarPubMed
Kohn, R.Saxena, S.Levav, I.Saraceno, B.The treatment gap in mental health care Bull World Health Organ 82 2004 858–866Google ScholarPubMed
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinology, North American Association for the study of obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes Diabetes Care 27 2004 596–601Google Scholar
De Hert, M.Dekker, J.M.Wood, D.Kahl, K.G.Holt, R.I.Moller, H.J.Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) Eur Psychiatry 24 2009 412–424CrossRefGoogle Scholar
de Leon, J.Diaz, F.J.A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors Schizophr Res 76 2005 135–157CrossRefGoogle ScholarPubMed
Brown, S.Kim, M.Mitchell, C.Inskip, H.Twenty-five year mortality of a community cohort with schizophrenia Br J Psychiatry 196 2010 116–121CrossRefGoogle ScholarPubMed
Kroken, R.A.Johnsen, E.Ruud, T.Wentzel-Larsen, T.Jorgensen, H.A.Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study BMC Psychiatry 9 2009 24CrossRefGoogle ScholarPubMed
Bret, P.Bret, M.C.Queuille, E.[Prescribing patterns of antipsychotics in 13 French psychiatric hospitals] Encephale 35 2009 129–138CrossRefGoogle Scholar
Weinbrenner, S.Assion, H.J.Stargardt, T.Busse, R.Juckel, G.Gericke, C.A.Drug prescription patterns in schizophrenia outpatients: analysis of data from a German health insurance fund Pharmacopsychiatry 42 2009 66–71CrossRefGoogle ScholarPubMed
IMS Health 2010.Google Scholar
Ranceva, N.Ashraf, W.Odelola, D.Antipsychotic polypharmacy in outpatients at Birch Hill Hospital: incidence and adherence to guidelines J Clin Pharmacol 50 2010 699–704CrossRefGoogle ScholarPubMed
Barbui, C.Nose, M.Mazzi, M.A.Thornicroft, G.Schene, A.Becker, T.Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries Int Clin Psychopharmacol 21 2006 355–362CrossRefGoogle ScholarPubMed
Biancosino, B.Barbui, C.Marmai, L.Dona, S.Grassi, L.Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study Int Clin Psychopharmacol 20 2005 305–309CrossRefGoogle ScholarPubMed
Zink, M.Englisch, S.Meyer-Lindenberg, A.Polypharmacy in schizophrenia Curr Opin Psychiatry 23 2010 103–111CrossRefGoogle Scholar
Broekema, W.J.de Groot, I.W.van Harten, P.N.Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study Pharm World Sci 29 2007 126–130CrossRefGoogle ScholarPubMed
Meltzer, H.Y.Suicide in schizophrenia, clozapine, and adoption of evidence-based medicine J Clin Psychiatry 66 2005 530–533CrossRefGoogle ScholarPubMed
Kay, S.R.Fiszbein, A.Opler, L.A.The positive and negative syndrome scale (PANSS) for schizophrenia Schizophr Bull 13 1987 261–276CrossRefGoogle Scholar
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