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Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders^*

Department of Psychiatry, University of North Carolina School of Medicine, USA

Mauricio Tohen, MD DrPH

Lilly Research Laboratories and Department of Psychiatry, Harvard Medical School, USA

Joseph McEvoy, MD

Department of Psychiatry, Duke University School of Medicine, USA

Alan Green, MD

Department of Psychiatry, Dartmouth Medical School, USA

Robert Zipursky, MD

Department of Psychiatry, University of Toronto Faculty of Medicine, Canada

Stephen Strakowski, MD

Department of Psychiatry, University of Cincinnati, USA

Tonmoy Sharma, MD

Clinical Neuroscience Research Centre, Dartford, UK

René Kahn, MD PhD

Department of Psychiatry, University of Utrecht Medical School

Raquel Gur, MD PhD

University of Pennsylvania School of Medicine, USA

Gary Tollefson, MD PhD

Lilly Research Laboratories, USA

the HGDH Research Group

Correspondence: Diana O. Perkins, Department of Psychiatry, C.B. #7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA. Tel: 919 966 3813; fax: 919 966 5620; e-mail: Diana_Perkins{at}med.unc.edu

Declaration of interest This work was supported by Lilly Research Laboratories and USPHS grants MH01905-01 (D.O.P.) MH00537, MH33127 (J.A.L.) the UNC Mental Health and Neuroscience Clinical Research Centre, the North Carolina Foundation of Hope, MH52376 and MH62157 (A.I.G.).

^* This paper was based (in part) on results from the study of the Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis by the HGDH Study Group sponsored by Eli Lilly and Company.

Background Duration of untreated psychosis (DUP) may contribute to the observed heterogeneity of the treatment response in first-episode schizophrenia.

Aims To examine the relationship of DUP and premorbid function with clinical outcomes following up to 2 years of antipsychotic treatment.

Method For a subsample (n=191) of subjects participating in a clinical trial, DUP and premorbid function were prospectively compared with clinical response to olanzapine or haloperidol.

Results Shorter DUP and good premorbid function each independently are associated with better clinical response, including improvement in overall psychopathology and negative symptoms. Premorbid function also is associated with positive symptom, social and vocational outcomes.

Conclusions Earlier antipsychotic treatment is associated with better outcomes in first-episode schizophrenia. Poor premorbid function could indicate an illness subtype less likely to respond to antipsychotic treatment regardless of when it is instituted.

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