The British Journal of Psychiatry (2009) 194: 439-445. doi: 10.1192/bjp.bp.108.055137
© 2009 The Royal College of Psychiatrists
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Cognitive effectiveness of olanzapine and risperidone in first-episode psychosis

Manuel J. Cuesta, MD, Elena Garcíade Jalón, MD, M. Soledad Campos, MD and Victor Peralta, MD

Psychiatric Unit, Virgen del Camino Hospital, Pamplona, Spain

Correspondence: Dr Manuel J. Cuesta, Psychiatric Unit, Virgen del Camino Hospital c/Irunlarrea 4, E-31008 Pamplona, Spain. Email: mcuestaz{at}cfnavarra.es

Funding

The Navarrás Government provided funding for implementation of the study (grants 946/2005 and 55/2007).

Declaration of interest

None.

Background

Cognitive impairment in schizophrenia-spectrum disorders is highly prevalent and notably influences functional outcomes.

Aims

To characterise the cognitive effectiveness of second-generation antipsychotic drugs.

Method

One hundred consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders were admitted. Seventy-seven completed baseline, 1-month and 6-month psychopathological and neuropsychological assessments. Patients were randomised to risperidone or olanzapine treatment. Four final treatment allocation groups were defined since patients continued treatment in their normal setting: risperidone, olanzapine, mixed and no-antipsychotic groups.

Results

There were no differences in cognitive effectiveness between the four treatment groups. Reliable change index methods demonstrated that nearly a half of patients showed an improvement in Global Cognitive Score at the 6-month assessment. Improvement on the neuropsychological tests ranged from 17 to 54%.

A strong predictor of cognitive response was poor performance on baseline neuropsychological tests; response was moderately influenced by a low premorbid scholastic performance and IQ.

Conclusions

Cognitive improvement related to second-generation antipsychotic drugs appeared within the first 4 weeks of treatment and persisted at 6 months irrespective of treatment group. Greater cognitive dysfunction at baseline and lower premorbid cognitive background predicted cognitive improvement in our sample.


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