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Researchers shocked by findings after their study flatly contradicts received wisdom on schizophrenia treatment

Older antipsychotics good as new

Older antipsychotics are just as effective for schizophrenia as the newer atypical drugs, reveal 'surprising' results from a new NHS study.

The findings flatly contradict received wisdom in the treatment of schizophrenia, which has seen atypical antipsychotics become the drugs of choice.

The study was commissioned by NHS managers to find out if atypical antipsychotics were worth their price-tag, 10 times that of first-generation antipsychotics. But it found no difference in efficacy or tolerability between the two types of drugs.

Study leader Professor Shôn Lewis, professor of psychiatry at the University of Manchester, said his team had been shocked by the results. 'We were a bit surprised the NHS wanted this because we thought it was plain the second-generation drugs were better. But we did a couple of studies and to our shock we found they weren't.'

The research, published in the Archives of General Psychiatry (October), followed 227 people aged 18-65 with schizophrenia who were under medication review. Each was randomised to receive first- or second-generation antipsychotics, with the choice of individual drug made by the managing psychiatrist.

At assessments at 12, 26 and 56 weeks, atypical antipsychotics were no more effective or better tolerated than the older drugs. The results echo parallel US research published last year and are expected to inform NICE guidance when it is reviewed in 2007.

But GP experts warned that the newer drugs should not be withheld on grounds of cost if they were appropriate for some patients.

Dr Andrew Hershon, a GP in Hyde, Manchester, with a special interest in mental health, said: 'It would be worth looking at because we spend a lot of NHS money giving atypical antipsychotics, but if they are better for patients then the money should be spent.'

Professor Lewis said drug choice often came down to side-effect profile, and the study meant doctors should not be afraid of using the older drugs.

Study findings

• Study of 227 patients with schizophrenia aged 18 to 65 at 14 community psychiatric services

• Patients randomised to either first- or second-generation antipsychotics, with choice of specific drug left to doctor

• Quality of life scores 49.2 and 46.6 respectively at 12 weeks, and 53.2 and 51.3 at 52 weeks

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