European Journal of Cardiovascular Medicine

Background:  Few long-term studies have compared the efficacy and safety of typical and atypical antipsychotic medications directly in patients with a first episode of psychosis who met the criteria for schizophrenia or a related psychotic disorder. This study compared the acute and long-term effectiveness of haloperidol with that of olanzapine in patients with first-episode psychosis in a large, controlled study. Materials and methods: Subjects who participated in this observational and naturalistic study were enrolled in the Hospital Follow-Up Study of Schizophrenia and Bipolar I Disorder. Fifty-two patients who fulfilled the DSM-IV criteria for schizophrenia were recruited over nine months among individuals attending three psychiatric outpatient units in our Hospital. Diagnoses were confirmed by the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the CATEGO computer program after a minimum disease progress of two years. The cohort of patients was divided into two groups according to the type of antipsychotic treatment. Only patients who took the same type of medication (conventional or atypical APDs) and were not hospitalized for the entire two years were evaluated. Changes in dosage were permitted. Result: Continuous antipsychotic treatment regardless of class was associated with improvement on verbal fluency, executive functions, and visual and verbal memory. Patients taking atypical antipsychotics did not show greater cognitive enhancement over two years than patients taking conventional antipsychotics. Conclusion: Our results did not show a clear advantage of atypical over conventional APDs on cognitive performance, however, the general improved tolerability profile of second generation antipsychotics regarding neurological side effects may facilitate treatment adherence, which in turn may result in cognitive improvement. Anyway, in the absence of other reasons to change ongoing treatment, which include negative or affective symptoms or lack of compliance with the regimen, the switch from typical APD at low or moderate doses to atypical APDs is not justified if based solely on the expectation of a more favorable cognitive outcome.