Psychiatric Times - Category 1 Credit
To earn AMA PRA Category 1 Credit(s)™:
Read the article "What to Make of CATIE: Are We Better Off With Atypical Antipsychotics?" from the January 2010 issue of Psychiatric Times, complete the posttest and the evaluation. (Note: A score of at least 70% must be achieved in order to be awarded credit.)
The posttest will be scored instantly and results will be shown onscreen. Please make a copy of your test results for your continuing education records. After submitting the activity evaluation, you may then print a Statement of Credit for your records.
You must keep your own records of this activity. Copy this information and include it in your continuing education file for reporting purposes.
CME LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CME LLC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CME LLC is approved by the California Board of Registered Nursing, Provider No. CEP12748, and designates this educational activity for 1.5 contact hours for nurses.
The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credits™ toward recertification requirements.
The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME.
Sponsored by CME LLC for 1.5 Category 1 credits.
Original release date 1/10. Approved for CME credit through January 2011.
Click here to take the post-test. You will be redirected to CME, LLC.
After reading this article, you will be familiar with:
• The different arms of the CATIE study
• The use of number needed to treat and number needed to harm in appraising the clinical relevance of study results
• CATIE efficacy, tolerability, and safety results for the atypical antipsychotics as well as the representative typical antipsychotic, perphenazine
• The advantages/disadvantages of one antipsychotic over another
Who will benefit from reading this article?
Psychiatrists, child and adolescent psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.
Efficacy variations among the atypical and typical antipsychotics result in overlaps between the 2 groups.1 Adverse-effect profiles differ as well. In general, typical antipsychotics have a greater propensity to cause extrapyramidal side effects, tardive dyskinesia, and prolactin elevations than do atypical anti-psychotics. The adverse effects associated with some atypical antipsychotics are more weight gain and greater disturbances in lipid and glucose regulation than are associated with typical antipsychotics. However, there is considerable heterogeneity among the individual agents in both classes and overlapping adverse effects.
According to Sackett and colleagues,2 the philosophy of evidence-based medicine requires the thoughtful clinician to incorporate the best available research findings into an individualized treatment plan, and to take into account clinical experience and patient preferences. When selecting antipsychotics for patients with schizophrenia, the prescribing physician can approach this decision-making process using these principles of evidence-based medicine.
On the basis of the results from the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), this article reviews the principles of antipsychotic therapy selection based on individual patient profiles as it pertains to perphenazine (the representative typical anti-psychotic in the CATIE study), olanzapine, risperidone, quetiapine, ziprasidone, and clozapine. Using a basic tool of evidence-based medicine—effect size as measured by number needed to treat—demonstrates that we are better off having choices.
1. Volavka J, Citrome L. Oral antipsychotics for the treatment of schizophrenia: heterogeneity in efficacy and tolerability should drive decision-making. Expert Opin Pharmacother. 2009;10:1917-1928.
2. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71-72.
3. Lieberman JA, Stroup TS, McEvoy JP, et al; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223.
4. Stroup TS, Lieberman JA, McEvoy JP, et al; CATIE Investigators. Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Am J Psychiatry. 2006;163:611-622.
5. McEvoy JP, Lieberman JA, Stroup TS, et al; CATIE Investigators. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600-610.
6. Stroup TS, Lieberman JA, McEvoy JP, et al; CATIE Investigators. Effectiveness of olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia after discontinuing perphenazine: a CATIE study. Am J Psychiatry. 2007;164:415-427.
7. Citrome L. Compelling or irrelevant? Using number needed to treat can help decide. Acta Psychiatr Scand. 2008;117:412-419.
8. Citrome L, Stroup TS. Schizophrenia, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and number needed to treat: how can CATIE inform clinicians? Int J Clin Pract. 2006;60:933-940.
9. Citrome L. Interpreting and applying the CATIE results: with CATIE, context is key, when sorting out phases 1, 1A, 1B, 2E, and 2T. Psy-chiatry (Edgemont). 2007;4:23-29. http://www.psychiatrymmc.com/interpreting-and-applying-the-catie-results. Accessed November 17, 2009.
10. Essock SM, Covell NH, Davis SM, et al. Effectiveness of switching antipsychotic medications. Am J Psychiatry. 2006;163:2090-2095.
11. Citrome L. Using oral ziprasidone effectively: the food effect and dose-response. Adv Ther. 2009;26:739-748.
12. Citrome L, Vreeland B. Schizophrenia, obesity, and antipsychotic medications: what can we do? Postgrad Med. 2008;120(2):18-33.
13. Karagianis J, Rosenbluth M, Tohen M, et al. Reviewing CATIE for clinicians: balancing benefit and risk using evidence-based medicine tools. Curr Med Res Opin. 2007;23:2551-2557.
14. Citrome L, Kantrowitz J. Antipsychotics for the treatment of schizophrenia: likelihood to be helped or harmed, understanding proximal and distal benefits and risks. Expert Rev Neurother. 2008;8:1079-1091.
15. Novartis. Clozaril (clozapine) tablets. Prescribing information. Revised July 2009. http://www.pharma.us.novartis.com/product/pi/pdf/Clozaril.pdf. Accessed November 17, 2009.
16. Swartz MS, Wagner HR, Swanson JW, et al. Substance use in persons with schizophrenia: baseline prevalence and correlates from the NIMH CATIE study. J Nerv Ment Dis. 2006;194:164-172.
17. Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80:33-43.