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What to Make of CATIE: Are We Better Off With Atypical Antipsychotics?

What to Make of CATIE: Are We Better Off With Atypical Antipsychotics?

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.)

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Educational Objectives

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.

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