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This study compares the effects of atypical and conventional antipsychotic medications on treatment continuation and outcomes in a first admission sample of patients with schizophrenia treated in usual practice settings. In a sample of 189 participants with a research diagnosis of DSM-IV schizophrenia drawn from the Suffolk County Mental Health Project, we compared the effects of atypical and conventional agents on change of medication, medication gaps, and rehospitalization. For these analyses we used the method of survival analysis for recurrent events, in which the episodes of treatment rather than individual subjects are the units of analysis. In addition, we compared improvement in positive and negative symptoms from intake to 24- or 48-month followups for subjects who stayed on one type of medication or changed to atypicals from conventional antipsychotics. Atypical agents were associated with lower risk of medication change, medication gaps, and rehospitalization. Both conventional and atypical agents were associated with improvement of positive symptoms at followup, but only subjects on atypical agents at followup experienced a significant improvement in negative symptoms. We conclude that in usual practice settings, as in randomized clinical trials, atypical agents are associated with improved treatment continuation and outcomes. [ABSTRACT FROM PUBLISHER]

This study assessed differences in negative symptom presentation between schizophrenia/schizoaffective, other psychotic, and depressed patients over a 10-year followup period. One hundred fifty individuals with schizophrenia or schizoaffective disorders (SZ/SZAF), other psychotic disorders (OP), and depressed patients (DP) were assessed at index hospitalization, then reassessed at 4.5-year, 7.5-year, and 10-year followups. SZ/SZAF patients significantly differed from DP patients in frequency and persistence of negative symptoms but were not significantly different from the OP group. Negative symptoms were not associated with depression in any diagnostic group. Dosage, but not simple use, of conventional antipsychotic medications was related to severity of symptoms in the SZ/SZAF group. Although negative symptoms were typically most severe and most common in the SZ/SZAF subjects in comparison to the DP patients, there were few statistically significant differences in the phenomenology of negative symptoms between the OP and SZ/SZAF groups. The data are consistent with a model that identifies negative symptoms as common to mental illnesses generally, with particularly high rates in psychotic illnesses. [ABSTRACT FROM PUBLISHER]

The search is on for meaningful psychopharmacological and cognitive/behavioral interventions for neurocognitive deficits in schizophrenia. Findings in this area are emerging rapidly, and in the absence of integrating frameworks, they are destined to emerge chaotically. Clear guidelines for testing neurocognitive interventions and interpreting results are critical at this early stage. In this article, we present three models of increasing complexity that attempt to elucidate the role of neurocognitive deficits in schizophrenia in relation to treatment and outcome. Through discussion of the models, we will consider methodological issues and interpretive challenges facing this line of investigation, including direct versus indirect neurocognitive effects of antipsychotic medications, selection of particular neurocognitive constructs for intervention, the importance of construct validity in interpreting cognitive/behavioral studies, and the expected durability of treatment effects. With a growing confidence that some neurocognitive deficits in schizophrenia can be modified, questions that seemed irrelevant only a few years ago are now fundamental. The field will need to reconsider what constitutes a successful intervention, what the relevant outcomes are, and how to define treatment efficacy. [ABSTRACT FROM PUBLISHER]