Combination therapy or monotherapy for the depressed type of schizoaffective disorder

Abstract

Several studies have demonstrated the effectiveness of adjunctive antidepressant drug therapy to improve the depressive or negative symptoms of schizoaffective disorder, however, monotherapy with atypical antipsychotics may be advantageous. We compared the efficacy and safety of risperidone monotherapy versus combination therapy of haloperidol with sertaline for the acute treatment of schizoaffective disorder, depressed type. This is an open label study of 52 female inpatients randomly assigned to risperidone alone (N = 26) or haloperidol in combination with sertraline (N = 26) for 12 weeks. The mean daily doses of medications were: risperidone: 3.75-3.29 mg/day, haloperidol: 5.35-4.15 mg/day, sertraline: 65.39-133.82 mg/day. Efficacy was measured using clinical rating scales of treatment, safety, and tolerability. Risperidone patients showed statistically significant greater improvement than haloperidol-sertraline patients on efficacy measures including Positive and Negative Syndrome Scale and Clinical Global Impressions rating. A higher number of risperidone patients dropped out of the study early. Fewer adverse events and lesser need for concomitant medications occurred in patients on risperidone. The risperidone group showed better psychological, social and occupational functioning (Global Assessment of Functioning) and higher quality of life (Heinrich's Quality of Life Scale). Risperidone has higher antipsychotic efficacy and tolerability compared with haloperidol-sertraline combination for the acute treatment of schizoaffective disorder, depressed type. Both treatments were comparable in terms of antidepressant efficacy.

Keywords: depressed type; haloperidol; risperidone; schizoaffective disorder; sertraline.

Figure 1

The grouped medians of Positive and Negative Syndrome Scale total scores at weeks 0, 2, 6, 12. Notes: R Group R; HS Group HS; *p ≤ 0.05; **p ≤ 0.001; ^†r_m ≥ 0.3; ^‡r_m ≥ 0.5. Wilcoxon test (z) and effect size (r_m): Group R: week 0–2: z = −4.281; p < 0.001; r_m = 0.65; week 0–6: z = −3.724; p < 0.001; r_m = 0.67; week 0–12: z = −3.062; p < 0.001; r_m = 0.68. Group HS: week 0–2: z = −4.398; p < 0.001; r_m = 0.66; week 0–6: z = −4.019; p < 0.001; r_m = 0.67; week 0–12: z = −3.622; p < 0.001; r_m = 0.67. Mann–Whitney U test (Z) and effect size (r_m): Group R vs Group HS; week 0: 320.50; Z = −0.320; p = 0.754; r_m = 0.04; week 2: 317.50; Z = −0.375; p = 713; r_m = 0,05; week 6: 123.00; Z = −1.861; p = 0.063; r_m = 0.30; week 12: 46.50; Z = −2.465; p = 0.012; r_m = 0.47.

Figure 2

The grouped medians of Calgary Depression Scale for Schizophrenia score at weeks 0, 2, 6, 12. Notes: *p ≤ 0.05; **p ≤ 0.001; ^†r_m ≥ 0.3. Wilcoxon test (z) and effect size (r_m): Group R: week 0–2: z = −3.868; p < 0.001; r_m = 0.61; week 0–6: z = −3.969; p < 0.001; r_m = 0.66; week 0–12: z = −3.070; p < 0.001; r_m = 0.68. Group HS: week 0–2: z = −4.295; p < 0.001; r_m = 0.66; week 0–6: z = −4.021; p < 0.001; r_m = 0.67; t week 0–12: z = −3.626; p < 0.001; r_m = 0.67. Mann–Whitney U test (Z) and effect size (r_m): Group R vs Group HS: week 0: 158.50; Z = −3.303; p = 0.001; r_m = 0.46; week 2: 207.50; Z = −2.228; p = 0.025; r_m = 0.32; week 6: 162.00; Z = −1.502; p = 0.136; r_m = 0.23; week 12: 59.50; Z = −2.502; p = 0.047; r_m = 0.32.

Figure 3

The grouped medians of Heinrich’s Quality of Life Scale score at weeks 0 and 12. Notes: ^†r_m ≥ 0.3. Wilcoxon test (z) and effect size (r_m): Group R: week 0–12: z = −3.063; p < 0.001; r_m = 0.68. Group HS: week 0–12: z = −3.66; p < 0.001; r_m = 0.65. Mann–Whitney U test (Z) and effect size (r_m): Group R vs Group HS: week 0: 290.00; Z = −0.881; p = 0.384; r_m = 0.12; week 12: 66.50; Z = −1.576; p = 0.119; r_m = 0.30.

Figure 4

The grouped medians of Global Assessment of Functioning score at weeks 0, 6, and 12. Notes: *p ≤ 0.05; ^†r_m ≥ 0.3. Wilcoxon test (z) and effect size (r_m): Group R: week 0–6: z = −3.523; p < 0.001; r_m = 0.65; week 0–12: z = −3.068; p < 0.001; r_m = 0.68. Group HS: week 0–6: z = −4.026; p < 0.001; r_m = 0.67; week 0–12: z = −3.635; p < 0.001; r_m = 0.67. Mann–Whitney U test (Z) and effect size (r_m): Group R vs Group HS: week 0: 327.00; Z = −0.203; p = 0.844; r_m = 0.03; week 6: 142.00; Z = −1.343; p = 0.183; r_m = 0.22; week 12: 57.00; Z = −2.015; p = 0.044; r_m = 0.38.

Figure 5

Concomitant psychotropic medication in Group R. Abbreviations: ANX-BZD, benzodiazepine anxiolytics; HYP-BZD, benzodiazepine hypnotics; HYP-NON, nonbenzodiazepine hypnotics; AP, antiparkinsonians.

Figure 6

Concomitant psychotropic medication in Group HS. Abbreviations: ANX-BZD, benzodiazepine anxiolytics; HYP-BZD, benzodiazepine hypnotics; HYP-NON, nonbenzodiazepine hypnotics; AP, antiparkinsonians.