Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013:9:1553-64.
doi: 10.2147/NDT.S46108. Epub 2013 Oct 11.

An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia

Jinichi Hirano  1 , Koichiro Watanabe, Takefumi Suzuki, Hiroyuki Uchida, Ryosuke Den, Taishiro Kishimoto, Takashi Nagasawa, Yusuke Tomita, Koichiro Hara, Hiromi Ochi, Yoshimi Kobayashi, Mutsuko Ishii, Akane Fujita, Yoshihiko Kanai, Megumi Goto, Hiromi Hayashi, Kanako Inamura, Fumiko Ooshima, Mariko Sumida, Tomoko Ozawa, Kayoko Sekigawa, Maki Nagaoka, Kae Yoshimura, Mika Konishi, Ataru Inagaki, Takuya Saito, Nobutaka Motohashi, Masaru Mimura, Yoshiro Okubo, Motoichiro Kato
Affiliations

An open-label study of algorithm-based treatment versus treatment-as-usual for patients with schizophrenia

Jinichi Hirano et al. Neuropsychiatr Dis Treat. 2013.

Abstract

Objective: The use of an algorithm may facilitate measurement-based treatment and result in more rational therapy. We conducted a 1-year, open-label study to compare various outcomes of algorithm-based treatment (ALGO) for schizophrenia versus treatment-as-usual (TAU), for which evidence has been very scarce.

Methods: In ALGO, patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) were treated with an algorithm consisting of a series of antipsychotic monotherapies that was guided by the total scores in the positive and negative syndrome scale (PANSS). When posttreatment PANSS total scores were above 70% of those at baseline in the first and second stages, or above 80% in the 3rd stage, patients proceeded to the next treatment stage with different antipsychotics. In contrast, TAU represented the best clinical judgment by treating psychiatrists.

Results: Forty-two patients (21 females, 39.0 ± 10.9 years-old) participated in this study. The baseline PANSS total score indicated the presence of severe psychopathology and was significantly higher in the ALGO group (n = 25; 106.9 ± 20.0) than in the TAU group (n = 17; 92.2 ± 18.3) (P = 0.021). As a result of treatment, there were no significant differences in the PANSS reduction rates, premature attrition rates, as well as in a variety of other clinical measures between the groups. Despite an effort to make each group unique in pharmacologic treatment, it was found that pharmacotherapy in the TAU group eventually became similar in quality to that of the ALGO group.

Conclusion: While the results need to be carefully interpreted in light of a hard-to-distinguish treatment manner between the two groups and more studies are necessary, algorithm-based antipsychotic treatments for schizophrenia compared well to treatment-as-usual in this study.

Keywords: algorithm; measurement-based treatment; open-label clinical trial; schizophrenia; treatment-as-usual.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The treatment algorithm. Abbreviation: PANSS, Positive and Negative Syndrome Scale.
Figure 2
Figure 2
Improvements in the ALGO and TAU groups. Note: The PANSS total scores = the baseline scores × (1 – the numbers on the Y-axis at each time point). Abbreviations: ALGO, algorithm-based treatment; TAU, treatment-as-usual; PANSS, Positive and Negative Syndrome Scale.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Antipsychotic combinations for schizophrenia.
    Ortiz-Orendain J, Castiello-de Obeso S, Colunga-Lozano LE, Hu Y, Maayan N, Adams CE. Ortiz-Orendain J, et al. Cochrane Database Syst Rev. 2017 Jun 28;6(6):CD009005. doi: 10.1002/14651858.CD009005.pub2. Cochrane Database Syst Rev. 2017. PMID: 28658515 Free PMC article.

References

    1. Correll CU, Kishimoto T, Nielsen J, Kane JM. Quantifying clinical relevance in the treatment of schizophrenia. Clin Ther. 2011;33(12):B16–B39. - PMC - PubMed
    1. Miller AL, Crismon ML, Rush AJ, et al. The Texas medication algorithm project: clinical results for schizophrenia. Schizophr Bull. 2004;30(3):627–647. - PubMed
    1. Janssen B, Ludwig S, Eustermann H, et al. Improving outpatient treatment in schizophrenia: effects of computerized guideline implementation – results of a multicenter-study within the German research network on schizophrenia. Eur Arch Psychiatry Clin Neurosci. 2010;260(1):51–57. - PubMed
    1. Trivedi MH, Rush AJ, Crismon ML, et al. Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project. Arch Gen Psychiatry. 2004;61(7):669–680. - PubMed
    1. Suzuki T, Uchida H, Watanabe K, Yagi G, Kashima H. A clinical case series of switching from antipsychotic polypharmacy to monotherapy with a second-generation agent on patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(2):361–369. - PubMed