What is the relevance of a 2-week response to an antipsychotic?
Individual patient characteristics determine how much these data aid clinical decision-making. If a patient has a good response to an antipsychotic in the first 2 weeks, continue the drug, but observe the patient closely because response may not be sustained. In first-episode patients who fail to respond within 2 weeks of starting an antipsychotic, it is reasonable to continue the drug for several weeks because these patients may be more likely to respond later in therapy.
Clinicians treating chronically ill patients who have failed several antipsychotics and demonstrate a poor response after 2 weeks of an appropriate antipsychotic dose are justified in changing medications because later significant response is unlikely. If a patient has a poor early response but has failed several other antipsychotics with few remaining alternatives, it is reasonable to continue the maximum tolerated dose of the current therapy because the patient may be a late responder. However, early non-response predicts future non-response in many patients.
Case continued
In the case described here, Mr. M is failing his current treatment regimen with a reasonable antipsychotic dose after 2 weeks. Because Mr. M has been on 2 antipsychotics and demonstrated a good response to olanzapine, changing medications should be considered.
Related Resource
- Correll CU, Hauser M. The year in psychosis and bipolar disorder: predicting response to schizophrenia treatment. www.medscape.com/viewarticle/735211_7.
Drug Brand Names
Aripiprazole • Abilify Quetiapine • Seroquel
Haloperidol • Haldol Risperidone • Risperdal
Olanzapine • Zyprexa Ziprasidone • Geodon
Paliperidone • Invega
Disclosures
Dr. Straley owns stock in Johnson & Johnson. Dr. Webster reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
