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First episode schizophrenia: Response to olanzapine at 4 weeks can predict final outcome

Key clinical point: Patients with first-episode schizophrenia (FES) responding to olanzapine therapy at 4 weeks are likely to achieve a positive treatment response at 8 weeks.

Major finding: The response of olanzapine therapy at 4 weeks was more accurate for the prediction of 8-week response (P less than .001) compared with response at week 2 (P = .964) and week 3 (P = .136). A statistically significant reduction in mean total Positive and Negative Syndrome Scale score was observed at 4 weeks (mean reduction, 31.78%; P less than .001).

Study details: A prospective, 8-week, observational study including 44 patients diagnosed with FES.

Disclosures: The study received no financial support. The authors declared no conflicts of interest.


“When individuals are initially diagnosed and treatment for schizophrenia, an early and positive medication response is particularly helpful in setting appropriate and timely recovery goals. For young people with first-episode schizophrenia, this may include plans to return to school or work if these were interrupted with the onset of an acute psychotic episode. This small prospective trial suggests that response to medication (in this case, olanzapine) at 4 weeks is reasonably predictive of future symptom remission. Early and robust response to olanzapine in first-episode patients is an opportunity for clinicians and other treatment team members to work with patients and families in setting up maintenance care and recovery goals.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

Willard Brown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine


Subeesh V et al. Int J Psychiatry Clin Pract. 2020 Apr 27. doi: 10.1080/13651501.2020.1757118.