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Newer Antipsychotics and the Differences Between Clinical Experiences and Clinical Trials

The CATIE study was a National Institute of Mental Health-sponsored trial that compared several antipsychotics. It is a complex study, with numerous stages. Phase I of the study, which is the phase most often quoted, compared numerous second-generation antipsychotics (SGAs), including risperidone, olanzapine, quetiapine, and ziprasidone, as well as the first-generation antipsychotic (FGA) perphenazine.There were other randomizations in later stages, when patients did not do well or needed their medications changed.The double-blind study was conducted at relatively typical clinical sites. Some of these sites were academic, a number were Veteran's Administration hospitals, and many were community clinics. The idea behind CATIE was that the study should be easy to translate from research to the usual clinical sites. As a result, outcome was defined in an unusual but interesting way.That is, it was not simply whether a patient improved on a medication, but rather whether the patient and his or her physicians thought that it was reasonable to continue use of that medication.