New trial data suggest that first generation antipsychotics may not be less effective than the newer atypical antipsychotics for initial treatment of schizophrenia, according to an article in the December issue of the American Journal of Psychiatry.

The CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) study compared perphenazine as the first generation antipsychotic with newer atypical agents for initial treatment of schizophrenia. The trial, organized by the National Institute of Mental Health (NIMH), was the first to directly compared several new agents with a representative first generation antipsychotic.

“The results from CATIE should encourage doctors to reconsider the use of perphenazine as another choice for patients with schizophrenia,” said NIMH Director Thomas R. Insel, MD.

Robert Rosenheck, MD, of Yale University, and colleagues analyzed costs and quality-of-life factors associated with each of the five medications used in Phase 1 of the CATIE trial ? olanzapine, quietapine, risperidone, ziprasidone, and perphenazine. They found no statistically significant difference in overall effectiveness between perphenazine and the second generation antipsychotics with regard to symptom relief and side effect burden.

The findings echo what was implied in the results of the first phase of CATIE, expanding the treatment options for patients with schizophrenia. It casts doubt on the notion that the second generation antipsychotics are better than the first generation antipsychotics, and suggests that perphenazine and other first generation antipsychotics may be just as beneficial for some patients.

Still, several conditions of CATIE limit any firm conclusions about perphenazine’s perceived advantages. Not all patients respond the same to different medications. In addition, the study lasted 18 months ? long enough to determine how patients respond to and initially tolerate the drugs, but not long enough to consider some serious long-term side effects, such as development of the movement disorder tardive dyskinesia, diabetes, cardiovascular problems, or other medical conditions that can develop even years after a patient with chronic schizophrenia starts taking an antipsychotic medication. Despite these caveats, the study results suggest new ways of thinking about medication treatments for schizophrenia.

“These results encourage doctors to revisit the older medication as an alternative, especially if a treatment change is warranted,” said Rosenheck. “By showing that perphenazine and possibly other older antipsychotics may be on equal footing with the second generation antipsychotics, CATIE has opened the door to more choice in treatment options.”