Original ArticleRisperidone, Quetiapine, and Fluphenazine in the Treatment of Patients With Therapy-Refractory SchizophreniaConley, Robert R MD*; Kelly, Deanna L PharmD, BCPP*; Nelson, Matthew W PharmD, BCPP*†; Richardson, Charles M MD*; Feldman, Stephanie LCSW, MSW*; Benham, Rhonda RN*†; Steiner, Patricia BA*; Yu, Yang MS*; Khan, Ijaz MD‡; McMullen, Ron EdD*; Gale, Elizabeth LCSW, MSW*; Mackowick, Marie PharmD, BCPP‡; Love, Raymond C PharmD, BCPP*Author Information From the *Maryland Psychiatric Research Center, Treatment Research Unit, University of Maryland, Baltimore; the †Perry Point VA Medical Center, Perrysville; and the ‡Crownsville Hospital Center, Maryland, USA. Supported by the National Institutes of Mental Health (NIMH grant MH-47311). Study medications were supplied by Janssen Pharmaceutica and Astra-Zeneca Pharmaceuticals. Other funding included the Intervention Research Center (IRC grant MH-40279), the VA Capitol Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), the University of Maryland General Clinical Research Center (GCRC, grant M01RR165001), General Clinical Research Centers Program, National Center for Research Resources (NCRR), NIH, and the Stanley Medical Research Institute. Reprints: Deanna L. Kelly, PharmD, BCPP, Maryland Psychiatric Research Center, University of Maryland, Box 21247, Baltimore, MD 21228 USA (e-mail: firstname.lastname@example.org). Clinical Neuropharmacology: July-August 2005 - Volume 28 - Issue 4 - p 163-168 doi: 10.1097/01.wnf.0000172993.89879.0f Buy Metrics Abstract This 12-week, double-blind study evaluated the effectiveness of risperidone (4 mg/day), quetiapine (400 mg/day), or fluphenazine (12.5 mg/day) in a stringently defined treatment-resistant population of people with schizophrenia. No differences were noted in total Brief Psychiatric Rating Scale (BPRS) or Clinical Global Impression scores among the drug groups (n = 38). More subjects tended to complete the study on risperidone (69%) or quetiapine (58%) than those treated with fluphenazine (31%; P value not significant). Eighty-nine percent of those who discontinued on fluphenazine (8 of 9) were due to lack of efficacy. Discontinuation due to adverse effects was low, with only 2 subjects (both on quetiapine) stopping due to side effects. Three of 13 risperidone-treated subjects (23%) and 3 of 12 quetiapine-treated subjects (25%) met response criteria (decrease of 20% of total BPRS score), whereas 2 of 13 subjects (15%) responded to fluphenazine. Side effect occurrence was similar among drug groups and EPS ratings on the Simpson Angus Scale improved in all drug groups (quetiapine, 1.64; risperidone, 1.30; fluphenazine, 0.69; P value not significant). Despite the newer class of second-generation antipsychotic medications, this treatment-resistant population remains difficult to treat. Many people have only minimal to modest improvements with antipsychotic treatment and most continue to have residual psychotic symptoms. Treatment with first- and second-generation antipsychotics may demonstrate similar efficacy; however, patients treated with second-generation antipsychotics may be more likely to adhere to treatment. © 2005 Lippincott Williams & Wilkins, Inc.