2.1 General Clinical Treatment Characteristics
By the endpoint of the study, a total of 143 patients who met the criteria were enrolled in this study. They were on a single dose of each of the following seven antipsychotic drugs: aripiprazole, ziprasidone, risperidone, olanzapine, quetiapine, perphenazine, and haloperidol. They were treated with general demographics and prescribed medication, as shown in Table 1.
Table 1
The general clinical characteristics of the included patients
Index | | Included patients (n = 143) |
Age - years | | |
Mean (SD) | | 29.37 (7.30) |
Range | | 18–45 |
Gender - (n, %) | | |
Female | | 80, 55.94% |
Male | | 63, 44.06% |
Onset age | | 24.41 (6.53) |
Course of disease | | 2.97 (1.79) |
Marital status - (n, %) | | |
Unmarried | | 63, 44.06% |
Married | | 66, 46.15% |
Divorced | | 14, 9.79% |
Living condition - (n, %) | | |
With spouse | | 62, 43.36% |
With parents | | 78, 54.54% |
Live alone | | 3, 2.10% |
Educational background - (n, %) | | |
Bachelor degree | | 7, 4.90% |
College degree | | 8, 5.59% |
Secondary specialized and high school | | 36, 25.17% |
Junior high school | | 69, 48.25% |
Primary school | | 22, 15.38% |
Illiteracy | | 1, 0.7% |
Family history | | |
Positive | | 35, 24.48% |
Negative | | 108, 75.52% |
Prescription drugs - (n, %) | | |
Aripiprazole | | 24, 16.78% |
Olanzapine | | 27, 18.88% |
Quetiapine | | 22, 15.38% |
Risperidone | | 28, 19.58% |
Ziprasidone | | 21, 14.69% |
Perphenazine | | 9, 6.29% |
Haloperidol | | 12, 8.39% |
2.2 Panss Score Reduction Rate And Grouping After Two Weeks
The enrolled patients were divided into two groups after two weeks of treatment based on the PANSS score reduction rate, with 70 cases in the early-response group, accounting for 48.95%, and 73 cases in the early non-response group, accounting for 51.05% (Table 2).
Table 2
Patient grouping based on PANSS score reduction rate after two weeks
| N, % | Baseline | 2 weeks later | Reduction rate (%) |
Total score | 143, 100% | 89.15 ± 11.19 | 76.14 ± 14.61 | 22.62 ± 17.84 |
Group A | 70, 48.95% | 86.94 ± 10.20 | 66.06 ± 10.75 | 37.07 ± 14.05 |
Group B | 73, 51.05% | 91.27 ± 11.74 | 85.82 ± 10.79 | 8.77 ± 6.44 |
Group A: early-response group, reduction rate ≥ 20%; Group B: early non-response group, reduction rate < 20% |
2.3 Comparison of differences in clinical parameters between the early-response group and the early non-response group
There were no statistically significant differences between the two groups in demographics and the type of antipsychotic medication prescribed (Table 3).
Table 3
Sociodemographic and clinical characteristics between the early-response group and the early non-response group
Variable | Group A | Group B | t\({/F/\chi }^{2}\) | P |
Age - years | 28.22 ± 7.20 | 30.47 ± 7.27 | -1.86 | 0.065 |
Gender - (n, %) | | | 1.96 | 0.161 |
Female | 34, 48.57% | 46, 63.01% | | |
Male | 36, 51,43% | 27, 36.99% | | |
Onset age | 23.93 ± 6.44 | 24.88 ± 6.62 | -0.87 | 0.387 |
Course of disease | 2.73 ± 1.93 | 3.21 ± 1.63 | -1.60 | 0.112 |
Marital status - (n, %) | | | 4.77 | 0.092 |
Unmarried | 32, 45.71% | 31, 42.47% | | |
Married | 35, 50.00% | 31, 42.47% | | |
Divorced | 3, 4.29% | 11, 15.07% | | |
Living condition - (n, %) | | | 0.80 | 0.671 |
With spouse | 32, 45.71% | 30, 41.10% | | |
With parents | 36, 51.43% | 42, 57.53% | | |
Live alone | 2, 2.86% | 1, 1.37% | | |
Educational background - (n, %) | | | 1.78 | 0.879 |
Bachelor degree | 3, 4.29% | 4, 5.48% | | |
College degree | 3, 4.29% | 5, 6.85% | | |
Secondary specialized and high school | 18, 25.71% | 18, 24.66% | | |
Junior high school | 35, 50.00% | 34, 46.58% | | |
Primary school | 10, 14.29% | 12, 16.44% | | |
Illiteracy | 1, 1.43% | 0, 0.00% | | |
Family history | | | 0.11 | 0.736 |
Positive | 18, 25.71% | 17, 23.29% | | |
Negative | 52, 74.29% | 56, 76.71% | | |
Prescription drugs - (n, %) | | | 11.83 | 0.066 |
Aripiprazole | 10, 14.29% | 14, 19.18% | | |
Olanzapine | 20, 28.57% | 7, 9.59% | | |
Quetiapine | 9, 12.86% | 13, 17.81% | | |
Risperidone | 16, 22.86% | 12, 16.44% | | |
Ziprasidone | 7, 10.00% | 14, 19.18% | | |
Perphenazine | 3, 4.29% | 6, 8.22% | | |
Haloperidol | 5, 7.14% | 7, 9.59% | | |
Group A: early-response group; Group B: early non-response group; PANSS: Positive and Negative Symptoms Scale Score; PSS: Positive Symptom Scale Score; NSS: Negative symptom scale score; GPS: General Pathology Scale Score |
2.4 Changes In The Scores And Reduction Rates Of The Panss And The Three Subscales
Compared with the early non-responder group, the PANSS total score, PSS score, and GPS score in the early response group were significantly lower at the baseline, 2nd week, 4th week, and 6th week, and the differences were statistically significant (P = 0.020, P = 0.000, P = 0.000, P = 0.000, respectively), (P = 0.007, P<0.001, P<0.001, P = 0.001, respectively), (P = 0.020, P<0.001, P<0.001, P<0.001, respectively). The NSS scores at 2 weeks, 4 weeks, and 6 weeks were significantly lower than those in the early non-response group, and the difference was statistically significant (P = 0.020, P<0.001, P<0.001, respectively) (Fig. 1A). Compared with the early non-response group, the reduction rate of PANSS, PSS, PNS, and GPS in the early response group were significantly increased in the 2nd week, 4th week, and 6th week and the differences were statistically significant (P<0.001, P<0.001, P<0.001 respectively), (P<0.001, P<0.001, P = 0.001, respectively), (P<0.001, P<0.001, P<0.001, respectively) (Fig. 1B).
2.5 Comparison Of Remission Rates Among Different Groups At Study Endpoints
At the 6th week, the number of remission cases in the early-response group was 30, accounting for 42.86%; and 8 remission cases, accounting for 10.96% in the early non-response group. There was a statistically significant difference in the proportion of remission patients between the two groups (P<0.001) (Fig. 2).
2.6 Comparison Of Differences In Metabolism-related Parameters At Study Endpoints
At the 6th week, the BW, BMI, blood creatinine (BC), blood uric acid (UA), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), FBG, PRL of the enrolled samples were significantly increased, with a significance level (P) of 0.013, 0.011, <0.001, 0.010, <0.001, <0.001, 0.002, <0.001, and <0.001, respectively. In contrast, high-density lipoprotein (HDL) was significantly decreased (P = 0.002) (Table 4). ANOVAs revealed a significant effect of treatment time on BC, UA,TC,TG,HDL,LDL,FBG,PRL (F = 22.84, P<0.001; F = 4.13, P = 0.043; F = 57.84, P<0.001; F = 78.42, P<0.001; F = 64.98, P<0.001; F = 10.67,P = 0.001; F = 74.58, P<0.001; F = 30.77, P<0.001; respectively ), a significant negative effect of early non-response to treatment on AC,BC,TG,FBG (F = 6.84, P = 0.009; F = 7.88, P = 0.005; F = 16.39, P<0.001; respectively ) and a significant effect of time × subgroup interaction on TG (F = 10.16, P = 0.002). (Table 5).
Table 4
Comparison of common metabolic parameters before and after treatment
| Baseline | 6th week | t | P |
BW - kg | 58.90 ± 11.18 | 59.49 ± 10.08 | -2.53 | 0.013* |
BMI - kg/m2 | 21.65 ± 3.33 | 21.93 ± 3.49 | -2.59 | 0.011* |
AC - cm | 78.56 ± 9.29 | 78.75 ± 9.51 | -0.98 | 0.328 |
BUN - mmol/L | 3.74 ± 1.20 | 3.67 ± 1.30 | 0.49 | 0.624 |
BC - mmol/L | 57.23 ± 12.90 | 66.90 ± 20.81 | -4.54 | 0.000* |
UA - mmol/L | 387.06 ± 115.10 | 415.1 ± 116.66 | -2.60 | 0.010* |
TC - mmol/L | 3.84 ± 0.75 | 4.70 ± 1.13 | -7.72 | 0.000* |
TG - mmol/L | 1.10 ± 0.58 | 2.43 ± 1.73 | -9.27 | 0.000* |
HDL - mmol/L | 1.18 ± 0.24 | 0.95 ± 0.33 | 8.100 | 0.000* |
LDL - mmol/L | 2.18 ± 0.61 | 2.46 ± 0.84 | -3.22 | 0.002* |
FBG - mmol/L | 4.52 ± 0.77 | 5.66 ± 1.42 | -8.53 | 0.000* |
PRL - ng/mL | 18.04 ± 13.49 | 37.06 ± 40.05 | -5.89 | 0.000* |
BW: body weight, BMI: body mass index, AC: abdominal circumference, BUN: blood urea nitrogen, BC: blood creatinine, UA: blood uric acid, TC: total cholesterol, TG: triglyceride, HDL: high-density lipoprotein, LDL: low-density lipoprotein, FBG: fasting blood glucose, PRL: prolactin; *P<0.05 |
Table 5
Common metabolic parameters before and after treatment in patients with schizophrenia, Grouped by early treatment response or not.
Parameters | Group A (n = 70) | Group B (n = 73) | Time F (P-value) | Subgroup F (P-value) | Time × subgroup F (P-value) |
| Baseline | 6th week | Baseline | 6th week |
BW - kg | 60.39 ± 11.05 | 60.71 ± 10.62 | 57.48 ± 11.20 | 58.32 ± 11.46 | 0.20 (0.659) | 4.08 (0.044*) | 0.04 (0.841) |
BMI - kg/m2 | 21.80 ± 3.23 | 22.08 ± 3.24 | 21.50 ± 3.45 | 21.78 ± 3.72 | 0.48 (0.489) | 0.54 (0.463) | 0.00 (0.986) |
AC - cm | 80.07 ± 8.58 | 80.54 ± 8.84 | 77.11 ± 9.76 | 84.03 ± 9.87 | 0.03 (0.858) | 8.67 (0.004*) | 0.06 (0.803) |
BUN - mmol/L | 3.80 ± 1.21 | 3.68 ± 1.20 | 3.73 ± 1.32 | 3.61 ± 1.28 | 0.27 (0.607) | 0.68 (0.409) | 0.00 (0.997) |
BC - mmol/L | 59.22 ± 12.38 | 70.31 ± 21.82 | 63.61 ± 19.38 | 70.33 ± 21.83 | 22.84 (0.000*) | 6.84 (0.009*) | 0.49 (0.486) |
UA - mmol/L | 383.27 ± 106.46 | 390.70 ± 123.44 | 396.17 ± 107.91 | 433.32 ± 122.47 | 4.13 (0.043*) | 2.66 (0.104) | 1.18 (0.278) |
TC - mmol/L | 3.83 ± 0.73 | 4.76 ± 1.13 | 3.84 ± 0.77 | 4.64 ± 1.13 | 57.84 (0.000*) | 0.20 (0.656) | 0.34 (0.560) |
TG - mmol/L | 1.13 ± 0.54 | 1.97 ± 1.36 | 1.07 ± 0.61 | 2.86 ± 1.94 | 78.42 (0.000*) | 7.88 (0.005*) | 10.16 (0.002*) |
HDL - mmol/L | 1.18 ± 0.25 | 0.98 ± 0.28 | 1.18 ± 0.23 | 0.93 ± 0.20 | 64.98 (0.000*) | 1.06 (0.305) | 0.70 (0.404) |
LDL - mmol/L | 2.15 ± 0.59 | 2.57 ± 0.83 | 2.22 ± 0.62 | 2.56 ± 0.84 | 10.67 (0.001*) | 0.80 (0.371) | 2.67 (0.103) |
FBG - mmol/L | 4.32 ± 0.68 | 5.31 ± 1.04 | 4.41 ± 1.04 | 5.99 ± 1.65 | 74.58 (0.000*) | 16.39 (0.000*) | 1.24 (0.266) |
PRL - ng/mL | 19.08 ± 14.78 | 37.92 ± 37.79 | 18.31 ± 12.14 | 38.37 ± 25.08 | 30.77 (0.000*) | 2.74 (0.099) | 0.90 (0.344) |
Group A: early-response group; Group B: early non-response group; BW: body weight, BMI: body mass index, AC: abdominal circumference, BUN: blood urea nitrogen, BC: blood creatinine, UA: blood uric acid, TC: total cholesterol, TG: triglyceride, HDL: high-density lipoprotein, LDL: low-density lipoprotein, FBG: fasting blood glucose, PRL: Prolactin; *P<0.05 |