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Annotation

McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods SW, Hawkins KA, Hoffman RE, Preda A, Epstein I, Addington D, Lindborg S, Trzaskoma Q, Tohen M, Breier A. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry . 2006 May 1 ; 163(5):790-9. PubMed Abstract

Comments on Paper and Primary News
Comment by:  Alison Yung (Disclosure)
Submitted 15 May 2006 Posted 15 May 2006
  I recommend this paper

Dr. McGlashan and the rest of the PRIME team are to be congratulated on their study. Having worked on similar studies myself, with the Ultra High Risk (or “prodromal”) population, I can attest to the difficulties of conducting such a trial. The high dropout rate from both the active medication group and the placebo group is of note. My experience working with young people in the UHR group, as well as young people with psychotic and non-psychotic disorders, is that they tend to be reluctant to take any medication for 12 months. So this finding from the PRIME study is not surprising. The high dropout rate does, however, have implications for the effectiveness (as opposed to efficacy) of using medication for the prodromal population. Additionally, the finding that cognitive therapy may significantly reduce the transition to psychosis rate in UHR individuals (Morrison et al., 2004) points to the need for the ongoing evaluation of which UHR patients should be medicated and when.

One area that needs...  Read more


View all comments by Alison Yung

Primary News: Attempts to Address Schizophrenia Prodrome Show Promise, Pitfalls

Comment by:  Thomas McGlashan
Submitted 18 May 2006 Posted 19 May 2006

I appreciate Dr. Yung's comments on our pharmacotherapeutic treatment trial in a sample of young persons with "prodromal" symptoms and high risk for becoming psychotic within a short period of time. It was her work with Pat McGorry that first demonstrated this population could be identified, thus opening up the potential for prospective study of the mechanisms of onset and the study of treatment as preventive as opposed to merely ameliorative. We were concerned about the high dropout rate for obvious reasons, but in retrospect we should not have been surprised. Our sample was young and perhaps more resistant for that reason, as Dr. Yung implies, but the fact is that 2 years is a very long clinical trail no matter what the age! In part we wanted to allow sufficient time to elapse to capture higher numbers of converting subjects, and that still seems to be a reasonable strategy insofar as the conversion rate in the placebo group had not clearly plateaued by 1 year. Nevertheless, in retrospect, a trial of 2 years was unrealistic.

The optimal design, clearly, would be larger...  Read more


View all comments by Thomas McGlashan

Primary News: Attempts to Address Schizophrenia Prodrome Show Promise, Pitfalls

Comment by:  Patricia Estani
Submitted 28 September 2006 Posted 28 September 2006
  I recommend this paper
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