The Switch Study - Efficacy of an Early Antipsychotic Switch in Case of Poor Initial Response to the Treatment of Schizophrenia

• PANSS total score change [ Time Frame: 8 weeks ]
• Cost of care [ Time Frame: 8 weeks ]
• Safety: Simpson-Angus Scale, Barnes Akathisia Scale, open interviews [ Time Frame: 8 weeks ]

The main aim of the trial is to study whether a change of medication in non-responders to a two-weeks antipsychotic drug trial is more effective than continued treatment with the same antipsychotic. Hypothesis: Non-responders who are switched at 2 weeks to another antipsychotic are more frequently in symptomatic remission at week 8 than non-responders who stay on the same antipsychotic

The patients will be randomised to a double-blind 2 week run in phase with fixed doses of either oral amisulpride 800 mg/day or olanzapine 20mg/day.

Those participants who have not responded to treatment at two weeks (PANSS improvement <25%) will be randomised to a 6 week double blind flexible dose phase:

1. Experimental intervention: switch to the other antipsychotic (oral olanzapine 5-20mg/d or oral amisulpride 200-800 mg/d)
2. Control intervention: continuation with the same drug as in the first 2 weeks in flexible dose ranges as above for another six weeks Those participants who have responded at week 2 (≥25% PANSS reduction) will continue on the same drug in flexible dose ranges as above Total duration of intervention per patient: 8 weeks

• Schizophrenia
• Schizoaffective Disorder
• Schizophreniform Disorder

• Active Comparator: initial olanzapin
  Intervention: Drug: Olanzapine or amisulpride
• Active Comparator: initial amisulpride
  Intervention: Drug: Olanzapine or amisulpride
• Active Comparator: early responders
  Intervention: Drug: Olanzapine or amisulpride
• Active Comparator: early non-responders switched
  Intervention: Drug: Olanzapine or amisulpride
• Active Comparator: ealy non-responders non-switched
  Intervention: Drug: Olanzapine or amisulpride

Inclusion Criteria:

• Inpatients with DSM-IV TR diagnosis of schizophrenia, schizophreniform or schizoaffective disorder
• PANSS total score at baseline > 75, at least two PANSS psychosis items ≥ 4, Clinical Global Impression of severity score moderately ill or more (≥4)
• Increase in the level of care (outpatient care to day clinic or inpatient care)

Exclusion Criteria:

• contraindication to study drugs