A Trial to Determine Whether Two Differing Strength Tablets (3 x 5 mg Versus 1 x 15 mg) of Sublingually Org 5222 (Asenapine) Are Safe and Equal in Subjects With Schizophrenia or Schizoaffective Disorder (P05937)

Inclusion criteria

• must provide written informed consent after the scope and nature of the investigation has been explained to them, but before signing any trial-related activities, including screening evaluations;
• must be at least 18 and less than 65 years of age;
• can be either male or female; females must be either surgically sterile, postmenopausal for at least 1 year, or non-pregnant using a method of birth control that was acceptable to the investigator;
• must be able to speak, read and understand English and be able to respond to questions and follow simple instructions;
• must be diagnosed at the screening interview according to Diagnostic & Statistical Manual of Mental Disorders, 4th edition (DSM-IV), with non-first episode schizophrenia or schizoaffective disorder (295.70); if schizophrenia, must be of the following types: schizophrenia of the paranoid type (295.30), schizophrenia of the disorganized type (295.10), schizophrenia of the catatonic type (295.20), schizophrenia of the undifferentiated type (295.90), schizophrenia of the residual type (295.60);
• must have discontinued all use of all antipsychotic medication except depot neuroleptics at least 3 days prior to baseline. For depot neuroleptics, subjects must have completed 1 dosing interval by the baseline interview;
• must not have taken any experimental medication for at least 30 days prior to baseline;
• with hypothyroidism, diabetes, high blood pressure, or chronic respiratory conditions can be considered as candidates for enrollment in the trial if their conditions are stable, they are receiving standard therapies for the condition, the prescribed dose and regimen of medication is stable for at least 3 months, and all appropriate clinical and laboratory parameters are within the clinically acceptable limits for the condition, and
• must be willing to remain in the hospital a minimum of 14 days to approximately 17 days (minimum of a 3- to a maximum of a 7-day washout period, a minimum of an 8-day in-patient period, and a possible 3-day stabilization period, if needed, prior to discharge).

Exclusion criteria

• they have any untreated or uncompensated clinically significant renal, endocrine, hepatic, respiratory, cardiovascular, hematologic, immunologic, or cerebrovascular disease, or malignancy;
• they are considered obese by the investigator (e.g., greater than 30% above ideal body weight);
• they have a seizure disorder or are taking anticonvulsants to prevent seizures;
• they have any clinically relevant electrocardiogram (ECG) abnormalities at the screening visit (Day -2) or at baseline (Day 0);
• they have a history of a clinically significant cardiac event that required resuscitation;
• at the screening visit, on admission to the trial, during the washout period or at baseline (Day 0), they have any clinically significant abnormal laboratory, vital sign, or physical examination findings which, in the opinion of the investigator, would preclude trial participation;
• they require concomitant treatment with hypnotics (for sleep induction) other than chloral hydrate ≤3000 mg/day, or Ambien (zolpidem tartrate) ≤10 mg qhs, and (for agitation) a benzodiazepine such as lorazepam, ≤10 mg/day;
• they have a score greater than mild at baseline (score >2) on any item of the Abnormal Involuntary Movement Scale (AIMS) assessment at screening and/or require ongoing treatment with anticholinergic medication beyond baseline (Day 0);
• they have a history of significant drug and/or alcohol abuse (according to DSM-IV criteria 305.00) within 30 days before the screening visit;
• they have a confirmed positive result on the alcohol/drug screen test for alcohol, illegal (excluding marijuana), or non-prescribed drugs at screening or at hospital admission;
• they had a primary psychiatric diagnosis (according to DSM-IV criteria) other than schizophrenia or schizoaffective disorder;
• they are actively suicidal at the screening visit, or become so at admission to the hospital, during the washout period, or at baseline (Day 0);
• they have a Clinical Global Impression (CGI) (Severity of Illness) rating greater than moderately ill (score >4) at screening or baseline;
• they are non-compliant (>25%) during the washout period (including baseline Day 0); or,
• they are pregnant, intend to become pregnant during the course of the trial, or are currently nursing mothers during the course of the trial.
• require concomitant medications that are substrates, inhibitors, or inducers of Cytochrome P450 CYP3A4.