Horticultural therapy plus standard care compared with standard care alone for schizophrenia[1]
Summary
Based on the current very low quality data, there is insufficient evidence to draw any conclusions on benefits or harms of horticultural therapy for people with schizophrenia. This therapy remains unproven and more and larger randomized trials are needed to increase high quality evidence in this area.[1]
Average scale score (Personal Wellbeing Index - PWI-C). Scale from: 0 to 77 (low = poor)
For people given horticultural therapy plus standard care the well-being and quality of life outcome was a little worse compared to those given standard care alone. There was no clear difference between the two groups and this finding is based on data of very limited quality.
Horticultural therapy plus standard care may increase loss to follow up, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Average scale score (DASS21). Scale from: 0 to 84 (high = poor)
For people given horticultural therapy plus standard care the score on this mental state measure was better compared to those given standard care alone. There was a clear difference between the two groups but this finding is based on data of very limited quality.
No study reported any data on outcomes such as adverse effects, clinical global response, general functioning and information relating to physical fitness
Life skills programme compared to standard care for chronic mental illnesses[2]
Summary
Currently there is no good evidence to suggest life skills programmes are effective for people with chronic mental illnesses. More robust data are needed from studies that are adequately powered to determine whether life skills training is beneficial for people with chronic mental health problems.[2]
- in household activity skills. Follow-up: mean 12 weeks
Life skills programmes may reduce the risk of not improving in day-to-day functioning for general household activity skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Life skills programmes may reduce the risk of not improving in day-to-day functioning for laundry skills when compared with standard care, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Life skills programmes make no difference to self-care when compared with standard care, but, at present it is not possible to be confident about the difference between these two treatments. This finding is based on data of very limited quality.
Life skills programme make no clear difference to the risk of loss to follow up compared with standard care. Data supporting this finding are very limited.
Average score (Quality of Well-Being Scale index). Follow-up: mean 24 weeks
On average, people receiving life skills programme scored 0.02 lower than people treated with standard care. There was no clear difference between the groups and this finding is based on data of very limited quality.*
Supportive therapy versus any other psychological or psychosocial treatment for schizophrenia[3]
Summary
There are few data to identify clear differences in a series of outcomes between supportive therapy and more sophisticated therapies for people with schizophrenia.[3]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Relapse. Follow-up: 2 to 3 years
Supportive therapy is not better - or worse - for making a difference to the risk of relapse when compared with other psychological treatments, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
No clinically important improvement. Follow-up: 1 to 2 years
Supportive therapy may increase the chance of experiencing 'no improvement' in mental state, but, at present there is only very limited data supporting this finding.
Supportive therapy probably causes little or no increase to the chance of being lost to follow up or finding treatment unacceptable or being withdrawn from treatment, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Recipient of care not satisfied with treatment. Follow-up: 1 years
Compared with other therapies, supportive therapy may increase the chance of be unsatisfied with treatment, but, at present there are only very limited data supporting this finding.
On average, people receiving supportive therapy scored a little lower than people treated with any other psychological or psycho-social treatment but there was no clear difference between the groups. The meaning of this in day-to-day care is unclear and data supporting this finding are very limited.
Token economy compared to standard care for schizophrenia[4]
Summary
The token economy approach may have effects on the 'negative symptoms' such as apathy and poverty of thought, but it is unclear if these results are reproducible, clinically meaningful and are maintained beyond the treatment programme. Token economy remains worthy of careful evaluation in modern well-designed, conducted and reported randomized trials.[4]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcome
Leaving the study early Follow-up: up to 6 months
Token economy does not have a convincing effect on the outcome of leaving the study early or loss to follow-up, but, at present data supporting this finding are very limited.
Average score (SANS, high=poor) Follow-up: up to 8 weeks
On average, people receiving token economy scored better than people treated with standard care. There was a clear difference between the groups, but, at present the meaning of this finding in day-to-day care is unclear.
Cannabis reduction: adjunct psychological therapy versus treatment as usual for schizophrenia[5]
Summary
Results are limited and inconclusive because of the small number and size of randomized controlled trials available and quality of data reporting within these trials. More research is needed to explore the effects of adjunct psychological therapy that is specifically about cannabis and psychosis as currently there is no evidence for any novel intervention being better than standard treatment, for those that both use cannabis and have schizophrenia[5]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Behavior
Frequency of cannabis use (group-based therapy) Follow up: 1 year
People in the intervention groups scored a little lower compared to people receiving treatment as usual but there was no clear difference between the therapy groups and standard care. This finding is based on data of moderate quality.
Average score (PANSS) - positive symptoms Follow up: 12 months
On average, people receiving cannabis reduction therapy scored lower than people treated with treatment as usual but there was no clear difference between groups. This finding is based on data of moderate quality.
Average score (WHO QOL questionnaire) Follow up: 1 years
On average, people receiving cannabis reduction therapy scored higher compared to people in the control group receiving treatment as usual. There was, however, no clear difference between the groups and these findings are based on data of moderate quality.
There is some, albeit preliminary, evidence that asenapine provides an improvement in positive, negative, and depressive symptoms, whilst having few adverse effects. However, due to the low-quality and limited quantity of evidence, it remains difficult to recommend the use of asenapine for people with schizophrenia. There is need for large-scale, longer-term, better-designed and conducted randomized controlled trials investigating the clinical effects and safety of asenapine.[6]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinically important change (CGI-I). Follow-up: up to 12 weeks
Asenapine may reduce the chance of experiencing 'no change' in global state when compared with placebo. Data are based on low quality evidence.
No clinically important change (PANSS) Follow-up: up to 12 weeks
Asenapine may reduce the chance of experiencing 'no change' in mental state when compared with placebo, but, at present there is only very limited data supporting this finding.
Average change score in negative symptoms. (PANSS, Marder negative factor score). Follow-up: up to 12 weeks
On average, people receiving asenapine scored a little lower (better) than people treated with placebo. There was no clear difference between the groups. The meaning of this finding in day-to-day care is unclear.
Asenapine may reduce the risk of adverse effects/events when compared with placebo, but, at present there is only very limited data supporting this finding.
Asenapine may reduce the chance of leaving the study or finding treatment unacceptable or being withdrawn from treatment outcome, but, at present the difference between people given asenapine and those receiving placebo is not clear and data supporting this finding are very limited.
Aripiprazole versus risperidone for schizophrenia[7]
Summary
Information is of limited quality, is incomplete and problematic to apply clinically, with few long-term data and quality of evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile.[7]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinically significant response (as defined by the original studies)
Aripiprazole may very slightly increase the chance of experiencing 'no response' in the global state outcome, but, there is no clear difference between people given aripiprazole and those receiving risperidone. These findings are based on data of low quality.
Aripiprazole may increase the chance of finding treatment unacceptable or being withdrawn from treatment outcome, but, at present it is not possible to be confident about the difference between people given aripiprazole and those receiving risperidone and data supporting this finding are very limited.
The important outcomes of 'General functioning in life skills', 'service use (e.g. hospitalization), and quality of life were not measured/reported in the included studies.
Paliperidone palmitate long-acting injection compared to risperidone for schizophrenia[8]
Summary
In short-term studies, paliperidone palmitate - the longer-acting injection - is an antipsychotic drug with a similar adverse effect profile to related compounds such as oral risperidone. No difference was found in the [high] incidence of reported adverse sexual outcomes and paliperidone palmitate is associated with substantial increases in serum prolactin. When flexibly dosed with an average dose of approximately 70-110 mg every four weeks, paliperidone palmitate appears comparable in efficacy and tolerability to risperidone.[8]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state: No clinically important change
No 30% improvement on PANSS score. Follow-up: 13-53 weeks
There is no clear difference between people given paliperidone palmitate and those receiving risperidone for this outcome. These findings are based on data of low quality.
Recurrence of psychotic symptoms. Follow up: 13-53 weeks
There is no clear difference between people given paliperidone palmitate and those receiving risperidone for the outcome of 'relapse'. Data supporting this finding are based on moderate quality evidence.
- Because of lack of efficacy. Follow up: 13-53 weeks
Paliperidone palmitate may increase the risk of finding treatment unacceptable or being withdrawn from treatment outcome for the reason of perceived lack of efficacy compared with risperidone. Data are based on moderate quality evidence.
There was no clear difference between people given paliperidone palmitate and those receiving risperidone for this rare outcome. These findings are based on data of low quality.
Experiencing 'intensified symptoms' Follow-up: average 16 weeks
At present it is not possible to be confident about the difference between trifluoperazine and placebo for this outcome and data supporting this finding are very limited.
- Because of any reason Follow-up: average 5 months
Trifluoperazine may reduce loss to Follow-up, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Add-on antioxidants for schizophrenia versus placebo[10]
Summary
Although 22 trials provide some limited evidence, the data are limited with short duration follow-up and mostly not relevant to clinicians or consumers. There is a need for larger trials with longer periods of follow-up and outcomes meaningful for people with schizophrenia.[10]
Adding antioxidants on top of antipsychotic drugs does not show clear advantage over adding on a placebo for people with schizophrenia. These findings are based on data of low quality.
On average, people receiving add-on antioxidants for schizophrenia scored lower (better) than people treated with add-on placebo. This finding is based on data of very limited quality.
On average, people receiving add-on antioxidants for schizophrenia scored lower (better) than people treated with placebo on this scale. There was a clear difference between the groups. This finding is based on data of low quality.
The average functioning in the antioxidant groups was scored a little lower but there was no clear difference between the groups. This finding is based on data of low quality.
The average general functioning across a longer period of follow up was a little higher in the antioxidant group. The difference was not clear difference between the groups. This finding is based on data of high quality.
Add-on antioxidants for schizophrenia probably causes little or no decrease to the chance of experiencing the treatment outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Add-on antioxidants for schizophrenia may slightly decrease to the chance of experiencing an adverse effect but there is no clear difference between people given the add-on antioxidants for schizophrenia and those receiving add-on placebo. These findings are based on data of low quality.
Pimozide versus any other antipsychotic for schizophrenia or related psychoses[11]
Summary
Enough overall consistency over different outcomes and time scales is present to confirm that pimozide is a drug with effectiveness similar to that of other, more commonly used antipsychotic drugs such as chlorpromazine for people with schizophrenia.[11]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Relapse Follow-up: average 38 weeks
These is no clear difference between pimozide and other antipsychotic drugs. Data supporting this finding are based on moderate quality evidence.
There is not a clear difference between pimozide and other antipsychotic drugs for this mental state outcome but data supporting this finding are very limited.
Presence of first-rank symptoms Follow-up: 3-12 months
Pimozide may reduce the chance of experiencing these problematic symptoms but there is no clear difference between people given pimozide and those receiving any other antipsychotic. These findings are based on data of low quality.
In the short term these is no clear difference between pimozide and other antipsychotic drugs for this adverse effect. These findings are based on data of low quality. There are no data in the longer term.
There is no clear difference between pimozide and other antipsychotic drugs for the adverse effect of causing tremor but these findings are based on data of low quality.
Haloperidol is an antipsychotic drug but often causes troublesome adverse effects. If there is no other antipsychotic drug, using haloperidol to offset the damaging and potentially dangerous consequences of untreated schizophrenia is justified. Where a choice of drug is available, however, an alternative antipsychotic with less likelihood of adverse effects such as parkinsonism, akathisia and acute dystonias may be more desirable.[12]
Outcome
Findings in words
Findings in numbers
Quality of evidence
General outcomes
No marked global improvement Follow-up: >6-24 weeks
Haloperidol, when compared with placebo, reduces the chance of experiencing 'no improvement'. Data are based on moderate quality evidence.
Not discharged from hospital Follow-up: > 6-24 weeks
Haloperidol may reduce the chance of staying in hospital, but, at present it is not possible to be confident about the difference between people receiving haloperidol and people taking placebo. Data supporting this finding are very limited.
Haloperidol probably slightly reduces the risk of loss to follow up, but the difference between the two treatments is not quite clear. Data supporting this finding are based on moderate quality evidence.
Atypical compared with typical antipsychotics (only short term)[13]
Summary
There is not any convincing evidence suggesting that atypical antipsychotic medications are superior to the older typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable because fewer symptomatic adverse effects are seen in the short term. Little evidence is available to support the superiority of one atypical antipsychotic medication over another.[13]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Worse or no improvement
There is no clear difference between the newer atypical antipsychotic drugs and the typical drugs for this global outcome. These findings are based on data of low quality.
Atypical probably reduces the chance of experiencing dry mouth, constipation, and blurred vision but often doses of the older drugs are such that these type of adverse effects are to be expected. Lower doses of control drug could have offset this risk. Data are based on moderate quality evidence.
Use of atypical drugs may increase the chance of leaving early because of adverse effects, but the difference between the treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Quetiapine compared to typical antipsychotics for schizophrenia[14]
Summary
Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms, general psychopathology, and negative symptoms. However, it causes fewer adverse effects in terms of abnormal ECG, extrapyramidal effects, abnormal prolactin levels and weight gain.[14]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinical significant response
There is no clear difference between people given quetiapine and those receiving typical antipsychotic drugs. These findings are based on data of moderate quality.
On average, people receiving quetiapine scored higher (worse) than people treated with typical antipsychotic drugs. There was, however, no clear difference between the groups. This finding is based on data of moderate quality.
On average, people receiving quetiapine scored lower (better) than people treated with typical antipsychotic drugs. This finding is based on data of moderate quality.
On average, people receiving quetiapine scored higher (better) than people treated with typical antipsychotic drugs. There was no clear difference between the groups. This finding is based on data of very limited quality.
On average, people receiving quetiapine scored lower (better) than people treated with typical antipsychotic drugs. There was a clear difference between the groups. This finding is based on data of moderate quality.
Risperidone compared to olanzapine for schizophrenia[15]
Summary
Risperidone seems to produce somewhat more extrapyramidal side effects and clearly more prolactin increase than most other atypical antipsychotics. It may also differ from other compounds in the occurrence of other adverse effects such as weight gain, metabolic problems, cardiac effects, sedation and seizures. Nevertheless, the large proportion of participants leaving studies early and incomplete reporting of outcomes makes it difficult to draw firm conclusions.[15]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No clinically significant response
Risperidone is not clearly different when compared to olanzapine. Data supporting this finding are based on moderate quality evidence.
Risperidone probably slightly increases the chance of leaving the study early, when compared with olanzapine. Data are based on moderate quality evidence.
Number of patients re-hospitalized Follow-up: up to 12 weeks
There is no clear difference between risperidone and olanzapine for the outcome of how much hospital/community care is used. These findings are based on data of low quality.
Average PANSS score (high = poor) Follow-up: up to 12 weeks
On average, people receiving risperidone scored slightly higher (worse) than people treated with olanzapine but there was no clear difference between the groups. The meaning of this in day-to-day care is unclear. This finding is based on data of low quality.
There was no clear difference between risperidone and olanzapine for this very general adverse effect outcome. These findings are based on data of low quality.
Average QLS scale score (high = poor) Follow-up: over 26 weeks
On average, people receiving risperidone scored higher than people treated with olanzapine. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality.
Valproate in combination with antipsychotics compared to antipsychotics plus placebo or antipsychotics alone for schizophrenia[16]
Summary
There is limited evidence that the augmentation of antipsychotics with valproate may be effective for overall clinical response and also for specific symptoms, especially in terms of excitement and aggression. Evidence was entirely based on open randomized controlled trials. Valproate was associated with a number of adverse events among which sedation and dizziness appeared significantly more frequently than in the control groups.[16]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcome
Clinically significant response
When added to antipsychotic drugs valproate probably increases the chance of improvement. Data are based on moderate quality evidence.
Valproate in combination with antipsychotics may slightly reduces the chance of leaving the study early, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
The combination of valproate and antipsychotic drugs may increase the chance of being given additional sedating medication, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
On average, people receiving the valproate combination scored lower (better) than people treated with antipsychotics in combination with placebo or antipsychotic drugs alone. There was a clear difference between the groups, but, the meaning of this in day-to-day care is unclear.
Adding valproate to antipsychotic drug treatment does not clearly cause liver problems. Data supporting this finding are based on moderate quality evidence.
Adding valproate to antipsychotic drugs probably causes little or no increase to the chance of feeling sick, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Adding glutamatergic drug to antipsychotics compared to the same antipsychotic plus a placebo for schizophrenia[17]
Summary
In general, all glutamatergic drugs appeared to be ineffective in further reducing 'positive symptoms' of the illness when added to the existing antipsychotic treatment. Glycine and D-serine may somewhat improve 'negative symptoms' when added to regular antipsychotic medication, but the results were not fully consistent and data are too few to allow any firm conclusions.[17]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcome
Relapse (add-on glycine)
At present it is not possible to be confident about the effect of adding the glutamatergic drug to standard antipsychotic treatment. Data supporting this finding are very limited.
There is no clarity about the benefits or otherwise of adding a glutamatergic drug to antipsychotics for outcomes about how much hospital/community care is used. Data supporting this finding are based on low quality evidence.
No clinically significant improvement (add-on glycine)
There is no evidence of clear advantage of using add-on glutamatergic to standard antipsychotic medication. These findings are based on data of low quality.
Pipotiazine palmitate compared to oral antipsychotics for schizophrenia[18]
Summary
Although well-conducted and reported randomized trials are still needed to fully inform practice (no trial data exists reporting hospital and services outcomes, quality of life, satisfaction with care and economics) pipotiazine palmitate is a viable choice for both clinician and person with schizophrenia.[18]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcomes
No important clinical response Follow-up: by 3 week)
There is no clear difference between people given pipotiazine palmitate and those receiving oral antipsychotics. These findings are based on data of low quality.
Pipotiazine palmitate may increase the chance of leaving the study early but the difference difference between people given pipotiazine palmitate and those receiving oral antipsychotics is not clear. These findings are based on data of low quality.
Oral antipsychotic drugs and pipotiazine palmitate carry similar risks of this problematic movement disorder. These findings are based on data of low quality.
Pipotiazine palmitate may slightly reduce the chance of experiencing this movement disorder but there is no clear difference between people given pipotiazine palmitate and those receiving oral antipsychotics. These findings are based on data of low quality.
The average overall mental state score in the perazine group was lower than for those given other antipsychotic drugs. These findings are based on data of low quality and the meaning of this outcome in day-to-day care remains unclear.
Needing antiparkinson medication Follow-up: average 4 weeks
At present it is not possible to be confident about the difference between perazine and other antipsychotic drugs. Data supporting this finding are very limited.
Leaving the study early - due to adverse events Follow-up: average 4 weeks
There was not a clear difference between perazine and the other antipsychotic drugs for this general outcome reflecting overall adverse event 'load'. These findings are based on data of low quality.
Clotiapine compared to other antipsychotic drugs for acute psychotic illnesses[20]
Summary
There was no evidence to support or refute the use of clotiapine in preference to other antipsychotic drug treatments for management of people with acute psychotic illness.[20]
Outcome
Findings in words
Findings in numbers
Quality of evidence
General clinical impression
No significant improvement
There is no clear difference between people given clotiapine and those receiving other antipsychotic drugs for acute psychotic illnesses. These findings are based on data of low quality.
Clotiapine is not clearly different to other antipsychotic drugs for this outcome - for people who are acutely unwell. These findings are based on data of low quality.
Movement disorders - use of antiparkinsonian medication
Clotiapine may reduce the use of antiparkinsonian drugs - implying that clotiapine causes less of this effect, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
There is no clear difference between people given clotiapine and those receiving other antipsychotics for acute psychotic illnesses. These findings are based on data of low quality.
Penfluridol compared to typical antipsychotics (oral) for schizophrenia[21]
Summary
Although there are shortcomings and gaps in the data, there appears to be enough overall consistency for different outcomes. The effectiveness and adverse effects profile of penfluridol are similar to other typical antipsychotics; both oral and depot. Furthermore, penfluridol is shown to be an adequate treatment option for people with schizophrenia, especially those who do not respond to oral medication on a daily basis and do not adapt well to depot drugs. One of the results favouring penfluridol was a lower drop out rate in medium term when compared to depot medications. It is also an option for people with long-term schizophrenia with residual psychotic symptoms who nevertheless need continuous use of antipsychotic medication. An additional benefit of penfluridol is that it is a low-cost intervention.[21]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No marked improvement (CGI) Follow-up: 3 to 12 months
Penfluridol does not clearly change the chance of experiencing 'no marked improvement' when compared with receiving typical antipsychotic drugs. These findings are based on data of low quality.
Global state - needing additional antipsychotic Follow-up: less than 3 months
There is no clear difference between people given penfluridol and those receiving typical antipsychotics. These findings are based on data of low quality.
On average, people receiving penfluridol scored higher than people treated with typical antipsychotics (oral) but there was no clear difference between the groups and this finding is based on data of low quality. The meaning of this in day-to-day care is unclear.
Needing antiparkinsonism medication Follow-up: less than 3 months
There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.
There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.
Perphenazine compared with any antipsychotic drug for schizophrenia[22]
Summary
Although perphenazine has been used in randomized trials for more than 50 years, incomplete reporting and the variety of comparators used make it impossible to draw clear conclusions. All data for the main outcomes were of very low quality evidence. At best it can be said that perphenazine showed similar effects - including adverse events - as several of the other antipsychotic drugs.[22]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
No better or deterioration Follow-up: mean 8 weeks
Perphenazine is not clearly different than other drugs for this global outcome and data supporting this finding are very limited.
Mental state - 'no effect' (BPRS score reduction) Follow-up: average 8 weeks
At present it is not possible to be confident about the difference between perphenazine and any other antipsychotic drug. Data supporting this finding are very limited.
Change in hypersalivation scores (high = good) Control: propantheline
On average, people receiving astemizole scored a little lower than people treated with control for clozapine-induced hypersalivation. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear.
Astemizole may increase the risk of experiencing fast heart rate, but, at present it is not possible to be confident about the difference between the two treatments because data supporting this finding are very limited.
Astemizole may reduce constipation but there is no clear difference between people given astemizole and those receiving propanthelinecontrol for clozapine-induced hypersalivation. These findings are based on data of low quality.
Levomepromazine versus atypical antipsychotic drugs for schizophrenia[24]
Summary
Data are few and not high quality and makes it impossible to be confident about on the effects of levomepromazine for schizophrenia.[24]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not much improved (CGI) Follow-up: short-term
Levomepromazine may increase the risk of not seeing an improvement when compared with atypical antipsychotic drugs, but, at present there are only very limited data supporting this finding.
Any response (<20% decrease PANSS Follow-up: short-term
At present it is not possible to be confident about the difference between people given levomepromazine and those receiving atypical antipsychotic drugs. There is very limited data to support this finding.
Levomepromazine may slightly reduce the risk of constipation but there is no clear difference between people given levomepromazine and those receiving atypical antipsychotics. These findings are based on data of low quality.
Levomepromazine may increase the chance of experiencing dizziness when compared with atypical antipsychotic drugs. Data are based on low quality evidence.
There is no clear difference for the outcome of 'drowsiness' between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
Dry mouth is no more or less common with levomepromazine compared with those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
Levomepromazine may reduce the risk of movement disorders but, with current data, there is no clear difference between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of very limited quality.
Pericyazine versus typical antipsychotic for schizophrenia[25]
Summary
On the basis of very low quality evidence it is not possible to determine the effects of pericyazine in comparison with antipsychotics such as chlorpromazine or trifluoperazine for the treatment of schizophrenia. There is some evidence, however, that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics.[25]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved Follow-up: 6-12 weeks
Pericyazine may increase the risk of being 'not improved', but, at present it is not possible to be confident about the difference between people receiving pericyazine and those given chlorpromazine or trifluoperazine. Data supporting this finding are very limited.
Pericyazine may reduce the chance of experiencing the movement disorder, compared with chlorpromazine or trifluoperazine, but, at present there is only very limited data supporting this finding.
Pericyazine may reduce the chance of leaving the study early, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Fluspirilene decanoate compared to oral antipsychotics for schizophrenia[26]
Summary
Participant numbers in each comparison were small so power to identify clear difference is limited. Randomized controlled trial data identified no clear differences between the long-acting injection of fluspirilene and oral medication for outcomes that include adverse effects.[26]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Global outcome
Leaving the study early Follow up: 6 weeks to 5 months
Fluspirilene decanoate may increase the risk of leaving the study (reasons not specified), but, the difference is not clear between people given fluspirilene decanoate and those receiving oral antipsychotics. These findings are based on data of low quality.
Using the depot, long-acting fluspirilene decanoate makes little difference for the outcome of 'relapse' compared with those receiving oral antipsychotics - at least for those willing to be engaged with trials. These findings are based on data of low quality.
Needing anticholinergic drugs Follow up: 6 weeks to 5 months
The depot fluspirilene decanoate does not seem to cause any more movement disorders - for which anticholinergic drugs are used - compared with oral antipsychotics. These findings are based on data of low quality.
