Schizophrenia

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: The lifetime prevalence of schizophrenia is approximately 0.7% and incidence rates vary between 7.7 and 43.0 per 100,000; about 75% of people have relapses and continued disability, and one third fail to respond to standard treatment. Positive symptoms include auditory hallucinations, delusions, and thought disorder. Negative symptoms (demotivation, self-neglect, and reduced emotion) have not been consistently improved by any treatment. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for positive, negative, or cognitive symptoms of schizophrenia? What are the effects of drug treatments in people with schizophrenia who are resistant to standard antipsychotic drugs? What are the effects of interventions to improve adherence to antipsychotic medication in people with schizophrenia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 51 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: amisulpride, chlorpromazine, clozapine, depot haloperidol decanoate, haloperidol, olanzapine, pimozide, quetiapine, risperidone, sulpiride, ziprasidone, zotepine, aripiprazole, sertindole, paliperidone, flupentixol, depot flupentixol decanoate, zuclopenthixol, depot zuclopenthixol decanoate, behavioural therapy, clozapine, compliance therapy, first-generation antipsychotic drugs in treatment-resistant people, multiple-session family interventions, psychoeducational interventions, and second-generation antipsychotic drugs in treatment-resistant people.

Cite as

Barry SJ, Gaughan TM and Hunter R. Schizophrenia. Clinical Evidence 2012; 06:.

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Substantive changes

Amisulpride New evidence added.[10][11][12][13][14] Categorised as Trade-off between benefits and harms.

Chlorpromazine New evidence added.[15][16][17][18] Categorised as Trade-off between benefits and harms.

Clozapine New evidence added.[11][16][19][20][21][22][23][24][25][26] Categorised as Trade-off between benefits and harms.

Depot haloperidol decanoate New evidence added.[28] Categorised as Unknown effectiveness as there remains insufficient good-quality evidence to assess the effects of depot haloperidol in people with schizophrenia.

Haloperidol New evidence added.[11][16][24][29][30][31][32][33][34] Categorised as Trade-off between benefits and harms

Olanzapine New evidence added.[11][21][35][36][37][38] Categorised as Trade-off between benefits and harms.

Pimozide New evidence added. Categorised as Trade-off between benefits and harms.[39]

Quetiapine New evidence added.[11][20][40][41] Categorised as Trade-off between benefits and harms.

Risperidone New evidence added.[11][25][26][42][43][44][45][46][47][48][49] Categorised as Trade-off between benefits and harms.

Sulpiride New evidence added.[51] Categorised as Unknown effectiveness.

Ziprasidone New evidence added.[11][53] Categorised as Trade-off between benefits and harms.

Zotepine New evidence added.[11] Categorised as Trade-off between benefits and harms.

Aripiprazole New evidence added.[11][54][55][56] Categorised as Trade-off between benefits and harms.

Sertindole New option added. Categorised as Unknown effectiveness.[11][30][44]

Paliperidone New option added.[37] Categorised as Trade-off between benefits and harms.

Flupentixol New option added.[46] Categorised as Unknown effectiveness.

Depot flupentixol decanoate New option added. We found no systematic review or RCTs. Categorised as Unknown effectiveness.

Zuclopenthixol New option added. We found no systematic review or RCTs. Categorised as Unknown effectiveness.

Depot zuclopenthixol decanoate New option added. We found no systematic review or RCTs. Categorised as Unknown effectiveness.

Clozapine versus first-generation antipsychotic drugs (treatment-resistant disease) One systematic review updated.[19] Categorisation changed from Beneficial to Trade-off between benefits and harms.

Clozapine versus other second-generation antipsychotic drugs (treatment-resistant disease) New evidence added.[60][61] Categorisation changed from Unknown effectiveness to Trade-off between benefits and harms.

Second-generation antipsychotics (other than clozapine) versus first-generation antipsychotics (treatment-resistant disease) New evidence added.[65] Categorisation unchanged (Unknown effectiveness), as there remains insufficient good-quality evidence.

Second-generation antipsychotics (other than clozapine) versus each other (treatment-resistant disease) New evidence added.[65] Categorisation unchanged (Unknown effectiveness), as there remains insufficient good-quality evidence.

Behavioural therapy New evidence added.[67] Categorisation changed from Likely to be beneficial to Unknown effectiveness, as there remains insufficient good-quality evidence to assess the effects of behavioural therapy in people with schizophrenia.

Psychoeducational interventions New evidence added.[69][71] Categorisation changed from Likely to be beneficial to Unknown effectiveness, as there is insufficient good-quality evidence to assess the effects of psychoeducational interventions in people with schizophrenia.

Compliance therapy New evidence added.[67] Categorisation unchanged (Unknown effectiveness), as there remains insufficient good-quality evidence to assess the effects of compliance therapy in people with schizophrenia.

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