User:Lena08041993/FinishedTables

This subpage contains the tables used for the trial.

Acetylcholinesterase inhibitors for schizophrenia

Review does not include evidence level, this table needs to be rewritten

Acetylcholinesterase inhibitors plus antipsychotic for schizophrenia

Summary
The results seem to favour the use of acetylcholinesterase inhibitors in combination with antipsychotics on a few domains of mental state and cognition, but because of the various limitations in the studies as mentioned in the main text, the evidence is weak. This review highlights the need for large, independent, well designed, conducted and reported pragmatic randomised studies.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global effect Medium-term - Average end point score on various outcomes - CGI-severity (low = favourable)(follow-up: mean 16 weeks) Still needs to be filled MD 0/15 lower to 1/07 higher ) ,,, Leaving the study early Adverse event: Short-term Can't find evidence level RR 1.91 (0.8 to 4.61 ) Mental state Average end point score on various outcomes-PANSS (medium-term) - Medium-term - PANSS negative end point score (low = favourable) The mean Mental state: Average end point score on various outcomes-PANSS (medium-term) - Medium-term - PANSS negative end point score (low = favourable) in the intervention groups was 1/69 lower (2/8 to 0/57 lower) MD 1/69 lower (2/8 to 0/57 lower) ,, Average end point score on various outcomes-PANSS (medium-term) - Medium term - PANSS general psychopathology end point score (low = favourable) The mean Mental state: Average end point score on various outcomes-PANSS (medium term) - Medium term - PANSS general psychopathology end point score (low = favourable) in the intervention groups was 3/86 lower (5/4 to 2/32 lower) MD 3/86 lower (5/4 to 2/32 lower) , Cognitive function Short-term - Average end point score on various subscales of WAIS III (high = favourable) - Digit symbol score The mean Cognitive function: Short-term - Average end point score on various subscales of WAIS III (high = favourable) - Digit symbol score in the intervention groups was 1.2 higher (0.14 to 2.26 higher) MD 1.2 higher (0.14 to 2.26 higher) ,, Short-term - Average end point score on various subscales of HVLT (high = favourable) - Recognition The mean Cognitive function: Short term - Average end point score on various subscales of HVLT (high = favourable) - Recognition in the intervention groups was 1/79 higher (0/62 to 2/96 higher) MD 1/79 higher (0/62 to 2/96 higher) Adverse event: Short-term Average end point score on EPSEs scale (low = favourable) - AIMS The mean Adverse event: Short term - Average end point score on EPSEs scale (low = favourable) - AIMS in the intervention groups was 1/5 higher (1/04 to 1/96 higher) MD 1/5 higher (1/04 to 1/96 higher) ,,,

Acupuncture for schizophrenia

Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved, endpoint - medium-term (various similar criteria) Acupuncture added to standard dose antipsychotics may reduce the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.4 (0.28 to 0.57) Very low Mental state PANSS (not improved, reduced rated < 25%, short-term) Acupuncture added to standard dose antipsychotics may reduce the chance of experiencing mental state outcome, but, at present there is only very limited data supporting this finding. RR 0.65 (0.45 to 0.94) Very low Behaviour Leaving the study early (short-term) Acupuncture added to standard dose antipsychotics may increase the chance of experiencing the behaviour outcome, 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. RR 1.33 (0.33 to 5.45) Very low Service outcomes Time in hospital (days) On average, people receiving acupuncture added to standard dose antipsychotics spent 16 days less in hospital than people treated with standard dose antipsychotics. 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. MD 16 lower (19.54 to 12.46 lower ) Moderate Adverse effects Central Nervous System - insomnia (short-term) Acupuncture added to standard dose antipsychotics may slightly reduce the chance of experiencing the adverse effect or event outcome. Data are based on low quality evidence. RR 0.30 (0.11 to 0.83) Low Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Acupuncture alternative tables from same review

Acupuncture added to low dose antipsychotics versus standard dose antipsychotics for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse (follow-up, long-term) Acupuncture added to low dose antipsychotics may reduce the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.57 (0.37 to 0.89) Very low Mental state BPRS (not improved, reduced rate < 30%, short-term) Acupuncture added to low dose antipsychotics may reduce the chance of experiencing the mental state outcome, 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. RR 0.75 (0.18 to 3.07) Very low Behaviour Leaving the study early (short-term) Acupuncture added to low dose antipsychotics may reduce the behaviour outcome, 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. RR 0.81 (0.29 to 2.29) Very low Service outcomes Hospitalisation The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal symptoms - specific - akathisia (short-term) Acupuncture added to low dose antipsychotics may reduce the adverse effect or event outcome. Data are based on low quality evidence. RR 0.03 (0 to 0.49 ) Low Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Acupuncture versus standard dose antipsychotics for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved (talk, behaviour and expression still existed as before; the reduction of BPRS < 29%), endpoint (short-term) Acupuncture may reduce the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.33 (0.19 to 0.59 ) Very low Mental state BPRS, endpoint (high score = worse, short-term) - traditional acupuncture The mean mental state: BPRS, endpoint (high score = worse, short-term) - traditional acupuncture in the intervention groups was 11.56 lower(16.36 to 6.76 lower) MD 11.56 lower (16.36 to 6.76 lower) Very low Behaviour Leaving the study early (short-term) The outcome was not measured/reported in the included studies. Low Service outcomes Hospitalisation The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal symptoms (short-term) Acupuncture may reduce the adverse effect or event outcome. Data are based on low quality evidence. RR 0.05 (0 to 0.83 ) Low Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Acupuncture added to tcm drug versus tcm drug for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved (talk, behaviour and expression still existed as before, the reduction of BPRS < 29%), endpoint (short-term) Acupuncture added to tcm drug may slightly reduce the global state outcome. Data are based on low quality evidence. RR 0.11 (0.02 to 0.59 ) Low Mental state No clinically important change in mental state The outcome was not measured/reported in the included studies. Behaviour Leaving the study early (short-term) The outcome was not measured/reported in the included studies. Low Service outcomes Hospitalisation The outcome was not measured/reported in the included studies. Adverse effects Clinically important general adverse effects The outcome was not measured/reported in the included studies. Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Acupuncture versus tcm drug for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved, endpoint (short-term) - Not improved (no change in symptoms) - Electroacupuncture Acupuncture may reduce the global state outcome. Data are based on low quality evidence. RR 0.52 (0.34 to 0.80 ) Low Mental state No clinically important change in general mental state The outcome was not measured/reported in the included studies. Behaviour Leaving the study early (short-term) The outcome was not measured/reported in the included studies. Service outcomes Hospitalisation The outcome was not measured/reported in the included studies. Adverse effects Clinically important general adverse effects The outcome was not measured/reported in the included studies. Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Electric acupuncture convulsive therapy versus electroconvulsive therapy for schizophrenia

Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse The outcome was not measured/reported in the included studies. Mental state No clinically important change in general mental state The outcome was not measured/reported in the included studies. Behaviour Leaving the study early (short-term) The outcome was not measured/reported in the included studies. Low Service outcomes Hospitalisation The outcome was not measured/reported in the included studies. Adverse effects Spinal fracture (short-term) Electric acupuncture convulsive therapy may reduce the adverse effect or event outcome. Data are based on low quality evidence. RR 0.33 (0.14 to 0.81 ) Low Quality of life No clinically important change in quality of life The outcome was not measured/reported in the included studies. Economic outcomes Cost of care The outcome was not measured/reported in the included studies.

Anticholinergics for neuroleptic-induced acute akathisia

exclude has no SoF

Amisulpride versus other atypical antipsychotics for schizophrenia

Amisulpride compared to olanzapine for schizophrenia

Summary
There is little randomised evidence comparing amisulpride with other second generation antipsychotic drugs. We could only find trials comparing amisulpride with olanzapine, risperidone and ziprasidone. We found amisulpride may be somewhat more effective than ziprasidone, and more tolerable in terms of weight gain and other associated problems than olanzapine and risperidone. These data, however, are based on only ten short to medium term studies and therefore too limited to allow for firm conclusions. Note: the 47 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response (as defined by original studies) Amisulpride may very slightly increase the chance of experiencing the global state outcome but there is no clear difference between people given amisulpride and those receiving olanzapine. These findings are based on data of low quality. RR 1.03 (0.87 to 1.22) Low Relapse (medium term 13 - 26 weeks) Amisulpride may slightly decrease the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between the two treatments. These findings are based on data of low quality. RR 0.93 (0.40 to 2.18) Low Service outcome Outcome: Not reported Mental state No clinically important change (medium term 13 - 26 weeks) Amisulpride probably makes little or no improvement to the mental state outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.09 (0.88 to 1.36) Moderate Adverse effects At least one adverse event Amisulpride probably makes little or no improvement to the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.03 (0.87 to 1.21) Moderate Suicide Amisulpride probably very slightly decreases the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.33 (0.01 to 8.09) Moderate Quality of life (medium term QLS total score, high=poor) On average, people receiving amisulpride scored the same compared to people receiving olanzapine. There was no clear difference between the groups and data supporting this finding are of low quality. The meaning of this in day-to-day care is not clear. MD 0 (0.22 lower to 0.22 higher) Low

Aripiprazole versus other atypical antipsychotics for schizophrenia

Aripiprazole versus clozapine for schizophrenia

Summary
Information on all comparisons is of limited quality, is incomplete and problematic to apply clinically. The quality of the evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerge from ongoing larger, independent pragmatic trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response. Follow-up: up to 12 weeks Aripiprazole may very slightly increase the chance of experiencing the global state outcome, but, there is no clear difference between people given aripiprazole and those receiving clozapine. These findings are based on data of low quality. RR 1.05 (0.87 to 1.27) Low Mental state As measured by BPRS (high score = poor) On average, people receiving aripiprazole scored 0.22 lower than people receiving clozapine. There was no clear difference between the two treatments and this finding is based on data of very limited quality. At present, the meaning of this in day-to-day care is not clear. MD 0.22 lower (1.44 lower to 1 higher) Very low Leaving the study early Any reason Follow-up: up to 12 weeks Aripiprazole may increase the chance of experiencing the finding treatment outcome, but, at present it is not possible to be confident about the difference between people given aripiprazole and those receiving clozapine and data supporting this finding are very limited. RR 1.41 (0.46 to 4.29) Very low Quality of life As measured by WHO-QOL-100 (low score = poor) Follow-up: up to 12 weeks On average, people receiving aripiprazole scored 2.59 higher than people receiving clozapine. There was a clear difference between the two treatments, but, this finding is based on data of very limited quality. At present, the meaning of this in day-to-day care is not clear. MD 2.59 higher (1.43 to 3.74 higher) Very low Adverse effects Extrapyramidal effects Follow-up: up to 12 weeks Aripiprazole may increase the chance of experiencing the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between people given aripiprazole and those receiving clozapine and data supporting this finding are very limited. RR 1.91 (0.75 to 4.85) Very low General functioning Not measured The outcome was not measured/reported in the included studies. Service use Not measured The outcome was not measured/reported in the included studies.

Alternative tables from same review

Comparison 2. aripiprazole versus quetiapine for schizophrenia

Summary
Information on all comparisons is of limited quality, is incomplete and problematic to apply clinically. The quality of the evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerge from ongoing larger, independent pragmatic trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response (as defined by original studies) Aripiprazole may very slightly reduce the chance of experiencing the global state outcome but there is no clear difference between people given comparison Aripiprazole and those receiving quetiapine. These findings are based on data of low quality. RR 0.92 (0.64 to 1.32) Low Mental state As assessed by PANSS positive symptom scale score. PANSS positive symptom subscale (high score = poor)Follow-up: up to 12 weeks On average, people receiving Aripiprazole scored 0.97 lower than people treated with quetiapine. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 0.97 lower (2.34 lower to 0.41 higher) Very low Leaving the study early Follow-up: up to 12 weeks Aripiprazole may reduce the chance of experiencing the 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 comparison aripiprazole and those receiving quetiapine and data supporting this finding are very limited. RR 0.8 (0.22 to 2.87) Very low Quality of life As measured by WHO-QOL-100 Follow-up: up to 12 weeks The mean quality of life: as measured by WHO-QOL-100 in the intervention groups was 2.6 higher(1.31 to 3.89 higher) Very low Adverse effects Extrapyramidal symptoms. Follow-up: up to 12 weeks Comparison . aripiprazole may increase the chance of experiencing the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between people given comparison . aripiprazole and those receiving quetiapine and data supporting this finding are very limited. RR 2.8 (0.64 to 12.31) Very low General functioning Not measured The outcome was not measured/reported in the included studies. Service use Not measured The outcome was not measured/reported in the included studies.

Comparison 3. aripiprazole versus risperidone for schizophrenia

Summary
Information on all comparisons is of limited quality, is incomplete and problematic to apply clinically. The quality of the evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerge from ongoing larger, independent pragmatic trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response (as defined by the original studies) Comparison . aripiprazole may very slightly increase the chance of experiencing the global state outcome, but, there is no clear difference between people given comparison . aripiprazole and those receiving risperidone. These findings are based on data of low quality. RR 1.08 (0.96 to 1.21) Low Mental state As measured by BPRSBPRS (high score = poor)Follow-up: up to 12 weeks The mean mental state: as measured by BPRS in the intervention groups was 1.33 lower(2.24 to 0.42 lower) MD 1.33 lower () Very low Leaving the study early Follow-up: up to 12 weeks Comparison . aripiprazole may increase the chance of experiencing the 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 comparison . aripiprazole and those receiving risperidone and data supporting this finding are very limited. RR 1.02 (0.79 to 1.32) Very low Quality of life Not measured The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal symptoms. Follow-up: up to 12 weeks Comparison . aripiprazole may reduce the chance of experiencing the adverse effect or event outcome when compared with risperidone. Data are based on low quality evidence. RR 0.39 (0.31 to 0.5) Low General functioning Not measured The outcome was not measured/reported in the included studies. Service use Not measured The outcome was not measured/reported in the included studies.

Comparison 4. aripiprazole versus ziprasidone for schizophrenia

Summary
Information on all comparisons is of limited quality, is incomplete and problematic to apply clinically. The quality of the evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerge from ongoing larger, independent pragmatic trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response (as defined by the original studies) Comparison . aripiprazole may reduce the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between people given comparison . aripiprazole and those receiving ziprasidone and data supporting this finding are very limited. RR 0.97 (0.62 to 1.52) Very low Mental state As measured with BPRSBPRS (high score = poor)Follow-up: up to 12 weeks The mean mental state: as measured with BPRS in the intervention groups was 2.2 lower(4.97 lower to 0.57 higher) MD 2.2 lower (4.97 lower to 0.57 higher) Very low Leaving the study early Follow-up: up to 12 weeks Comparison . aripiprazole may reduce the chance of experiencing the 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 comparison . aripiprazole and those receiving ziprasidone and data supporting this finding are very limited. RR 0.94 (0.66 to 1.34) Very low Quality of life Not measured The outcome was not measured/reported in the included studies. Adverse effects Weight gain Follow-up: up to 12 weeks Comparison . aripiprazole may increase the chance of experiencing the adverse effect or event outcome when compared with ziprasidone, but, at present there is only very limited data supporting this finding. RR 4.01 (1.1 to 14.6) Very low General functioning Not measured The outcome was not measured/reported in the included studies. Service use Not measured The outcome was not measured/reported in the included studies.

Comparison 5. aripiprazole versus olanzapine for schizophrenia

Summary
Information on all comparisons is of limited quality, is incomplete and problematic to apply clinically. The quality of the evidence is all low or very low. Aripiprazole is an antipsychotic drug with an important adverse effect profile. Long-term data are sparse and there is considerable scope for another update of this review as new data emerge from ongoing larger, independent pragmatic trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response Follow-up: up to 12 weeks Comparison . aripiprazole may increase the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between people given comparison . aripiprazole and those receiving olanzapine and data supporting this finding are very limited. RR 1.06 (0.96 to 1.17) Very low Mental state As measured with PANSSPANSS (high score = poor)Follow-up: up to 12 weeks The mean mental state: as measured with PANSS in the intervention groups was 0.61 higher(0.23 lower to 1.46 higher) MD 0.61 higher (0.23 lower to 1.46 higher) Very low Leaving the study early Follow-up: up to 12 weeks Comparison . aripiprazole may slightly increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome when compared with olanzapine. Data are based on low quality evidence. RR 1.15 (1.05 to 1.25) Low Quality of life As measured with GQOLI-74GQOLI-74 (low score = poor) The mean quality of life: as measured with gqoli-74 in the intervention groups was 1.26 lower(6.37 lower to 3.85 higher) Very low Adverse effects Weight gain Follow-up: up to 12 weeks Comparison . aripiprazole may reduce the chance of experiencing the adverse effect or event outcome when compared with olanzapine, but, at present there is only very limited data supporting this finding. RR 0.25 (0.15 to 0.43) Very low General functioning Not measured The outcome was not measured/reported in the included studies. Service use Not measured The outcome was not measured/reported in the included studies.

Art therapy for schizophrenia or schizophrenia-like illnesses

Art therapy plus standard care compared to standard care for schizophrenia-like illnesses

Summary
Randomised studies are possible in this field. Further evaluation of the use of art therapy for serious mental illnesses is needed as its benefits or harms remain unclear.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early Art therapy plus standard care may very slightly decrease the chance of experiencing the outcome but there is no clear difference between people given art therapy plus standard care and those receiving standard care. These findings are based on data of low quality. RR 0.97 (0.41 to 2.29) Low Service outcome Outcome: Not reported Mental state SANS average scale score (high = poor) On average, people receiving art therapy plus standard care scored 2.3 lower than people treated with standard care. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 2.3 lower (4.1 lower to 0.5 lower) Low Adverse event Outcome: Not reported Quality of life Perc.Qo.L average scale score (high = good) On average, people receiving art therapy plus standard care scored 0.1 higher than people treated with standard care. 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. MD 0.1 higher (0.27 lower to 0.47 higher) Low

Asenapine versus placebo for schizophrenia

Asenapine versus placebo for schizophrenia

Summary
There is some, albeit preliminary, evidence that asenapine provides an improvement in positive, negative, and depressive symptoms, whilst minimising the risk of 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. We identify a need for large-scale, longer-term, better-designed and conducted randomised controlled trials investigating the clinical effects and safety of asenapine.
Measured 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 the global state outcome when compared with placebo. Data are based on low quality evidence. RR 0.81 (0.68 to 0.97) Low Mental state No clinically important change PANSS Follow-up: up to 12 weeks Asenapine may reduce the chance of experiencing the mental state outcome when compared with placebo, but, at present there is only very limited data supporting this finding. RR 0.72 (0.59 to 0.86) Very low Average change score in negative symptoms. PANSS Marder negative factor score. Follow-up: up to 12 weeks On average, people receiving asenapine scored 1.1 lower than people treated with placebo. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 1.1 lower (2.29 lower to 0.09 higher) Very low Adverse effects Incidence of serious adverse effects. Follow-up: 13-26 weeks Asenapine may reduce the chance of experiencing the adverse effect or event outcome when compared with placebo, but, at present there is only very limited data supporting this finding. RR 0.29 (0.14 to 0.63) Very low Clinically significant extrapyramidal symptoms. AIMS Follow-up: 13-26 weeks No trial reported this outcome. Leaving the study early Any reason. Follow-up: up to 12 weeks Asenapine may reduce the chance of experiencing the 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 asenapine and those receiving placebo and data supporting this finding are very limited. RR 0.91 (0.80 to 1.04) Very low Economic Costs No trial reported this outcome.

Benperidol for schizophrenia

Benperidol compared to other antipsychotics for schizophrenia

Summary
Currently, there are insufficient data from randomised trials to assess the clinical effects of benperidol. This compound merits further research interest.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No better or deterioration Benperidol may improve the global state outcome. Data are based on low quality evidence. RR 8.00 (2.11 to 30.34) Low Global outcome Leaving the study early - any reason not estimable -

Benzodiazepines for schizophrenia

Benzodiazepines as sole treatment versus placebo as sole treatment for schizophrenia

Summary
There is currently no convincing evidence to confirm or refute the practise of administering benzodiazepines as monotherapy or in combination with antipsychotics for the pharmacological treatment of schizophrenia and schizophrenia-like psychosis. Low-quality evidence suggests that benzodiazepines are effective for very short-term sedation and could be considered for calming acutely agitated people with schizophrenia. Measured by the overall attrition rate, the acceptability of benzodiazepine treatment appears to be adequate. Adverse effects were generally poorly reported. High-quality future research projects with large sample sizes are required to clarify the evidence of benzodiazepine treatment in schizophrenia, especially regarding long-term augmentation strategies.
Measured Outcome Findings in words Findings in numbers Quality of evidence No clinically important response to treatment Short term Benzodiazepines as sole treatment may reduce the chance of experiencing the outcome, 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. RR 0.67 (0.44 to 1.02) Very low Leaving the study early Due to any reason (overall acceptability of treatment) Benzodiazepines as sole treatment might slightly decrease the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 0.89 (0.57 to 1.38) Very low Due to adverse effects (overall tolerability of treatment) corrupted RevMan file Very low Number of participants tranquillised at endpoint of the study Desired sedation/tranquillisation The outcome was not measured/reported in the included studies.

Benzodiazepines for schizophrenia alternative tables from same review

Benzodiazepines versus antipsychotics for schizophrenia

Summary
There is currently no convincing evidence to confirm or refute the practise of administering benzodiazepines as monotherapy or in combination with antipsychotics for the pharmacological treatment of schizophrenia and schizophrenia-like psychosis. Low-quality evidence suggests that benzodiazepines are effective for very short-term sedation and could be considered for calming acutely agitated people with schizophrenia. Measured by the overall attrition rate, the acceptability of benzodiazepine treatment appears to be adequate. Adverse effects were generally poorly reported. High-quality future research projects with large sample sizes are required to clarify the evidence of benzodiazepine treatment in schizophrenia, especially regarding long-term augmentation strategies.
Measured Outcome Findings in words Findings in numbers Quality of evidence No clinically important response to treatment Ultra short term (at 60 minutes) Benzodiazepines may reduce the chance of experiencing the outcome, 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. RR 0.61 (0.2 to 1.86) Very low Ultra short term (at 12 hours) Benzodiazepines may reduce the chance of experiencing the outcome but there is no clear difference between people given benzodiazepines and those receiving antipsychotics. These findings are based on data of low quality. RR 0.75 (0.44 to 1.3) Low Short term Benzodiazepines may increase the chance of experiencing the outcome, 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. RR 1.48 (0.64 to 3.46) Very low Leaving the study early Due to any reason (overall acceptability of treatment) Benzodiazepines may decrease the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 0.73 (0.45 to 1.18) Very low Due to adverse effects (overall tolerability of treatment) Benzodiazepines may increase the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 13 (0.78 to 216.39) Very low Desired sedation Ultra short term - asleep at 12 hours Benzodiazepines may reduce the chance of experiencing the outcome but there is no clear difference between people given benzodiazepines and those receiving antipsychotics. These findings are based on data of low quality. RR 0.75 (0.44 to 1.3) Low

Adjunctive benzodiazepines + antipsychotics versus placebo/no adjunctive treatment + antipsychotics for schizophrenia

Summary
There is currently no convincing evidence to confirm or refute the practise of administering benzodiazepines as monotherapy or in combination with antipsychotics for the pharmacological treatment of schizophrenia and schizophrenia-like psychosis. Low-quality evidence suggests that benzodiazepines are effective for very short-term sedation and could be considered for calming acutely agitated people with schizophrenia. Measured by the overall attrition rate, the acceptability of benzodiazepine treatment appears to be adequate. Adverse effects were generally poorly reported. High-quality future research projects with large sample sizes are required to clarify the evidence of benzodiazepine treatment in schizophrenia, especially regarding long-term augmentation strategies.
Measured Outcome Findings in words Findings in numbers Quality of evidence No clinically important response to treatment Ultra short term (at 60 minutes) Adjunctive benzodiazepines + antipsychotics may reduce the chance of experiencing the outcome, 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. RR 0.07 (0 to 1.13) Very low Ultra short term (at 12 hours) Adjunctive benzodiazepines + antipsychotics may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given adjunctive benzodiazepines + antipsychotics and those receiving placebo/no adjunctive treatment + antipsychotics. These findings are based on data of low quality. RR 0.85 (0.51 to 1.41) Low Short term (3 weeks or longer) Adjunctive benzodiazepines + antipsychotics may reduce the chance of experiencing the outcome, 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. RR 0.87 (0.49 to 1.54) Very low Leaving the study early Due to any reason (overall acceptability of treatment) Adjunctive benzodiazepines + antipsychotics may increase the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 1.36 (0.81 to 2.3) Very low Due to adverse effects (overall tolerability of treatment) - short term Adjunctive benzodiazepines + antipsychotics may increase tha chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 3.24 (0.68 to 15.45) Very low Desired sedation Ultra short term - tranquillised at 60 minutes Adjunctive benzodiazepines + antipsychotics may increase the chance of experiencing the outcome. Data are based on low quality evidence. RR 1.39 (1.06 to 1.83) Low Ultra short term - asleep at 12 hours Adjunctive benzodiazepines + antipsychotics may slightly reduce the outcome but there is no clear difference between people given adjunctive benzodiazepines + antipsychotics and those receiving placebo/no adjunctive treatment + antipsychotics. These findings are based on data of low quality. RR 0.85 (0.51 to 1.41) Low

Benzodiazepines for catatonia in people with schizophrenia and other serious mental illnesses

no SoF

Chlorpromazine versus placebo for schizophrenia

Already placed different SoF

Chlorpromazine versus placebo for schizophrenia

Summary
The results of this review confirm much that clinicians and recipients of care already know but aim to provide quantification to support clinical impression. Chlorpromazine's global position as a 'benchmark' treatment for psychoses is not threatened by the findings of this review. Chlorpromazine, in common use for half a century, is a well-established but imperfect treatment. Judicious use of this best available evidence should lead to improved evidence-based decision making by clinicians, carers and patients.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death Follow-up: 5 weeks The outcome was not measured/reported in the included studies. Relapse Follow-up: 6 months to 2 years Chlorpromazine may reduce the chance of experiencing the global state (relapse) outcome, but, at present there is only very limited data supporting this finding. RR 0.65 (0.47 to 0.90) Very low Global state No overall improvement (psychiatrist - rated) Follow-up: 9 weeks to 6 months Chlorpromazine may reduce the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.71 (0.58 to 0.90) Very low Leaving the study early Follow-up: 9 weeks to 6 months Chlorpromazine may slightly reduce the treatment outcome. Data are based on low quality evidence. RR 0.64 (0.53 to 0.78) Low Satisfaction with treatment Not reported The outcome was not measured/reported in the included studies. Behaviour Deteriorated/ disturbed/ un-cooperative. Follow-up: 9 weeks to 6 months Chlorpromazine may reduce the chance of experiencing the behaviour outcome, 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. RR 0.49 (0.24 to 1.00) Very low Cost of care Not reported The outcome was not measured/reported in the included studies.

Clotiapine for acute psychotic illnesses

Clotiapine compared to standard medication - other antipsychotics for acute psychotic illnesses

Summary
We found no evidence to support the use of clotiapine in preference to other 'standard' or 'non-standard' treatments for management of people with acute psychotic illness. All trials in this review have important methodological problems. We do not wish to discourage clinicians from using clotiapine in the psychiatric emergency, but well-designed, conducted and reported trials are needed to properly determine the effectiveness of this drug. [Note: the one citation in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
Measured Outcome Findings in words Findings in numbers Quality of evidence Behavioural outcome Tranquillisation (feeling of calmness, and/or calm, non-sedated behaviour) or agression, or injury to others) No study reported this outcome. Sedation Sleepiness and drowsiness No study reported this outcome. General clinical impression No significant improvement Clotiapine may very slightly decrease the chance of experiencing the global state (significant response) outcome but there is no clear difference between people given clotiapine and those receiving standard medication - other antipsychotics for acute psychotic illnesses. These findings are based on data of low quality. RR 0.88 (0.39 to 1.98) Low Adverse effects Movement disorders - use of antiparkinsonian medication Clotiapine may reduce the chance of experiencing the adverse effect or event outcome, 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. RR 0.43 (0.05 to 3.53) Very low Incidence of specific side-effects - seizure Clotiapine may increase the chance of experiencing the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of low quality. RR 3.67 (0.16 to 84.66) Low Hospital and service outcome Not well enough to be discharged Clotiapine may very slightly increase the chance of experiencing the outcomes to do with how much hospital/community care is used but there is no clear difference between people given clotiapine and those receiving standard medication - other antipsychotics for acute psychotic illnesses. These findings are based on data of low quality. RR 1.04 (0.93 to 1.16) Low Satisfaction with care Recipient of care leaving the study early due to any reason Clotiapine may increase the chance of experiencing the satisfaction with care outcome but there is no clear difference between people given clotiapine and those receiving standard medication - other antipsychotics for acute psychotic illnesses. These findings are based on data of low quality. RR 2.09 (0.81 to 5.42) Low

Clotiapine alternative table from same review

Clotiapine compared to standard medication - benzodiazepines for acute psychotic illnesses

Summary
We found no evidence to support the use of clotiapine in preference to other 'standard' or 'non-standard' treatments for management of people with acute psychotic illness. All trials in this review have important methodological problems. We do not wish to discourage clinicians from using clotiapine in the psychiatric emergency, but well-designed, conducted and reported trials are needed to properly determine the effectiveness of this drug. [Note: the one citation in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
Measured Outcome Findings in words Findings in numbers Quality of evidence Behavioural outcomes Tranquillisation (feeling of calmness, and/or calm, non-sedated behaviour) or agression, or injury to others) No study reported this outcome Sedation Sleepiness and drowsiness No study reported this outcome General clinical Impression No significant improvement No study reported this outcome Mental state No significant improvement - three days after beginning of treatment On average, people receiving clotiapine scored 3.36 lower than people treated with standard medication. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of very limited quality. MD 3.36 lower (8.09 lower to 1.37 higher) Very low Adverse effects 1. Movement disorders - use of antiparkinsonian medication No study reported this outcome Hospital and service outcomes Outcome: No study reported this outcome Satisfaction with care Recipient of care leaving the study early Clotiapine makes no difference to the satisfaction with care outcome, but, at present it is not possible to be confident about this difference between the two treatments. This finding is based on data of very limited quality. RR 1.00 (0.07 to 15.26) Very low

Clozapine versus other atypical antipsychotics for schizophrenia

Clozapine compared to olanzapine for schizophrenia

Summary
Clozapine may be a little more effective than zotepine and risperidone but further trials are required to confirm this finding. Clozapine differs more clearly in adverse effects from other second generation antipsychotics and the side-effect profile could be key in the selection of treatment depending on the clinical situation and a patient’s preferences. Data on other important outcomes such as cognitive functioning, quality of life, death or service use are currently largely missing, making further large and well-designed trials necessary. It is also important to take into account that the large number of people leaving the studies early limits the validity and interpretation of our findings.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically important change (medium term 13 - 26 weeks) Clozapine may slightly increase the chance of experiencing the global state outcome but there is no clear difference between people given clozapine and those receiving olanzapine. These findings are based on data of low quality. RR 1.13 (0.93 to 1.38) Low Global outcome Leaving the study early for any reason (short term up to 12 weeks) Clozapine may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given clozapine and those receiving olanzapine. These findings are based on data of low quality. RR 1.06 (0.65 to 1.74) Low Service outcome Outcome: Not reported Mental state PANSS total score (high = poor, short term up to 12 weeks) On average, people receiving clozapine scored 1.97 higher than people treated with olanzapine. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 1.97 higher (1.48 lower to 5.42 higher) Low Adverse effects At least one adverse effect (short term up to 12 weeks) Clozapine may increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.56 (0.85 to 2.85) Very low Cardiac problems (short term up to 12 weeks) Clozapine may slightly increase the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given clozapine and those receiving olanzapine. These findings are based on data of low quality. RR 2.17 (0.22 to 20.94) Low Quality of life SWN 38 total score (high = good, medium term 13 - 26 weeks) On average, people receiving clozapine scored 8.2 lower than people treated with olanzapine. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 8.2 lower (21.67 lower to 5.27 higher) Low

Cognitive behavioural therapy versus other psychosocial treatments for schizophrenia

Cognitive behavioural therapy compared with other psychosocial therapies for schizophrenia

Summary
Trial-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other - and sometime much less sophisticated - therapies for people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Adverse effect/event Adverse effects - any - medium-term only. Follow-up: 26-52 weeks Cognitive behavioural therapy may increase the chance of experiencing the outcome, 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. RR 2 (0.71 to 5.64) Very low Global state Relapse - long-term. Follow-up: 12 months Cognitive behavioural therapy may very slightly reduce the chance of experiencing the global state outcome but there is no clear difference between people given cognitive behavioural therapy and those receiving other psychosocial therapies. These findings are based on data of low quality. RR 0.91 (0.63 to 1.32) Low Rehospitalisation - long-term. Follow-up: 12 months Cognitive behavioural therapy may very slightly reduce the chance of experiencing the global state outcome but there is no clear difference between people given cognitive behavioural therapy and those receiving other psychosocial therapies. These findings are based on data of low quality. RR 0.86 (0.62 to 1.21) Low Mental state General - No important or reliable change - long-term. Follow-up: 12 months Cognitive behavioural therapy may reduce the chance of experiencing the mental state outcome, 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. RR 0.84 (0.64 to 1.09) Very low Social functioning Average scores (Social Functioning Scale, high = good) Follow-up: median 26 weeks On average, people receiving cognitive behavioural therapy scored 8.8 higher than people treated with other psychosocial therapies. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. MD 8.8 higher (4.07 lower to 21.67 higher) Very low Quality of life Average score (Euro. QOL, high = good) - long-term only. Follow-up: 26 weeks On average, people receiving cognitive behavioural therapy scored 1.86 lower than people treated with other psychosocial therapies. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 1.86 lower (19.2 lower to 15.48 higher) Very low

Cognitive rehabilitation for people with schizophrenia and related conditions

Cognitive rehabilitation compared to occupational therapy for people with schizophrenia and related conditions

Summary
Data are inconclusive and provide no evidence for or against cognitive rehabilitation as a treatment for schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Self esteem Average Rosenberg score (low = poor) On average, people receiving cognitive rehabilitation scored 6.3 higher than people treated with occupational therapy for people with schizophrenia and related conditions. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 6.3 higher (1.07 higher to 11.53 higher) Low Global outcome Leaving the study early People receiving cognitive rehabilitation therapy may have a slightly higher chance of leaving the study earlier compared to people receiving occupational therapy. However, there were no clear differences between the groups and the findings are based on data of low quality. OR 3.21 (0.30 to 34.64 ) Low Service outcome Outcome: Not reported Mental state Average BPRS (endpoint score, high=poor) On average, people receiving cognitive rehabilitation scored 2.5 lower than people treated with occupational therapy for people with schizophrenia and related conditions. 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. MD 2.5 lower (10.64 lower to 5.64 higher) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality

Community mental health teams compared to standard care for severe mental illnesses and disordered personality

Summary
Community mental health team management is not inferior to non-team standard care in any important respects and is superior in promoting greater acceptance of treatment. It may also be superior in reducing hospital admission and avoiding death by suicide. The evidence for CMHT based care is insubstantial considering the massive impact the drive toward community care has on patients, carers, clinicians and the community at large.
Measured Outcome Findings in words Findings in numbers Quality of evidence Service use Admitted to hospital (medium term up to 12 months) Community mental health teams can probably slightly reduce the chance of experiencing the outcomes to do with how much hospital/community care is used. Data are based on moderate quality evidence. RR 0.81 (0.67 to 0.97) Moderate Global outcome Leaving study early (medium term up to 12 months) Community mental health teams may very slightly increase the chance of experiencing the outcome but there is no clear difference between people experiencing community mental health teams and those receiving standard care for severe mental illnesses and disordered personality. These findings are based on data of low quality. RR 1.10 (0.68 to 1.78) Low Service outcome Use of accident and emergency or general hospital (medium term up to 12 months) Community mental health teams may very slightly increase the chance of experiencing the outcomes to do with how much hospital/community care is used but there is no clear difference between people experiencing community mental health teams and those receiving standard care for severe mental illnesses and disordered personality. These findings are based on data of low quality. RR 0.86 (0.66 to 1.12) Low Mental state Average CPRS endpoint scores (high = poor, medium term up to 12 months) There was no numeric data provided for this outcome. Adverse event Death (medium term up to 12 months) Community mental health teams may very slightly decrease the chance of experiencing the outcome but there is no clear difference between people treated with community mental health teams and those receiving standard care for severe mental illnesses and disordered personality. These findings are based on data of low quality. RR 0.47 (0.17 to 1.34) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Compliance therapy for schizophrenia

Compliance therapy compared to non-specific counselling for schizophrenia

Summary
There is no clear evidence to suggest that compliance therapy is beneficial for people with schizophrenia and related syndromes but more randomised studies are justified and needed in order for this intervention to be fully examined.
Measured Outcome Findings in words Findings in numbers Quality of evidence Attitudes to treatment Non-compliance with medication (by 1 year) Compliance therapy may increase non-compliance but there is no clear difference between people given compliance therapy and those receiving non-specific counselling. These findings are based on data of low quality. RR 1.23 (0.74 to 2.05) Low Global Functioning - average GAF endpoint score (high = poor, by 1 year) On average, people receiving compliance therapy scored 4.2 lower than people treated with non-specific counselling. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear and this finding is based on data of low quality. MD 4.2 lower (16.42 lower to 8.02 higher) Low Service use Inpatient bed occupancy (high = poor, skewed data) For this outcome there were no numeric data available. Mental state Average PANSS endpoint score (high = poor, by 1 year) On average, people receiving compliance therapy scored 6.1 higher than people treated with non-specific counselling. 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. MD 6.1 higher (4.54 lower to 16.74 higher) Low Adverse event Death (by 1 year) Compliance therapy may increase the chance of experiencing the outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of low quality. RR 3.00 (0.13 to 70.64) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Dance therapy for schizophrenia

Dance therapy compared with standard care for schizophrenia

Summary
Based on predominantly moderate quality data, there is no evidence to support - or refute - the use of dance therapy in this group of people. This therapy remains unproven and those with schizophrenia, their carers, trialists and funders of research may wish to encourage future work to increase high quality evidence in this area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Service utilisation - days in hospital Outcome: No data available Clinical global response Leaving the study early (short term) Follow-up: 4 months Dance therapy probably slightly reduces the chance of experiencing the global state (significant response) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.44 (0.04 to 4.49) Moderate Leaving the study early (long term) Follow-up: 4 months Dance therapy may reduce the chance of experiencing the global state (significant response) outcome but there is no clear difference between people given dance therapy and those receiving standard care. These findings are based on data of low quality. RR 0.68 (0.31 to 1.51) Low Mental state Negative symptoms - average score (PANSS negative endpoint, high = poor)Follow-up: 4 months On average, people participating in dance therapy scored 4.4 lower compared with people receiving standard care, but, at present the meaning of this in day-to-day care remains not clear. This finding is based on data of moderate quality. MD 4.4 lower (8.15 to 0.65 lower) Moderate Negative symptoms - not improved (PANSS negative symptom reduction less than 20-40%) Follow-up: 4 months Dance therapy probably reduces the chance of experiencing the mental state outcome. Data are based on moderate quality evidence. RR 0.62 (0.39 to 0.97) Moderate Satisfaction with care Average endpoint score (CAT, high = good) Follow-up: 4 months On average, people receiving dance therapy scored 0.4 higher than people treated with standard care. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 0.4 higher (0.78 lower to 1.58 higher) Moderate Quality of life Manchester Short Assessment (MANSA, high = good) Follow-up: 4 months On average, people receiving dance therapy scored the same as people treated with standard care. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. 0 higher (0.48 lower to 0.48 higher) Moderate

Treatments for delusional disorder

Adjunct cognitive behavioural therapy versus adjunct supportive psychotherapy

Summary
Despite international recognition of this disorder in psychiatric classification systems such as ICD-10 and DSM-5, there is a paucity of high quality randomised trials on delusional disorder. There is currently insufficient evidence to make evidence-based recommendations for treatments of any type for people with delusional disorder. The limited evidence that we found is not generalisable to the population of people with delusional disorder. Until further evidence is found, it seems reasonable to offer treatments which have effectiveness in other psychotic disorders. Further research is needed in this area and could be enhanced in two ways: firstly, by conducting randomised trials specifically for people with delusional disorder and, secondly, by high quality reporting of results for people with delusional disorder who are often recruited into larger studies for people with a variety of psychoses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Clinically significant improvement The outcome was not measured/reported in the included studies. Mental state Delusions - clinically significant improvement The outcome was not measured/reported in the included studies. Depression. BDI Follow-up: 6 months Not sure how to fill Low Anxiety. BAI Follow-up: 6 months not sure how to fill Low Service use Admission The outcome was not measured/reported in the included studies. Social function: Self worth Average score. Social Self-Esteem Inventory. Follow-up: 6 months On average, people receiving adjunct cognitive behavioural therapy scored 30.5 higher than people receiving adjunct supportive psychotherapy, but, the meaning of this in day-to day care is not clear. This finding is based on data of low quality. MD 30.5 higher (7.51 to 53.49 higher) Very low Adverse event Leaving the study early. Follow-up- 6 months Adjunct cognitive behavioural therapy probably reduces the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.17 (0.02 to 1.18) Moderate

First rank symptoms for schizophrenia

manually create SoF since data is different

Drama therapy for schizophrenia or schizophrenia-like illnesses

Inpatient stay plus psychodrama plus medication compared to inpatient stay plus medication for schizophrenia or schizophrenia-like illnesses

Summary
Randomised studies are possible in this field. The use of drama therapy for schizophrenia and schizophrenia-like illnesses should continue to be under evaluation as its benefits, or harms, are unclear.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early Short term (up to 12 weeks) Results for this outcome were not estimable. Very low Global outcome Outcome: Not reported Service outcome Outcome: Not reported Mental state Medium term (skewed endpoint data, various scales, high=poor) Data for this outcome were skewed. Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Droperidol for psychosis-induced aggression or agitation

Droperidol versus placebo

Summary
Previously, the use of droperidol was justified based on experience rather than evidence from well-conducted and reported randomised trials. However, this update found high-quality evidence with minimal risk of bias to support the use of droperidol for acute psychosis. Also, we found no evidence to suggest that droperidol should not be a treatment option for people acutely ill and disturbed because of serious mental illnesses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Tranquillisation or asleep Tranquillised/sleep - by around 30 minutes Droperidol increases the chance of experiencing the tranquilisation or asleep outcome. Data are based on high quality evidence. RR 1.18 (1.05 to 1.31) High Global state Use of additional medication - by 60 minutes after initial adequate sedation until ED discharge (various psychotropic drugs) Droperidol reduces the chance of experiencing the global state outcome. Data are based on high quality evidence. RR 0.55 (0.36 to 0.85) High Adverse effects Cardiovascular - arrhythmia Droperidol probably causes little or no reduction to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.34 (0.01 to 8.31) Moderate Respiratory - airway obstruction Droperidol may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given droperidol and those receiving placebo. These findings are based on data of low quality. RR 0.62 (0.15 to 2.52) Low Service use Person able to be discharged home Droperidol slightly increases the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. RR 1.16 (0.90 to 1.48) High Mental state Improvement No trial reported this important outcome. Economic Direct costs No trial reported this important outcome.

Droperidol alternative tables

Droperidol versus haloperidol

Summary
Previously, the use of droperidol was justified based on experience rather than evidence from well-conducted and reported randomised trials. However, this update found high-quality evidence with minimal risk of bias to support the use of droperidol for acute psychosis. Also, we found no evidence to suggest that droperidol should not be a treatment option for people acutely ill and disturbed because of serious mental illnesses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Tranquillisation or asleep Tranquillised/sleep - by around 30 minutes Droperidol causes little or no increase to the the chance of experiencing the outcome, but the difference between the two treatments is not clear. RR 1.01 (0.93 to 1.09) High Global state Use of additional medication - by 60 minutes after initial adequate sedation until ED discharge (various psychotropic drugs) Droperidol reduces the chance of experiencing the global state outcome. Data are based on high quality evidence. RR 0.37 (0.16 to 0.90) High Adverse effects Cardiovascular - hypotension Droperidol probably causes little or no increase to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 2.80 (0.30 to 26.49) Moderate Cardiovascular - hypotension/desaturation Droperidol may increase the chance of experiencing the outcome, but, at present it is not possible to be confident about the difference between the two treatments. These findings are based on data of low quality. RR 2.80 (0.12 to 67.98) Low Service use Person able to be discharged home Not pooled Mental state Mean score by 13 days (Scale for Quantification of Psychotic Symptom Severity, high = poor) Fill manually MD 0.11 undefined more (0.07 fewer to 0.29 more) Economic Direct costs

Droperidol versus midazolam

Summary
Previously, the use of droperidol was justified based on experience rather than evidence from well-conducted and reported randomised trials. However, this update found high-quality evidence with minimal risk of bias to support the use of droperidol for acute psychosis. Also, we found no evidence to suggest that droperidol should not be a treatment option for people acutely ill and disturbed because of serious mental illnesses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Tranquillisation or asleep Tranquillised/asleep - by 30 minutes (at 10 minutes) Droperidol causes little or no reduction to the chance of experiencing the tranquilisation or asleep outcome, but the difference between the two treatments is not clear. RR 0.96 (0.72 to 1.28) High Global state Use of additional medication - by 60 minutes after initial adequate sedation until ED discharge (various psychotropic drugs) Droperidol probably slightly reduces the chance of experiencing the global state outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.54 (0.24 to 1.20) Moderate Adverse effects Respiratory - airway obstruction Droperidol may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given droperidol and those receiving midazolam. These findings are based on data of low quality. RR 0.13 (0.01 to 2.55) Low Respiratory - hypoxia Droperidol probably causes little or no reduction to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.70 (0.16 to 3.03) Moderate Service use Person able to be discharged home Mental state Improvement Economic Direct costs

Droperidol versus olanzapine

Summary
Previously, the use of droperidol was justified based on experience rather than evidence from well-conducted and reported randomised trials. However, this update found high-quality evidence with minimal risk of bias to support the use of droperidol for acute psychosis. Also, we found no evidence to suggest that droperidol should not be a treatment option for people acutely ill and disturbed because of serious mental illnesses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Tranquillisation or asleep Tranquillised/asleep - by around 30 minutes Droperidol causes little or no increase to the the chance of experiencing outcome, but the difference between the two treatments is not clear. RR 1.02 (0.94 to 1.11) High Global state Use of additional medication - by 60 minutes after initial adequate sedation until ED discharge (various psychotropic drugs) Droperidol reduces the chance of experiencing the global state outcome. Data are based on high quality evidence. RR 0.56 (0.36 to 0.87) High Adverse effects Cardiovascular - arrhythmia Droperidol probably causes little or no reduction to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.32 (0.01 to 7.88) Moderate Respiratory - airway obstruction Droperidol may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given droperidol and those receiving olanzapine. These findings are based on data of low quality. RR 0.97 (0.20 to 4.72) Low Service use Person able to be discharged home Droperidol causes little or no increase to the the chance of experiencing outcome, but the difference between the two treatments is not clear. RR 1.06 (0.83 to 1.34) High Mental state Improvement Economic Direct costs

Early intervention for psychosis

Phase specific treatment (risperidone + cbt) + specialised team compared to specialised team for psychosis

Summary
There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early By 12 months. Follow-up: 12 months No participant left early: this would be unusual for most situations. Moderate Progression to psychosis By 6 months. Follow-up: 6 months Phase specific treatment (risperidone + cbt) + specialised team probably reduces the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 0.27 (0.08 to 0.89) Moderate By 12 months. Follow-up: 12 months Phase specific treatment (risperidone + cbt) + specialised team probably reduces the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.54 (0.23 to 1.3) Moderate

Alternative table from same review

Specialised team compared to standard care for psychosis

Summary
There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Compliance with treatment Treatment stopped in spite of need - by one year. Follow-up: 12 months Specialised team probably reduces the chance of experiencing the adherence with treatment outcome. Data are based on moderate quality evidence. RR 0.2 (0.1 to 0.42) Moderate Treatment stopped in spite of need - by two years. Follow-up: 24 months Specialised team probably causes little or no reduction to the chance of experiencing the adherence with treatment outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.66 (0.29 to 1.5) Moderate Service use 1. Average mean number of days per month in hospital - by 5 years. Follow-up: 5 years The mean Service use: 1. Average mean number of days per month in hospital - by 5 years in the intervention groups was 1.11 lower(3.21 lower to 0.99 higher) Moderate 2. Not hospitalised - by five years. Follow-up: 5 years Specialised team probably causes little or no increase to the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.05 (0.9 to 1.22) Moderate Social outcomes 1. Not living independently - by 5 years. Follow-up: 5 years Specialised team probably slightly reduces the chance of experiencing functioning (in day-to-day life) outcome. Data are based on moderate quality evidence. RR 0.42 (0.21 to 0.83) Moderate 2. Not working or in education - by 5 years. Follow-up: 5 years Specialised team probably causes little or no increase to the chance of experiencing functioning (in day-to-day life) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.06 (0.92 to 1.23) Moderate

Educational games for mental health professionals

Educational game plus standard training compared to standard training for mental health professionals

Summary
Current limited evidence suggests educational games could help mental health students gain more points in their tests, especially if they have left revision to the last minute. This salient study should be refined and repeated.
Measured Outcome Findings in words Findings in numbers Quality of evidence Knowledge No significant improvement in test scores (> 10%) Students had a slightly improved chance of improvement in test scores when receiving educational game plus standard training. These findings are based on data of very low quality. OR 0.06 (0.01 to 0.27) Very low Global outcome Knowledge (average test score, high = good) On average, students receiving educational game plus standard training scored 6 higher than students with standard training. There was a clear difference between the groups. This finding is based on data of low quality. MD 6 higher (2.63 higher to 9.37 higher ) Low Service outcome Outcome: Not reported Mental state Outcome: Not reported Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Oestrogen for schizophrenia

Estrogen (mostly 100 mcg) plus standard treatment compared to placebo plus standard treatment for schizophrenia

Summary
Adjunctive estrogen with or without progesterone does not appear to offer convincing advantages over placebo. Before any more research is undertaken in this area, all completed and unpublished work should be made available in order to ensure that more trials are justified.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early (up to 8 weeks) Estrogen (mostly 100 mcg) plus standard treatment may very slightly decrease the chance of experiencing the outcome but there is no clear difference between people given estrogen plus standard treatment and those receiving placebo plus standard treatment. These findings are based on data of low quality. RR 0.95 (0.15 to 6.07) Low Service outcome Outcome: Not reported Mental state Average endpoint in general mental state scores (PANSS total, high=poor, 100 mcg estrogen) On average, people receiving estrogen (mostly 100 mcg) plus standard treatment scored 2.26 lower than people treated with placebo plus standard treatment. 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. MD 2.26 lower (15.44 lower to 10.92 higher) Moderate Adverse effects Abnormal involuntary movements scale score For this outcome there were no numeric data. Simpson & Angus extrapyramidal rating scale score For this outcome there were no numeric data. Quality of life Outcome: Not reported

Electroconvulsive therapy for schizophrenia

Ect compared to placebo or sham ect for schizophrenia

Summary
The evidence in this review suggests that ECT, combined with treatment with antipsychotic drugs, may be considered an option for people with schizophrenia, particularly when rapid global improvement and reduction of symptoms is desired. This is also the case for those with schizophrenia who show limited response to medication alone. Even though this initial beneficial effect may not last beyond the short term, there is no clear evidence to refute its use for people with schizophrenia. The research base for the use of ECT in people with schizophrenia continues to expand, but even after more than five decades of clinical use, there remain many unanswered questions regarding its role in the management of people with schizophrenia.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global impression Not improved (at end of course of ECT) ECT probably reduces the chance of experiencing the global state outcome. Data are based on moderate quality evidence. RR 0.72 (0.59 to 0.86) Moderate Global outcome Relapse - (short term < 6 weeks) ECT may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given ECT and those receiving placebo or sham ECT. These findings are based on data of low quality. RR 0.26 (0.03 to 2.20) Low Service outcome Not discharged from hospital ECT may reduce the chance of experiencing the outcomes to do with how much hospital/community care is used but there is no clear difference between people given ECT and those receiving placebo or sham ECT. These findings are based on data of low quality. RR 0.59 (0.34 to 1.01) Low Mental state Average BPRS endpoint score (high = poor, at end of course of ECT) On average, people receiving ECT scored 6.14 lower than people treated with placebo or sham ECT. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 6.14 lower (10.01 lower to 2.27 lower) Low Adverse event Leaving the study early (short to medium term, up to 6 months) ECT probably reduces the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.85 (0.58 to 1.25) Moderate Leaving the study early (long term 5 years) ECT may very slightly decrease the chance of experiencing the outcome but there is no clear difference between people given ECT and those receiving placebo or sham ECT. These findings are based on data of low quality. RR 0.97 (0.77 to 1.24) Low Quality of life Outcome: Not reported

Crisis intervention for people with severe mental illnesses

Crisis intervention compared with standard care for people with severe mental illnesses

Summary
Care based on crisis-intervention principles, with or without an ongoing homecare package, appears to be a viable and acceptable way of treating people with serious mental illnesses. However only eight small studies with unclear blinding, reporting and attrition bias could be included and evidence for the main outcomes of interest is low to moderate quality. If this approach is to be widely implemented it would seem that more evaluative studies are still needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Global Assessment Scale (GAS) Follow-up: 20 months On average, people receiving crisis intervention scored 5.7 higher than people treated with standard care. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 5.7 higher (0.26 lower to 11.66 higher) Moderate Mental state General. Brief Psychiatric Rating Scale (BPRS) Follow-up: 3 months On average, people receiving crisis intervention scored 4.03 lower than people treated with standard care. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 4.03 lower (8.18 lower to 0.12 higher) Low Patient Satisfaction Client Satisfaction Questionnaire (CSQ-8) Follow-up: 20 months On average, people receiving crisis intervention scored 5.4 higher than people treated with standard care. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 5.4 higher (3.91 to 6.89 higher) Moderate Quality of Life Manchester Short Assessment (MANSA) Follow-up: 6 months On average, people receiving crisis intervention scored 1.5 lower than people treated with standard care. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 1.5 lower (5.15 lower to 2.15 higher) Low Burden on family Numbers of families stating that overall burden is great. Follow-up: 6 months Crisis intervention may reduce the chance of experiencing the outcome. Data are based on low quality evidence. RR 0.34 (0.2 to 0.59) Low Hospital use Repeat admissions excluding index admission. Follow-up: 6 months Crisis intervention reduces the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. Data are based on high quality evidence. RR 0.75 (0.50 to 1.13) High

Intercessory prayer for the alleviation of ill health

Intercessory prayer (contemporaneous ) versus standard care

Summary
These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death By end of trial Intercessory prayer (contemporaneous ) may very slightly decrease the chance of experiencing the adverse event or effect (death) outcome but there is no clear difference between people given intercessory prayer and those receiving standard care. These findings are based on data of low quality. RR 0.72 (0.38 to 1.38) Low Clinical state Improved/not improved- intermediate or bad outcome Intercessory prayer may very slightly decrease the chance of experiencing the outcome but there is no clear difference between people given intercessory prayer and those receiving standard care. These findings are based on data of low quality. RR 0.98 (0.86 to 1.11 ) Low Significant complications (readmission to CCU) Intercessory prayer makes no difference to the outcome, but, at present it is not possible to be confident about this difference between the two treatments. The finding is based on data of moderate quality. RR 1 (0.77 to 1.3) Moderate Leaving the study early Outcome: Intercessory prayer may decrease the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of moderate quality. RR 0.75 (0.43 to 1.31) Moderate

Intercessory prayer alternative tables

Summary of findings 2. intercessory prayer (retrospective) versus standard care

Summary
These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death By end of trial Intercessory prayer (retrospective) probably causes little or no decrease to the chance of experiencing the adverse event or effect (death) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.93 (0.84 to 1.03) Moderate

Summary of findings 3. awareness of intercessory prayer versus standard care

Summary
These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death By end of trial Awareness of intercessory prayer probably causes little or no decrease to the chance of experiencing the adverse event or effect (death) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.92 (0.44 to 1.95) Moderate Clinical state Improved/not improved- intermediate or bad outcome Awareness of intercessory prayer probably makes little or no improvement to the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.06 (0.79 to 1.4) Moderate Significant complications (readmission to CCU) Awareness of intercessory prayer probably makes little or no decrease to the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.91 (0.64 to 1.29) Moderate

Summary of findings 4. awareness of intercessory prayer versus intercessory prayer

Summary
These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death By end of trial Awareness of intercessory prayer probably makes little or no decrease to the adverse event or effect (death) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.82 (0.4 to 1.68) Moderate Clinical state Improved/not improved- intermediate or bad outcome Awareness of intercessory prayer probably makes little or no decrease to the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.78 (0.6 to 1.02) Moderate Significant complications (readmission to CCU) Awareness of intercessory prayer probably makes little or no decrease to the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.95 (0.67 to 1.36) Moderate

Flupenthixol versus low-potency first-generation antipsychotic drugs for schizophrenia

Flupenthixol versus low-potency antipsychotics for schizophrenia

Summary
The evidence base of flupenthixol versus low-potency first-generation antipsychotics is currently restricted to one randomised comparison with chlorpromazine. The few reported data do not suggest a difference in effectiveness, but flupenthixol appeared to produce more movement disorders and dizziness, while chlorpromazine was associated with the anticholinergic side effect - dryness of mouth. More trials are needed to make conclusions about the relative effects of flupenthixol and low-potency antipsychotics.
Measured Outcome Findings in words Findings in numbers Quality of evidence Response to treatment Outcome: The outcome was not measured/reported in the included studies. Acceptability to treatment Leaving the study early due to any reason Adverse effects At least one adverse effect At least one movement disorder Sedation Death Quality of life Outcome:

Fluphenazine versus low-potency first-generation antipsychotic drugs for schizophrenia

Fluphenazine versus low-potency antipsychotic drugs for schizophrenia

Summary
The results do not show a clear difference in effectiveness between fluphenazine and low-potency antipsychotics. The number of included studies was low and their quality moderate. Therefore, further studies would be needed to draw firm conclusions about the relative effects of fluphenazine and low-potency antipsychotics.
Measured Outcome Findings in words Findings in numbers Quality of evidence Response to treatment Follow-up: mean 4 weeks Fluphenazine probably very slightly increases the chance of experiencing the global state outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.03 (0.73 to 1.45) Moderate Acceptability of treatment Leaving the study early due to any reason. Follow-up: 1-6 months Fluphenazine makes no difference to the global state (acceptability of treatment) outcome, but, at present it is not possible to be confident about this difference between the two treatments. Data supporting this finding are based on moderate quality evidence. RR 1 (0.88 to 1.14) Moderate Adverse effects At least one adverse effect. Follow-up: mean 4 weeks Fluphenazine probably reduces the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.79 (0.58 to 1.07) Moderate Movement disorders-at least one movement disorder. Follow-up: 2-6 months Fluphenazine may slightly increase the chance of experiencing the adverse effect or event outcome. Data are based on low quality evidence. RR 2.11 (1.41 to 3.15) Low Other-sedation. Follow-up: 2-6 months Fluphenazine reduces the chance of experiencing the adverse effect or event outcome. Data are based on high quality evidence. RR 0.31 (0.13 to 0.77) High Death The outcome was not measured/reported in the included studies. Quality of life Outcome:

Depot fluspirilene for schizophrenia

Fluspirilene decanoate compared to oral antipsychotics for schizophrenia

Summary
Participant numbers in each comparison were small and we found no clear differences between fluspirilene and oral medication or other depots. The choice of whether to use fluspirilene as a depot medication and whether it has advantages over other depots cannot, at present, be informed by trial-derived data. Well-conducted and reported randomised trials are still needed to inform practice.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early (short term 6 weeks to 5 months) Fluspirilene decanoate may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given fluspirilene decanoate and those receiving oral antipsychotics. These findings are based on data of low quality. RR 1.18 (0.08 to 16.78) Low Service outcome Outcome: Not reported Mental state Relapse (short term 6 weeks to 5 months) Fluspirilene decanoate may very slightly increase the chance of experiencing the mental state outcome, but, there is no clear difference between people given fluspirilene decanoate and those receiving oral antipsychotics. These findings are based on data of low quality. RR 1.18 (0.08 to 16.78) Low Adverse effects Needing anticholinergic drugs (short term 6 weeks to 5 months) Fluspirilene decanoate may reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given fluspirilene decanoate and those receiving oral antipsychotics. These findings are based on data of low quality. RR 0.07 (0.00 to 1.07) Low Dizziness Fluspirilene decanoate may reduce the chance of experiencing the adverse effect or event outcome. Data are based on low quality evidence. RR 0.59 (0.37 to 0.95) Low Quality of life Outcome: Not reported

Glutamatergic drugs for schizophrenia

Glutamatergic drug plus antipsychotics compared to placebo plus antipsychotics for schizophrenia

Summary
In general, all glutamatergic drugs appeared to be ineffective in further reducing positive symptoms of the disease 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. Many participants in the included trials were treatment-resistant which may have reduced treatment response. Additional research on glutamatergic mechanisms of schizophrenia is needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global Effects - no clinically significant improvement in global state (D-cycloserine + different antipsychotics) Results were not estimable. This is based on data of low evidence. Low Global outcome Relapse (glycine + different antipsychotics) Glutamatergic drug plus antipsychotics may reduce the chance of experiencing the outcome, 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. RR 0.39 (0.02 to 8.73) Very low Service outcome Hospital admission (glycine + different antipsychotics) Glutamatergic drug plus antipsychotics may very slightly increase the chance of experiencing the outcomes to do with how much hospital/community care is used, but, at present it is not possible to be confident about the difference between the two treatments. Data supporting this finding are based on low quality evidence. RR 2.63 (0.12 to 59.40) Low Mental state No clinically significant improvement of overall symptoms (glycine + different antipsychotics) Glutamatergic drug plus antipsychotics may slightly reduce the mental state outcome but there is no clear difference between people given glutamatergic drug plus antipsychotics and those receiving placebo plus antipsychotics. These findings are based on data of low quality. RR 0.92 (0.79 to 1.08) Low Adverse effects Constipation (glycine or D-serine + different antipsychotics) Glutamatergic drug plus antipsychotics may reduce the chance of experiencing the adverse effect or event outcome, 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. RR 0.61 (0.06 to 6.02) Very low Insomnia (glycine or D-serine + different antipsychotics) Glutamatergic drug plus antipsychotics may reduce the chance of experiencing the adverse effect or event outcome, 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. RR 0.61 (0.13 to 2.84) Very low Quality of life Outcome: Not reported

Haloperidol versus placebo for schizophrenia

Haloperidol versus placebo for schizophrenia

Summary
Haloperidol is a potent antipsychotic drug but has a high propensity to cause adverse effects. Where there is no treatment option, use of haloperidol to counter the damaging and potentially dangerous consequences of untreated schizophrenia is justified. However, where a choice of drug is available, people with schizophrenia and clinicians may wish to prescribe an alternative antipsychotic with less likelihood of adverse effects such as parkinsonism, akathisia and acute dystonias. Haloperidol should be less favoured as a control drug for randomised trials of new antipsychotics.
Measured Outcome Findings in words Findings in numbers Quality of evidence Death Suicide and natural causes The outcome was not measured/reported in the included studies. Overall improvement No marked global improvement rated by clinician. Follow-up: >6-24 weeks Haloperidol probably reduces the chance of experiencing the global state (overall improvement) outcome. Data are based on moderate quality evidence. RR 0.67 (0.58 to 0.78) Moderate Not discharged from hospital Follow-up: > 6-24 weeks Haloperidol may reduce the chance of experiencing the outcomes to do with how much hospital/community care is used, but, at present it is not possible to be confident about the difference between people receiving haloperidol and people receiving placebo and data supporting this finding are very limited. RR 0.85 (0.47 to 1.52) Very low Relapse Follow-up: < 52 weeks Haloperidol may reduce the chance of experiencing the global state (relapse) outcome, but, at present there is only very limited data supporting this finding. RR 0.69 (0.55 to 0.86) Very low Leaving the study early Follow-up: > 6-24 weeks Haloperidol probably slightly reduces 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. RR 0.54 (0.29 to 1) Moderate Satisfaction with treatment Outcome: The outcome was not measured/reported in the included studies. Adverse effects Movement disorders - parkinsonism. Follow-up: 3 weeks to 3 months Haloperidol probably increases the chance of experiencing the adverse effect or event outcome. Data are based on moderate quality evidence. RR 5.48 (2.68 to 11.22) Moderate

Horticultural therapy for schizophrenia

Horticultural therapy plus standard care compared with standard care alone for schizophrenia

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 randomised trials are needed to increase high quality evidence in this area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Well-being and quality of life 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 0.9 lower 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. MD -0.9 (-10.35 to 8.55 ) Very low Clinical global response Outcome: No data available General functioning Outcome: Physical fitness Outcome: Satisfaction with treatment Leaving the study early Horticultural therapy plus standard care may increase the outcome, 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. RR 5.00 (0.27 to 94.34) Very low Adverse effect Outcome: No data available Mental state and behaviour DASS21. Scale from: 0 to 84 (high = poor) For people given horticultural therapy plus standard care the mental state outcome was 23.7 lower compared to those given standard care alone. There was a clear difference between the two groups and this finding is based on data of very limited quality. MD -23.7 (-35.37 to -12.03 ) Very low

Pharmacological interventions for clozapine-induced hypersalivation

Antimuscarinic: 1. astemizole compared to control for clozapine-induced hypersalivation

Summary
There are currently insufficient data to confidently inform clinical practice. The limitations of these studies are plentiful and the risk of bias is high. These trials, however, are invaluable guides for current and future study design. Well conducted randomised trials are possible. Some may be underway. Current practice outside of well designed randomised trials should be clearly justified.
Measured Outcome Findings in words Findings in numbers Quality of evidence Hypersalivation No effect / not cured / not markedly improved (control = propantheline) Astemizole probably increases the risk of experiencing the outcome. Data are based on moderate quality evidence. RR 2.46 (1.63 to 3.72) Moderate Global outcome Change in hypersalivation scores (high = good, control = propantheline antimuscarinic) On average, people receiving astemizole scored 0.64 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. MD 0.64 lower (1.14 lower to 0.14 lower) Low Service outcome Outcome: Not reported Mental state Outcome: Not reported Adverse effects Tachycardia (control = doxepin) Astemizole may increase the risk of experiencing the adverse effect or event outcome, 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. RR 5.00 (0.25 to 99.16) Very low Constipation (control = propantheline) Astemizole may reduce the adverse effect or event outcome but there is no clear difference between people given astemizole and those receiving control for clozapine-induced hypersalivation. These findings are based on data of low quality. RR 0.60 (0.26 to 1.39) Low Quality of life Outcome: Not reported

Hypnosis for schizophrenia

Hypnosis compared to standard treatment for schizophrenia

Summary
The studies in this field are few, small, poorly reported and outdated. Hypnosis could be helpful for people with schizophrenia. If we are to find this out, better designed, conducted and reported randomised studies are required. This current update has not revealed any new studies in this area since 2003.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early (short term up to 12 weeks) No data available. Low Service outcome Outcome: Not reported Mental state BPRS average scores (by 1 week) (endpoint score, high=poor) On average, people receiving hypnosis scored 3.63 lower than people treated with standard treatment. 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. MD 3.63 lower (12.05 lower to 4.79 higher) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Compulsory community and involuntary outpatient treatment for people with severe mental disorders

Court orderd outpatient commitment compared with entirely voluntary care for people with severe mental disorders

Summary
These review data show CCT results in no clear difference in service use, social functioning or quality of life compared with voluntary care or brief supervised discharge. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and low- to moderate-quality evidence. In addition, clinical trials may not fully reflect the potential benefits of this complex intervention.
Measured Outcome Findings in words Findings in numbers Quality of evidence Health service Readmission to hospital by 11 to 12 months Court ordered outpatient commitment may very slightly reduce the chance of readmission to hospital but there is no clear difference between people given court orderd outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 0.98 (0.79 to 1.21) Low Compliance with medication by 11 to 12 months Court ordered outpatient commitment may very slightly reduce the chance of experiencing the outcomes to do with how much hospital/community care is used but there is no clear difference between people given court ordered outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 0.99 (0.83 to 1.19) Low Participant level outcomes Social functioning- trouble with police by 11 to 12 months, at least 1 arrest Court ordered outpatient commitment may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given court ordered outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 0.97 (0.62 to 1.52) Low Social functioning- trouble with police by 11 to 12 months, ever arrested/picked up by police for violence against a person Court ordered outpatient commitment may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given court ordered outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 0.82 (0.56 to 1.21) Low Social functioning- homeless by 11 to 12 months Court ordered outpatient commitment may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given court ordered outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 0.67 (0.39 to 1.15) Low Quality of life- victimisation by 11 to 12 months Court ordered outpatient commitment may reduce the chance of experiencing the outcome. Data are based on low quality evidence. RR 0.5 (0.31 to 0.8) Low Satisfaction with care/adverse events- perceived coercion by 11 to 12 months Court ordered outpatient commitment may slightly increase the chance of experiencing the outcome but there is no clear difference between people given court ordered outpatient commitment and those receiving entirely voluntary care for people with severe mental disorders. These findings are based on data of low quality. RR 1.36 (0.97 to 1.89) Low

Alternative table from same review

Community treatment orders compared with supervised dischare (section 17) for people with severe mental disorders

Summary
These review data show CCT results in no clear difference in service use, social functioning or quality of life compared with voluntary care or brief supervised discharge. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and low- to moderate-quality evidence. In addition, clinical trials may not fully reflect the potential benefits of this complex intervention.
Measured Outcome Findings in words Findings in numbers Quality of evidence Health service Readmission to hospital by 12 months Community treatment orders probably causes little or no reduction to the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.99 (0.74 to 1.32) Moderate Hospital bed-days by 12 months On average, people receiving community treatment orders scored 8.7 lower than people treated with supervised discharge. 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. MD 8.7 lower (30.88 lower to 13.48 higher) Moderate Number of readmissions by 12 months SPLITMD Community treatment orders: The mean health service outcomes: 3. number of readmissions by 12 months in the intervention groups was 0.2 lower(0.45 lower to 0.05 higher). Community treatment orders compared with supervised dischare : - 0.2 lower(0.45 lower to 0.05 higher) Moderate Number with multiple readmissions by 12 months Community treatment orders probably causes little or no reduction to the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.56 (0.27 to 1.17) Moderate Days in community to first admission by 12 months SPLITMD Community treatment orders: The mean days in community to 1st admission in the intervention groups was 5 higher(21.74 lower to 31.74 higher). Community treatment orders compared with supervised dischare : - - Moderate Participant level outcomes: Mental state Psychiatric symptoms at 12 months (BPRS) On average, people receiving community treatment orders scored 0.1 lower than people treated with community treatment orders compared with supervised dischare . There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 0.1 lower (3.17 lower to 2.97 higher) Moderate Participant level outcomes: 3. Satisfaction with care: perceived coercion at 11 12 months SPLITMD Community treatment orders: The mean participant level outcomes: Satisfaction with care: perceived coercion intervention groups was 0.5 lower(1.71 lower to 0.71 higher). Community treatment orders compared with supervised dischare : - - Moderate

Compulsory community treatment compared with standard care for people with severe mental disorders

Summary
These review data show CCT results in no clear difference in service use, social functioning or quality of life compared with voluntary care or brief supervised discharge. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and low- to moderate-quality evidence. In addition, clinical trials may not fully reflect the potential benefits of this complex intervention.
Measured Outcome Findings in words Findings in numbers Quality of evidence Health service Outcomes: 1. Readmission to hospital by 11 to 12 months Compulsory community treatment probably causes little or no reduction to the chance of experiencing the outcomes to do with how much hospital/community care is used, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.98 (0.83 to 1.17) Moderate Outcomes: 2. Hospital bed-days SPLITMD Compulsory community treatment: The mean health service outcomes: 2. hospital bed-days in the intervention groups was 3.35 lower(15.14 lower to 8.44 higher). Standard care for people with severe mental disorders: - - Moderate Outcomes: 3. Number with multiple readmissions by 12 months Compulsory community treatment makes no difference to the outcomes to do with how much hospital/community care is used, but, at present it is not possible to be confident about the difference between the two treatments. RR 1.0 (0.6 to 1.66) Moderate Participant level outcomes 1. Global state- GAF at 12 months SPLITMD Compulsory community treatment: The mean participant level outcomes: global state: GAF at 12 months in the intervention groups was 1.36 lower(4.07 lower to 1.35 higher). Standard care for people with severe mental disorders: - - Moderate 2. Satisfaction with care- perceived coercion or leverage at 11 to 12 months Compulsory community treatment probably slightly increases the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.3 (0.98 to 1.71) Moderate Outcome: Other pre-stated participant level outcomes of interest: Social functioning: trouble with police, homeless; Quality of life: victimisation; not reported

Lamotrigine for schizophrenia

'missing file

Levomepromazine for schizophrenia

Levomepromazine compared to typical antipsychotics for schizophrenia

Summary
Available data does not enable us to confidently comment on the effectiveness of levomepromazine for schizophrenia. Larger, more robust, studies comparing levomepromazine with other antipsychotics including clozapine are much needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early Short term - any reason Levomepromazine may very slightly increase the chance of experiencing the treatment outcome, but, there is no clear difference between people given levomepromazine and those receiving typical antipsychotics. These findings are based on data of low quality. RR 1.11 (0.45 to 2.74) Low Short term - due to lack of efficacy Levomepromazine may very slightly reduce the chance of experiencing the treatment outcome but there is no clear difference between people given levomepromazine and those receiving typical antipsychotics. These findings are based on data of low quality. RR 0.95 (0.22 to 4.18) Low Short term - due to adverse events Levomepromazine may increase the chance of experiencing the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is supported by data of low quality. RR 4.77 (0.24 to 93.67) Low Medium term - any reason Levomepromazine may increase the chance of experiencing the treatment outcome, 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. RR 2 (0.2 to 19.62) Very low Long term - any reason Levomepromazine probably reduces 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. RR 0.4 (0.09 to 1.81) Moderate Long term - due to adverse events Levomepromazine makes no difference to the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of moderate quality. RR 1 (0.07 to 14.85) Moderate Long term - lost to follow-up Levomepromazine makes no difference to the treatment outcome, but, at present it is not possible to be confident about this difference between the two treatments. This finding is based on data of moderate quality. RR 1 (0.07 to 14.85) Moderate

Alternative table same review

Levomepromazine compared to atypical antipsychotics for schizophrenia

Summary
Available data does not enable us to confidently comment on the effectiveness of levomepromazine for schizophrenia. Larger, more robust, studies comparing levomepromazine with other antipsychotics including clozapine are much needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early Short term - any reason Levomepromazine makes no difference to the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of low quality. RR 1 (0.67 to 1.49) Low Short term - due to adverse events Levomepromazine may increase tha chance of experiencing the outcome, but, at present it is not possible to be confident about this difference between the two treatments. This finding is based on data of moderate quality. RR 5 (0.25 to 98.27) Moderate Short term - due to lack of efficacy Levomepromazine may reduce the chance of experiencing the treatment outcome, 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. RR 0.83 (0.4 to 1.74) Very low Short term - due to patient deterioration Levomepromazine may increase the treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of moderate quality. RR 5 (0.25 to 98.27) Moderate Short term - lost to follow-up Levomepromazine may very slightly reduce the chance of experiencing the treatment outcome but there is no clear difference between people given levomepromazine and those receiving atypical antipsychotics. These finding is based on data of low quality. RR 0.33 (0.01 to 7.74) Low

Life skills programmes for chronic mental illnesses

Life skills programme compared to standard care for chronic mental illnesses

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.
Measured Outcome Findings in words Findings in numbers Quality of evidence Life skills No important change in household activity skills. Royal Edinburgh Occupational Therapy Assessment Form. Follow-up: mean 12 weeks Life skills programme may reduce the risk of experiencing the functioning (in day-to-day life) outcome, 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. RR 0.24 (0.01 to 4.72) Very low No important change kitchen skills. Royal Edinburgh Occupational Therapy Assessment Form. Follow-up: mean 12 weeks The outcome was not measured/reported in the included studies. Very low No important change laundry skills. Royal Edinburgh Occupational Therapy Assessment Form. Follow-up: mean 12 weeks Life skills programme may reduce the risk of experiencing the functioning (in day-to-day life) outcome, 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. RR 0.14 (0.01 to 2.38) Very low No important change self-care skills. Royal Edinburgh Occupational Therapy Assessment Form. Follow-up: mean 12 weeks Life skills programme make no difference to the functioning (in day-to-day life) outcome, 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. RR 1 (0.28 to 3.54) Very low Leaving the study early Follow-up: 6 to 16 weeks Life skills programme may increase the chance of experiencing the treatment outcome, 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. RR 1.16 (0.4 to 3.36) Very low Mental state Endpoint score. PANSS positive syndrome. Scale from: 7 to 48. Follow-up: mean 24 weeks People receiving life skills programme scored the same as people receiving standard care. The meaning of this in day-to-day care is unclear. Findings are based on data of very limited quality. MD 0 (3.12 lower to 3.12 higher ) Very low Quality of life Endpoint score. Quality of Well-Being Scale index. Scale from: 0 to 10. 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. The meaning of this in day-to-day care is unclear. MD 0.02 lower (0.07 lower to 0.03 higher) Very low

Alternative table from same review

Life skills programme compared to attention-control for chronic mental illnesses

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.
Measured Outcome Findings in words Findings in numbers Quality of evidence Life skills Endpoint score UCSD Performance-based Skills Assessment - UPSA Follow-up: mean 24 weeks On average, people receiving life skills programme scored 2.5 lower than people treated with attention-control. There was no clear difference between the groups and this finding is based on data of very limited quality. The meaning of this in day-to-day care is unclear. MD 2.5 lower (8.94 lower to 3.94 higher) Very low Mental state Endpoint score PANSS. Scale from: 16 to 96. Follow-up: mean 24 weeks On average, people receiving life skills programme scored 2.7 higher than people treated with attention-control. There was no clear difference between the groups and this finding is based on data of very limited quality. The meaning of this in day-to-day care is unclear. MD 2.7 higher (4.78 lower to 10.18 higher) Very low Quality of life Endpoint score. Quality of Well-Being Scale. Scale from: 0 to 100. Follow-up: mean 24 weeks On average, people receiving life skills programme scored 0.9 higher than people treated with attention-control. There was no clear difference between the groups and this finding is based on data of very limited quality. The meaning of this in day-to-day care is unclear. MD 0.9 higher (3.12 lower to 4.92 higher) Very low

Cannabis for schizophrenia

Cannabis reduction: adjunct psychological therapy versus treatment as usual for schizophrenia

Summary
Results are limited and inconclusive due to the small number and size of randomised controlled trials available and quality of data reporting within these trials. More research is needed to a) 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 use cannabis and have schizophrenia b) decide the most effective drug treatment in treating those that use cannabis and have schizophrenia, and c) assess the effectiveness of cannabidiol in treating schizophrenia. Currently evidence is insufficient to show cannabidiol has an antipsychotic effect.
Measured Outcome Findings in words Findings in numbers Quality of evidence Behaviour Cannabis use: 1. frequency of use (group-based therapy) (high = bad) - medium term. Cannabis use. Scale from: 0 to 17. Follow-up: 1 year People in the intervention groups scored 0.1 lower compared to people receiving treatment as usual. There was no clear difference between the groups and the finding is based on data of moderate quality. MD 0.1 lower (2.44 lower to 2.24 higher) Moderate Mental state PANSS score Positive symptoms - medium term. PANSS Scale from: 7 to 49.Follow-up: 12 months On average, people receiving cannabis reduction: adjunct psychological therapy scored 0.3 lower than people treated with treatment as usual. There was no clear difference between the groups and this finding is based on data of moderate quality. The meaning of this in day-to-day care is unclear. MD 0.3 lower (2.55 lower to 1.95 higher) Moderate Global state Relapse - medium term - not reported The outcome was not measured/reported in the included studies. General Functioning 1: Subjective quality of life (WHO QOL, BREF) - medium term. WHO QOL questionnaire. Scale from: 0 to 20. Follow-up: 1 years On average, people receiving cannabis reduction: adjunct psychological therapy scored 0.9 higher compared to people in the control group receiving treatment as usual. There was no clear difference between the groups and the meaning of this in day-to-day care is not clear. These findings are based on data of moderate quality. MD 0.9 higher (1.15 lower to 2.95 higher) Moderate Adverse effects No clinically important adverse effects - medium term - not measured The outcome was not measured/reported in the included studies. Leaving the study early Medium term - not reported The outcome was not measured/reported in the included studies. Satisfaction with treatment Medium term - not measured The outcome was not measured/reported in the included studies.

Cannabis alternative tables from same review

Cannabis reduction: psychological therapy (specifically about cannabis and psychosis) versus non-specific psycoeduction for schizophrenia

Summary
Results are limited and inconclusive due to the small number and size of randomised controlled trials available and quality of data reporting within these trials. More research is needed to a) 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 use cannabis and have schizophrenia b) decide the most effective drug treatment in treating those that use cannabis and have schizophrenia, and c) assess the effectiveness of cannabidiol in treating schizophrenia. Currently evidence is insufficient to show cannabidiol has an antipsychotic effect.
Measured Outcome Findings in words Findings in numbers Quality of evidence Behaviour Cannabis use: Used cannabis in last 4 weeks - medium term. Cannabis use. Follow-up: 6 months Cannabis reduction: psychological therapy (specifically about cannabis and psychosis) probably causes little or no increase to the chance of experiencing the behaviour outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.04 (0.62 to 1.74) Moderate Mental state 1. Average score (BPRS-E total endpoint, higher scores = poor) - medium term. BPRS-E. Scale from: 0 to 168. Follow-up: mean 6 months On average, people receiving cannabis reduction: psychological therapy (specifically about cannabis and psychosis) scored 3.60 lower than people treated with non-specific psycoeduction. There was no clear difference between the groups and this finding is based on data of moderate quality. The meaning of this in day-to-day care is unclear. MD 3.60 lower (12.81 lower to 5.61 higher) Moderate Global state Relapse - medium term - not reported The outcome was not measured/reported in the included studies. General functioning No clinically important change in general functioning - medium term - not reported The outcome was not measured/reported in the included studies. Adverse effects No clinically important adverse effects - medium term - not measured The outcome was not measured/reported in the included studies. Leaving the study early Medium term - not reported The outcome was not measured/reported in the included studies. Satisfaction with treatment Medium term - not measured The outcome was not measured/reported in the included studies.

Cannabis reduction: antipsychotic 'a' versus antipsychotic 'b' for

Summary
Results are limited and inconclusive due to the small number and size of randomised controlled trials available and quality of data reporting within these trials. More research is needed to a) 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 use cannabis and have schizophrenia b) decide the most effective drug treatment in treating those that use cannabis and have schizophrenia, and c) assess the effectiveness of cannabidiol in treating schizophrenia. Currently evidence is insufficient to show cannabidiol has an antipsychotic effect.
Measured Outcome Findings in words Findings in numbers Quality of evidence Behaviour Cannabis use 3: Traces of cannabis breakdown products in urine - medium term. Follow-up: 14 weeks Cannabis reduction: antipsychotic 'a' probably increases the chance of experiencing the behaviour outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.8 (0.52 to 6.22 ) Moderate **Mental state: Obsessive–Compulsive Drug Use Scale (OCDUS) (short-term, higher=bad) Short term. Scale from: 0 to 44.Follow-up: 6 weeks On average, people receiving cannabis reduction: antipsychotic 'a' scored 1.3 lower than people treated with antipsychotic 'b'. There was no clear difference between the groups and this finding is based on data of moderate quality. The meaning of this in day-to-day care is unclear. MD 1.3 lower (6.11 lower to 3.51 higher) Moderate Global state Relapse - medium term - not measured The outcome was not measured/reported in the included studies. General functioning No clinically important change in general functioning - medium term - not measured The outcome was not measured/reported in the included studies. Adverse effects Measured adverse events - Simpson scale - medium term. Scale from: 0 to 40.Follow-up: 14 weeks On average, people receiving cannabis reduction: antipsychotic 'a' scored 0.08 higher than people treated with antipsychotic 'b' . There was no clear difference between the groups and this finding is based on data of moderate quality. The meaning of this in day-to-day care is unclear. MD 0.08 higher (1.06 lower to 1.22 higher) Moderate Leaving the study early Any reason - medium term. Follow-up: 14 weeks Cannabis reduction: antipsychotic 'a' probably reduces 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. RR 0.5 (0.19 to 1.29) Moderate Satisfaction with treatment Medium term - not measured The outcome was not measured/reported in the included studies.

Cannabinoid as treatment: cannabidiol compared with amisulpride for schizophrenia

Summary
Results are limited and inconclusive due to the small number and size of randomised controlled trials available and quality of data reporting within these trials. More research is needed to a) 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 use cannabis and have schizophrenia b) decide the most effective drug treatment in treating those that use cannabis and have schizophrenia, and c) assess the effectiveness of cannabidiol in treating schizophrenia. Currently evidence is insufficient to show cannabidiol has an antipsychotic effect.
Measured Outcome Findings in words Findings in numbers Quality of evidence Behaviour Cannabis use: 1. frequency of use (group-based therapy) (high = bad) - medium term - not measured The outcome was not measured/reported in the included studies. Mental state PANSS total (high = bad) - medium term - not measured The outcome was not measured/reported in the included studies. Global state Relapse - medium term - not measured The outcome was not measured/reported in the included studies. General functioning No clinically important change in general functioning - medium term - not measured The outcome was not measured/reported in the included studies. Adverse effects Measured adverse events - medium term - not measured The outcome was not measured/reported in the included studies. Leaving the study early Any reason - medium term - not measured The outcome was not measured/reported in the included studies. Satisfaction with treatment Medium term - not measured The outcome was not measured/reported in the included studies.

Loxapine for schizophrenia

Loxapine compared to atypical antipsychotics for schizophrenia

Summary
Loxapine is an antipsychotic which is not clearly distinct from typical or atypical drugs in terms of its effects on global or mental state. Loxapines profile of adverse effects is similar to that of the older generation of antipsychotic drugs.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early for any reason (up to 8 weeks) Loxapine may very slightly increase the chance of experiencing outcome but there is no clear difference between people given loxapine and those receiving atypical antipsychotics. These findings are based on data of low quality. RR 1.26 (0.32 to 5.00) Low Service outcome Outcome: Not reported Mental state Not Improved (up to 8 weeks) Loxapine may very slightly increase the chance of experiencing the mental state outcome but there is no clear difference between people given loxapine and those receiving atypical antipsychotics. These findings are based on data of low quality. RR 1.07 (0.75 to 1.53) Low Adverse effects Extrapyramidal movement disorder (up to 8 weeks) Loxapine probably increases the chance of experiencing the adverse effect or event outcome. Data are based on moderate quality evidence. RR 2.18 (1.55 to 3.06) Moderate Insomnia (up to 8 weeks) Loxapine may reduce the chance of experiencing the adverse effect or event outcome. Data are based on low quality evidence. RR 0.18 (0.04 to 0.78) Low Service outcome Outcome: Not reported Quality of life Outcome: Not reported

Antioxidant treatments for schizophrenia

Adjunctive antioxidants for schizophrenia versus placebo

Summary
Although 22 trials could be included in this review, the evidence provided is limited and mostly not relevant to clinicians or consumers. Overall, although there was low risk of attrition and selective data reporting bias within the trials, the trials themselves were not adequately powered and need more substantial follow-up periods. There is a need for larger trials with longer periods of follow-up to be conducted. Outcomes should be meaningful for those with schizophrenia, and include measures of improvement and relapse (not just rating scale scores), functioning and quality of life and acceptability and, importantly, safety data.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Improvement, short term. PANSS Follow-up: 6 to 8 weeks Adjunctive antioxidants for schizophrenia may reduce the chance of experiencing the global state outcome but there is no clear difference between people given adjunctive antioxidants for schizophrenia and those receiving placebo. These findings are based on data of low quality. RR 0.77 (0.53 to 1.12) Low Total PANSS scores, short term PANSS Follow-up: 6 to 12 weeks On average, people receiving adjunctive antioxidants for schizophrenia scored 6.0 lower than people treated with placebo. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of very limited quality. MD 6.0 lower (10.53 lower to 1.65 lower) Very low Total BPRS scores, short term BPRS Follow-up: 6 to 16 weeks On average, people receiving adjunctive antioxidants for schizophrenia scored 3.2 lower than people treated with placebo. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is bsed on data of low quality. MD 3.2 lower (5.63 lower to 0.78 lower) Low General functioning Short term. GAS Follow-up: 6 weeks The mean general functioning - short term in the intervention groups was 1.11 lower. There was no clear difference between the groups and the meaning of these findings in day-to-day care remain unclear. This finding is based on data of low quality. MD 1.11 lower (8.07 lower to 5.86 higher) Low Medium term. GAS Follow-up: 24 weeks The mean general functioning - medium term in the intervention groups was 2.84 higher. There was no clear difference between the groups and the meaning of these findings in day-to-day care remain unclear. This finding is based on data of high quality. MD 2.84 higher (2.09 lower to 7.77 higher) High Leaving the study early Short term. Follow-up: 6 to 16 weeks Adjunctive 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. RR 0.73 (0.48 to 1.11) Moderate Adverse effects 1. Serious (any time point) - any serious adverse effect. Various methods Adjunctive antioxidants for schizophrenia may cause very slightly decrease to the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given adjunctive antioxidants for schizophrenia and those receiving placebo. These findings are based on data of low quality. RR 0.65 (0.19 to 2.27) Low

Antiglucocorticoid and related treatments for psychosis

Any antiglucocorticoid compared with placebo as sole treatment (data only for mifepristone) for psychosis

Summary
Good evidence is insufficient to conclude whether antiglucocorticoid drugs provide effective treatment for psychosis. Some global state findings suggest a favourable effect for mifepristone, and a few overall adverse effect findings favour placebo. Additional large randomised controlled trials are needed to justify findings.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state General - average endpoint score. BPRS total scores. Follow-up: 4 days On average, people receiving any antiglucocorticoid scored 5.2 lower than people treated with any antiglucocorticoid compared with placebo as sole treatment. There was no clear difference between the groups and this finding is based on data of very limited quality. The meaning of this in day-to-day care is unclear. MD 5.2 lower (17.91 lower to 7.51 higher) Very low Specific - depression - average endpoint score. HAMD total. Follow-up: 4 days On average, people receiving any antiglucocorticoid scored 1.67 higher than people treated with any antiglucocorticoid compared with placebo as sole treatment. There was no clear difference between the groups and this finding is based on data of very limited quality. The meaning of this in day-to-day care is unclear. MD 1.67 higher (16.44 lower to 19.78 higher) Very low Global state General - no clinically significant improvement - short term < 30% improvement on BPRSFollow-up: 7 days Any antiglucocorticoid may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.58 (0.38 to 0.89) Low Specific: positive - no clinically significant improvement - short term (< 50% improvement on BPRS PSS)Follow-up: 7 days Any antiglucocorticoid may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.6 (0.43 to 0.84) Low General functioning Improved to an important degree The outcome was not measured/reported in the included studies. Adverse effects General: overall number of events. Follow-up: 7 days Any antiglucocorticoid probably slightly reduces the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.92 (0.77 to 1.09) Moderate Quality of life Improved to an important degree The outcome was not measured/reported in the included studies.

Alternative tables from review

Any antiglucocorticoid compared with placebo as adjunct to atypical antipsychotic treatment (data only for dhea) for psychosis

Summary
Good evidence is insufficient to conclude whether antiglucocorticoid drugs provide effective treatment for psychosis. Some global state findings suggest a favourable effect for mifepristone, and a few overall adverse effect findings favour placebo. Additional large randomised controlled trials are needed to justify findings.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state General - average endpoint score. PANSS total. Follow-up: 12 weeks On average, people receiving any antiglucocorticoid scored 1.7 lower than people treated with any antiglucocorticoid compared with placebo as adjunct to atypical antipsychotic treatment. 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. MD 1.7 lower (10.78 lower to 7.38 higher) Low Specific - negative symptoms - average endpoint score. PANSS subscale. Follow-up: 12 weeks On average, people receiving any antiglucocorticoid scored 0.7 higher than people treated with any antiglucocorticoid compared with placebo as adjunct to atypical antipsychotic treatment. There was no clear difference between the groups and data supporting this finding are of low quality. The meaning of this in day-to-day care is unclear. MD 0.7 higher (2.63 lower to 4.03 higher) Low Global state General - no clinically significant improvement The outcome was not measured/reported in the included studies. General functioning Improved to an important degree The outcome was not measured/reported in the included studies. Adverse effects Specific: extrapyramidal symptoms - average endpoint scores parkinsonism. SAS total. Follow-up: 12 weeks Mean adverse effects: extrapyramidal symptoms - average endpoint scores parkinsonism in intervention groups were the same in both groups. These findings are based on data with limited quality. The meaning of this in day-today- care is not clear. MD 0 higher (0.88 lower to 0.88 higher ) Low Quality of life Improved to an important degree The outcome was not measured/reported in the included studies.

Any antiglucocorticoid compared with placebo as adjunct to combination treatment for psychosis

Summary
Good evidence is insufficient to conclude whether antiglucocorticoid drugs provide effective treatment for psychosis. Some global state findings suggest a favourable effect for mifepristone, and a few overall adverse effect findings favour placebo. Additional large randomised controlled trials are needed to justify findings.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state General - average endpoint score - short term - only mifepristone. BPRS total. Follow-up: 7 days On average, people receiving any antiglucocorticoid scored 2.1 higher than people treated with placebo as adjunct to combination treatment. 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. MD 2.1 higher (2.86 lower to 7.06 higher) Low Specific - negative symptoms - average endpoint scores - immediate. PANSS negative subscale On average, people receiving any antiglucocorticoid scored 1.68 higher than people treated with placebo as adjunct to combination treatment. 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. MD 1.68 higher (0.93 lower to 4.3 higher) Low Global state General -no clinically significant improvement - data only for mifepristone < 30% improvement on BPRSFollow-up: 6 weeks Any antiglucocorticoid may reduce the chance of experiencing the global state outcome, 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. RR 0.58 (0.32 to 1.06) Very low General functioning Average endpoint scores - data only for DHEAGAF/SOFA Follow-up: 6 weeks On average, people receiving any antiglucocorticoid scored 4.4 higher than people treated with placebo as adjunct to combination treatment. 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. MD 4.4 higher (3.4 lower to 12.2 higher) Low Adverse effects General - overall number of events. Follow-up: 12 weeks Any antiglucocorticoid probably increases the chance of experiencing the adverse effect or event outcome. Data are based on moderate quality evidence. RR 2.66 (1.33 to 5.32) Moderate Adverse events Specific - extrapyramidal symptoms - average endpoint scores - data only for DHEASHRS total. Follow-up: 6 weeks Mean adverse events: 2. Specific - extrapyramidal symptoms - average endpoint scores - data only for DHEA in intervention groups was 5 lower (8.85 to 1.15 lower) MD ) Low Quality of life Improved to an important degree The outcome was not measured/reported in the included studies.

Molindone for schizophrenia and severe mental illness

Molindone compared to atypical antipsychotics: risperidone for schizophrenia and severe mental illness

Summary
The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic but its adverse effect profile does not differ significantly from that of typical antipsychotics (apart from the event of weight loss). Data from this review suggest, at present, there is no evidence to suggest that it may have an atypical profile. From the 2010 update useful data on this drug for the treatment of adults with schizophrenia are limited.
Measured Outcome Findings in words Findings in numbers Quality of evidence No clincial response Outcome: Molindone may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given molindone and those receiving atypical antipsychotics: risperidone. These findings are based on data of low quality. RR 1.08 (0.69 to 1.70) Low Global outcome CGI improvement Molindone may increase the chance of experiencing the outcome but there is no clear difference between people given molindone and those receiving atypical antipsychotics: risperidone. These findings are based on data of low quality. RR 1.29 (0.85 to 1.96) Low Service outcome Outcome: Not reported Mental state PANSS score On average, people receiving molindone scored 3.3 lower than people treated with atypical antipsychotics: risperidone. There was no clear difference between the groups and data supporting this finding are based on low quality evidence. The meaning of this in day-to-day care is unclear. MD 3.3 lower (12.84 lower to 6.24 higher) Low Adverse event Extrapyramidal side effects (adjunctive benzodiazepine) Molindone may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given molindone and those receiving atypical antipsychotics: risperidone. These findings are based on data of low quality. RR 0.96 (0.57 to 1.63) Low Weight change On average, people receiving molindone scored 3.3 lower than people treated with atypical antipsychotics: risperidone. 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. MD 3.3 lower (4.82 lower to 1.78 lower) Low Quality of life Outcome: Not reported

Lithium for schizophrenia

Lithium as sole treatment compared with placebo as sole treatment for schizophrenia

Summary
The evidence base for the use of lithium in schizophrenia is limited to 22 studies of overall low methodological quality. There is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. There is some GRADE low quality evidence that augmentation of antipsychotics with lithium is effective, but the effects are not significant when more prone-to-bias open RCTs are excluded. Nevertheless, further large and well-designed trials are justified. These should concentrate on two target groups: (1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, and (2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Response to treatment Clinically relevant response as defined by the authors. Follow-up: mean 3 weeks Lithium as sole treatment may slightly reduce the chance of experiencing the global state (Response to treatment) outcome but there is no clear difference between people given lithium as sole treatment and those receiving placebo as sole treatment. These findings are based on data of low quality. RR 0.83 (0.44 to 1.55) Low Acceptability of treatment Leaving early due to any reason. Follow-up: mean 3 weeks Lithium as sole treatment may very slightly increase the chance of experiencing the global state (acceptability of treatment) outcome, but, there is no clear difference between people given lithium as sole treatment and those receiving placebo as sole treatment. These findings are based on data of low quality. RR 1.14 (0.29 to 4.44) Low Clinically significant response on depressive symptoms At least 50% MADRS improvement. Follow-up: Mean 8 weeks Lithium as sole treatment may increase the chance of experiencing the outcome but there is no clear difference between people given lithium as sole treatment and those receiving placebo as sole treatment. These findings are based on data of low quality. RR 1.43 (0.65 to 3.16) Low Clinically significant response on manic symptoms At least 50% Bech-Rafaelsen improvement. Follow-up: Mean 8 weeks Lithium as sole treatment may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given lithium as sole treatment and those receiving placebo as sole treatment. These findings are based on data of low quality. RR 1.03 (0.38 to 2.81) Low Clinically significant response on positive symptoms At least 50% MS improvement. Follow-up: Mean 8 weeks Lithium as sole treatment may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given lithium as sole treatment and those receiving placebo as sole treatment. These findings are based on data of low quality. RR 0.86 (0.44 to 1.69) Low Kidney dysfunction Outcome: Outcome not available in any study Thyroid dysfunction Outcome: Outcome not available in any study

ALternative tables from same review

Lithium compared with antipsychotics for schizophrenia

Summary
The evidence base for the use of lithium in schizophrenia is limited to 22 studies of overall low methodological quality. There is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. There is some GRADE low quality evidence that augmentation of antipsychotics with lithium is effective, but the effects are not significant when more prone-to-bias open RCTs are excluded. Nevertheless, further large and well-designed trials are justified. These should concentrate on two target groups: (1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, and (2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Response to treatment Clinically relevant response as defined by the authors. Follow-up: mean 5 weeks Lithium may reduce the chance of experiencing the global state (Response to treatment) outcome but there is no clear difference between people given lithium and those receiving antipsychotics. These findings are based on data of low quality. RR 0.72 (0.28 to 1.84) Low Acceptability of treatment Leaving early due to any reason. Follow-up: mean 10.6 weeks Lithium may increase the chance of experiencing the global state (acceptability of treatment) outcome, but, at present there is only very limited data supporting this finding. RR 1.77 (1.01 to 3.11) Very low Clinically significant response on depressive symptoms At least 50% MADRS improvement. Follow-up: Mean 8 weeks Lithium may reduce the chance of experiencing the outcome but there is no clear difference between people given lithium and those receiving antipsychotics. These findings are based on data of low quality. RR 0.73 (0.43 to 1.25) Low Clinically significant response on manic symptoms At least 50% Bech-Rafaelsen improvement. Follow-up: Mean 8 weeks Lithium may reduce the chance of experiencing the outcome but there is no clear difference between people given lithium and those receiving antipsychotics. These findings are based on data of low quality. RR 0.51 (0.24 to 1.09) Low Clinically significant response on positive symptoms At least 50% MS improvement. Follow-up: Mean 8 weeks Lithium may reduce the chance of experiencing the outcome. Data are based on low quality evidence. RR 0.49 (0.29 to 0.83) Low Kidney dysfunction Outcome: Outcome not available in any study Thyroid dysfunction Outcome: Outcome not available in any study

Adjunctive lithium + antipsychotics compared with placebo/no adjunctive treatment + antipsychotics for schizophrenia

Summary
The evidence base for the use of lithium in schizophrenia is limited to 22 studies of overall low methodological quality. There is no randomised trial-based evidence that lithium on its own is an effective treatment for people with schizophrenia. There is some GRADE low quality evidence that augmentation of antipsychotics with lithium is effective, but the effects are not significant when more prone-to-bias open RCTs are excluded. Nevertheless, further large and well-designed trials are justified. These should concentrate on two target groups: (1) people with no affective symptoms, so that trialists can determine whether lithium has an effect on the core symptoms of schizophrenia, and (2) people with schizoaffective disorders for whom lithium is widely used in clinical practice, although there is no evidence to support this use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Response to treatment Clinically relevant response as defined by the authors. Follow-up: mean 10 weeks Adjunctive lithium + antipsychotics may increase the chance of experiencing the global state (Response to treatment) outcome. Data are based on low quality evidence. RR 1.81 (1.1 to 2.97) Low Acceptability of treatment Leaving early due to any reason. Follow-up: mean 10.2 weeks Adjunctive lithium + antipsychotics may increase the chance of experiencing the global state (acceptability of treatment) outcome, 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. RR 1.89 (0.93 to 3.84) Very low Clinically significant response on depressive symptoms At least 50% MADRS improvement. Follow-up: Mean 8 weeks Adjunctive lithium + antipsychotics may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given adjunctive lithium + antipsychotics and those receiving placebo/no adjunctive treatment + antipsychotics. These findings are based on data of low quality. RR 1.05 (0.69 to 1.58) Low Clinically significant response on manic symptoms At least 50% Bech-Rafaelsen improvement. Follow-up: Mean 8 weeks Adjunctive lithium + antipsychotics may slightly increase the chance of experiencing the outcome but there is no clear difference between people given adjunctive lithium + antipsychotics and those receiving placebo/no adjunctive treatment + antipsychotics. These findings are based on data of low quality. RR 1.13 (0.7 to 1.82) Low Clinically significant response on positive symptoms At least 50% MS improvement. Follow-up: Mean 8 weeks Adjunctive lithium + antipsychotics may reduce the chance of experiencing the outcome but there is no clear difference between people given adjunctive lithium + antipsychotics and those receiving placebo/no adjunctive treatment + antipsychotics. These findings are based on data of low quality. RR 0.84 (0.62 to 1.13) Low Kidney dysfunction Outcome: Outcome not available in any study Thyroid dysfunction Outcome: Outcome not available in any study

Morita therapy

Morita therapy for schizophrenia

Summary
Morita therapy for schizophrenia remains an experimental intervention. New trials are justified and specific plans for the design of future studies are outlined. [Note: the 10 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state Overall no clinically important improvement (BPRS) - short term - 25-30% change BPRS (follow-up: 10 weeks) Morita therapy may reduce the chance of experiencing the mental state outcome but there is no clear difference between people given morita therapy and those recieving the control. These findings are based on data of low quality. RR 0.36 (0.13 to 1.03) Low Overall no clinically important improvement (BPRS) - medium term - 25-30% change BPRS (follow-up: 5 months) Morita therapy may reduce the chance of experiencing the mental state outcome. Data are based on low quality evidence. RR 0.36 (0.14 to 0.89) Low

Music therapy for people with schizophrenia and schizophrenia-like disorders

Music tharapy compared with standard care

Summary
Moderate- to low-quality evidence suggests that music therapy as an addition to standard care improves the global state, mental state (including negative and general symptoms), social functioning, and quality of life of people with schizophrenia or schizophrenia-like disorders. However, effects were inconsistent across studies and depended on the number of music therapy sessions as well as the quality of the music therapy provided. Further research should especially address the long-term effects of music therapy, dose-response relationships, as well as the relevance of outcome measures in relation to music therapy.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically important overall improvement (as rated by individual trials) - medium term (follow-up: 3-6 months) Music therapy (in addition to standard care) may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.38 (0.24 to 0.59) Low Mental state Specific - negative symptoms - average endpoint score (SANS, high score = poor) medium term (follow-up: 3-6 months) On average, people receiving music therapy (in addition to standard care) scored 0.55 lower than people treated with standard care alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 0.55 lower (0.87 lower to 0.24 lower) Low General - average endpoint score (PANSS, high score = poor) - medium term, (follow-up: 3-6 months) On average, people receiving music therapy (in addition to standard care) scored 0.97 lower than people treated with standard care alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 0.97 lower (1.31 lower to 0.63 lower) Low General - average endpoint score (BPRS, high score = poor) - medium term (follow-up: 3-6 months) On average, people receiving music therapy (in addition to standard care) scored 1.25 lower than people treated with standard care alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 1.25 lower (1.77 lower to 0.73 lower) Moderate Functioning: general Average endpoint score (GAF, high score = good) medium term (follow-up: 3-6 months) On average, people receiving music therapy (in addition to standard care) scored 0.19 lower than people treated with standard care alone. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 0.19 lower (0.56 lower to 0.18 higher) Moderate Functioning: social Average endpoint score (SDSS, high score = poor) medium term, (follow-up: 3-6 months) On average, people receiving music therapy (in addition to standard care) scored 0.72 lower than people treated with standard care alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 0.72 lower (1.04 lower to 0.4 lower) Moderate Quality of life General - average endpoint score (GWB, high score = good) - short term(follow-up: less than 3 months) On average, people receiving music therapy (in addition to standard care) scored 1.82 higher than people treated with standard care alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 1.82 higher (1.27 higher to 2.38 higher) Moderate

Nidotherapy for people with schizophrenia

Nidotherapy-enhanced standard care compared with standard care for people with schizophrenia

Summary
Further research is needed into the possible benefits or harms of this newly-formulated therapy. Until such research is available, patients, clinicians, managers and policymakers should consider it an experimental approach.
Measured Outcome Findings in words Findings in numbers Quality of evidence Functioning Specific - social On average, people receiving nidotherapy-enhanced standard care scored 1.7 lower than people treated with standard care for people with schizophrenia. 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 very limited quality. MD 1.7 lower (4.6 lower to 1.2 higher) Very low General - no important change The outcome was not measured/reported in the included studies. Mental state No important change - medium term (6 - 12 months) Brief Psychiatric Rating Scale (BPRS). Scale from: 0 to 96. Follow-up: 12 months data skewed, what to put? Low Quality of life No important change - medium term (6-12 months) - not measured The outcome was not measured/reported in the included studies. Satisfaction with treatment Outcome: No study reported this outcome Economic outcomes Total costs (12 months) NHS Reference Costs and unit costs. Follow-up: 12 months data skewed, what to put? Low Adverse effects Specific - death. Number of individual deaths of participants. Follow-up: 12 months Nidotherapy-enhanced standard care may reduce the chance of experiencing the adverse effect or event outcome, 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. RR 0.29 (0.01 to 6.74) Very low

Olanzapine versus other atypical antipsychotics for schizophrenia

no SoF in review exclude

Paliperidone palmitate for schizophrenia

Paliperidone palmitate compared to placebo for people with schizophrenia

Summary
In short-term studies, paliperidone palmitate is an antipsychotic drug that is more effective than placebo. We found its adverse effects to be similar to those of its related compounds, paliperidone and risperidone, with extrapyramidal movement disorders, weight gain, and tachycardia all more common with paliperidone palmitate than placebo. While no difference was found in the incidence of reported adverse sexual outcomes, paliperidone palmitate is associated with substantial increases in serum prolactin. When flexibly dosed with a mean doses of approximately 70 to 110 mg every four weeks, paliperidone palmitate appears comparable in efficacy and tolerability to risperidone long-acting injection flexibly dosed with mean doses of approximately 35 mg every two weeks. Note: the 56 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early Any reason. Reported by trial author. Follow-up: median 13 weeks Paliperidone palmitate reduces the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome. Data are based on high quality evidence. RR 0.76 (7 to 84) High No clinically important change Number of people whose PANSS score either increased or did not decrease by at least 30% from the beginning to the end of the trial. Follow-up: median 13 weeks Paliperidone palmitate probably reduces the chance of experiencing the global state (significant response) outcome. Data are based on moderate quality evidence. RR 0.79 (0.74 to 0.85) Moderate Relapse Recurrence of psychotic symptoms. Reported by trial author as adverse event. Follow-up: median 13 weeks Paliperidone palmitate probably slightly reduces the chance of experiencing the global state (relapse) outcome. Data are based on moderate quality evidence. RR 0.56 (0.46 to 0.7) Moderate Average change in prolactin in men Serum prolactin level (ng/mL) Follow-up: Median 13 weeks On average, people receiving paliperidone palmitate scored 13.19 higher than people receiving placebo. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is supported by data of high quality. MD 13.19 higher (11.54 to 14.83 higher) High Average change in prolactin in women Serum prolactin level (ng/mL) Follow-up: Median 13 weeks On average, people receiving paliperidone palmitate scored 36.91 higher than people receiving placebo. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is supported by data of high quality. MD 36.91 higher (31.09 to 42.73 higher) High Average change in weight Change in weight (kg) from beginning to end of trial. Follow-up: Median 13 weeks On average, people receiving paliperidone palmitate scored 1.34 higher than people receiving placebo. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is supported by data of high quality. 1.34 higher (0.97 to 1.7 higher) High Health-related quality of life Not measured The outcome was not measured/reported in the included studies.

Alternative table from same review

Paliperidone palmitate compared to risperidone long-acting injection for schizophrenia

Summary
In short-term studies, paliperidone palmitate is an antipsychotic drug that is more effective than placebo. We found its adverse effects to be similar to those of its related compounds, paliperidone and risperidone, with extrapyramidal movement disorders, weight gain, and tachycardia all more common with paliperidone palmitate than placebo. While no difference was found in the incidence of reported adverse sexual outcomes, paliperidone palmitate is associated with substantial increases in serum prolactin. When flexibly dosed with a mean doses of approximately 70 to 110 mg every four weeks, paliperidone palmitate appears comparable in efficacy and tolerability to risperidone long-acting injection flexibly dosed with mean doses of approximately 35 mg every two weeks. Note: the 56 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Leaving the study early Any reason. Reported by trial author. Follow-up: 13-53 weeks Paliperidone palmitate causes little or no increase to the the chance of experiencing outcome, but the difference between the two treatments is not clear. RR 1.12 (1 to 1.25) High Lack of efficacy. Reported by trial author. Follow-up: 13-53 weeks Paliperidone palmitate probably causes very little or no increase to the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome. Data are based on moderate quality evidence. RR 1.35 (1.06 to 1.71) Moderate Death Reported by trial author. Follow-up: 13-53 weeks Paliperidone palmitate may very slightly increase the chance of experiencing the adverse event or effect (death) outcome, but, there is no clear difference between people given paliperidone palmitate and those receiving risperidone long-acting injection. These findings are based on data of low quality. RR 3.62 (0.6 to 21.89) Low No clinically important change Number of people whose PANSS score either increased or did not decrease by at least 30% from the beginning to the end of the trial. Follow-up: 13-53 weeks Paliperidone palmitate may very slightly increase the chance of experiencing the global state (significant response) outcome, but, there is no clear difference between people given paliperidone palmitate and those receiving risperidone long-acting injection. These findings are based on data of low quality. RR 1.03 (0.93 to 1.14) Low Relapse Recurrence of psychotic symptoms. Reported by trial authors as adverse event. Follow-up: 13-53 weeks Paliperidone palmitate probably causes little or no increase to the chance of experiencing the global state (relapse) outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.23 (0.98 to 1.53) Moderate Cost Not measured The outcome was not measured/reported in the included studies. Health related quality of life Not measured The outcome was not measured/reported in the included studies.

Atypical antipsychotics for psychosis in adolescents

Atypical antipsychotics compared with placebo (only short term)

Summary
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people 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, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
Measured Outcome Findings in words Findings in numbers Quality of evidence Weight gain Outcome: Atypical antipsychotics probably increase the chance of experiencing the outcome compared with people receiving placebo. Data are based on moderate quality evidence. RR 3.56 (1.14 to 11.11) Moderate Weight gain ≥ 7% of baseline Outcome: Atypical antipsychotics increase the chance of experiencing the outcome compared with people receiving placebo. Data are based on high quality evidence. RR 3.12 (1.34 to 7.27) High High prolactin at any time during treatment Outcome: Atypical antipsychotics increase the chance of experiencing the outcome compared with people receiving placebo. Data are based on high quality evidence. RR 4.7 (2.25 to 9.82) High Change in corrected QT Outcome: On average, people receiving atypical antipsychotics scored 6.3 lower compared with people receiving placebo,but, the meaning of this in day-to-day care is not clear. This finding is based on data of high quality. 6.3 lower (12.51 to 0.09 lower) High

Alternative tables same review

Atypical compared with typical antipsychotics (only short term)

Summary
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people 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, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
Measured Outcome Findings in words Findings in numbers Quality of evidence Worse or no improvement Outcome: Atypical may increase the chance of experiencing the outcome but there is no clear difference between people given atypical and those receiving atypical compared with typical antipsychotics. These findings are based on data of low quality. RR 3.3 (0.41 to 26.81) Low Anticholinergic adverse effects Outcome: Atypical probably reduces the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 0.2 (0.05 to 0.8) Moderate Drop in the absolute neutrophil count below 1500 per mm3 Outcome: Atypical makes no difference to the outcome, but, at present it is not possible to be confident about the difference between the two treatments. RR 12 (0.75 to 192.86) Very low Leaving the study early Because of adverse effects Atypical probably increases the the chance of experiencing outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 3.3 (0.41 to 26.81) Moderate

Atypical vs atypical antipsychotics (only short term)

Summary
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people 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, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
Measured Outcome Findings in words Findings in numbers Quality of evidence No improvement Risperidone vs olanzapine The intervention probably causes little or no increase to the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.50 (0.24 to 1.07) Moderate Clozapine vs olanzapine The intervention reduces the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data are based on high quality evidence. RR 0.5 (0.24 to 1.03) High Use of other antipsychotics Outcome: The intervention probably slightly reduces the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.5 (0.05 to 4.9) Moderate Drug-induced diabetes Clozapine vs olanzapine The intervention may increase the chance of experiencing the outcome, but, at present it is not possible to be confident about the difference between the two treatments. RR 3 (0.13 to 67.91) Moderate Elevated prolactin Risperidone vs quetiapine The intervention probably increases the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 10 (1.53 to 65.41) Moderate Weight gain in kg Risperidone vs olanzapine On average, people receiving the intervention scored 2.5 lower compared to the control group, but, the meaning of this for day-to-day care is not clear. This finding is based on data of high quality. MD 2.5 lower (4.21 to 0.79 lower) High Leaving the study early Because of weight gain (risperidone vs olanzapine) The intervention may slightly reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome but there is no clear difference between people given the intervention and those receiving the control . These findings are based on data of low quality. RR 0.37 (0.02 to 8.01) Low

Atypical (standard-dose) vs atypical (low-dose) antipsychotics (only short term)

Summary
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable to young people 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, but side effect profiles are different for different medications. Treatment with olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trials should ensure uniform ways of reporting.
Measured Outcome Findings in words Findings in numbers Quality of evidence No response Outcome: The intervention reduces the chance of experiencing the outcome. Data are based on high quality evidence. RR 0.54 (0.38 to 0.75) High Symptomatic hyperprolactinaemia Outcome: The outcome was not measured/reported in the included studies. High Use of antiparkinsonian medications Outcome: The intervention increases the chance of experiencing the outcome. Data are based on high quality evidence. RR 4.86 (1.91 to 12.38) High Weight gain Standard-dose vs low-dose risperidone The intervention increases the chance of experiencing the outcome. Data are based on high quality evidence. RR 3.32 (1.47 to 7.49) High

Penfluridol for schizophrenia

Penfluridol compared to typical antipsychotics (oral) for schizophrenia

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 chronic sufferers of 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. Note: the eight citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No marked improvement (measured by CGI, medium term 3 to 12 months) Penfluridol may very slightly increase the chance of experiencing the global state outcome, but, there is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality. RR 0.92 (0.68 to 1.24) Low Global outcome Global state - needing additional antipsychotic (short term less than 3 months) Penfluridol may slightly increase the chance of experiencing the outcome but there is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality. RR 1.35 (0.90 to 2.01) Low Service outcome Outcome: Not reported Mental state BPRS mean endpoint score (medium term 3 to 12 months) On average, people receiving penfluridol scored 1.24 higher than people treated with typical antipsychotics (oral). 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. MD 1.24 higher (4.4 lower to 6.88 higher) Low Adverse events Needing antiparkinsonism medication (short term less than 3 months) Penfluridol may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality. RR 1.09 (0.61 to 1.97) Low Insomnia (short term less than 3 months) Penfluridol may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality. RR 1.07 (0.51 to 2.24) Low Quality of life Outcome: Not reported

Perazine for schizophrenia

Perazine versus placebo for schizophrenia

Summary
The number, size and reporting of randomised controlled perazine trials are insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics but this is based on small comparisons. This should be clarified in larger, well-designed trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Acceptability of treatment Leaving the study early due to any reason. Follow-up: mean 5 weeks Perazine may reduce the chance of experiencing the global state (acceptability of treatment) outcome, 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. RR 0.62 (0.35 to 1.1) Very low Global state Change over time (no better or deterioration)Follow-up: mean 5 weeks Perazine may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.43 (0.23 to 0.81) Low Overall mental state Less than 30% BPRS reduction. Follow-up: Mean 5 weeks Perazine may reduce the chance of experiencing the outcome but there is no clear difference between people given perazine and those receiving placebo. These findings are based on data of low quality. RR 0.82 (0.61 to 1.09) Low Movement disorders Number of participants receiving antiparkinson medication: Follow-up mean 5 weeks Perazine may increase the chance of experiencing the outcome, but, at present there is only very limited data supporting this finding. RR 4.5 (1.04 to 19.45) Very low Overall tolerability Leaving the studies early due to adverse events The outcome was not measured/reported in the included studies. Satisfaction with care Not reported The outcome was not measured/reported in the included studies. Quality of life Not reported The outcome was not measured/reported in the included studies.

Perazine alternative table

Perazine versus other antipsychotics for schizophrenia

Summary
The number, size and reporting of randomised controlled perazine trials are insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics but this is based on small comparisons. This should be clarified in larger, well-designed trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Change over time (no better or deterioration) Follow-up: mean 4 weeks Perazine may slightly increase the chance of experiencing the global state outcome but there is no clear difference between people given perazine and those receiving other antipsychotics. These findings are based on data of low quality. RR 1.33 (0.36 to 4.97) Low Overall mental state BPRS endpoint score, scale from 0 to 108. Follow-up- mean 4 weeks The mean overall mental state in the intervention groups receiving perazine was 0.4 lower. These findings are based on data of low quality and the meaning of this outcome in day-to-day care remains unclear. MD 0.4 lower (0.74 to 0.06 lower) Low Movement disorders, number of participants receiving antiparkinson medication Number of participants receiving antiparkinson medication: Follow-up mean 4 weeks Perazine may increase the chance of experiencing the outcome, 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. RR 1.21 (0.53 to 2.76) Very low Overall tolerabilityLeaving the study early due to adverse eventsFollow-up Leaving the study early due to adverse events: Follow-up mean 4 weeks Perazine may very slightly decrease the chance of experiencing the outcome, but, there is no clear difference between people given perazine and those receiving other antipsychotics. These findings are based on data of low quality. RR 0.87 (0.4 to 1.9) Low Acceptability of treatment Leaving the studies early due to any reason. Follow-up: 1-3 months Perazine may very slightly decrease the chance of experiencing the global state (acceptability of treatment) outcome, but, there is no clear difference between people given perazine and those receiving other antipsychotics. These findings are based on data of low quality. RR 0.97 (0.68 to 1.38) Low Satisfaction with care Not reported The outcome was not measured/reported in the included studies. Quality of life Not reported The outcome was not measured/reported in the included studies.

Pericyazine for schizophrenia

Pericyazine versus typical antipsychotic for schizophrenia

Summary
On the basis of very low quality evidence we are unable to determine the effects of pericyazine in comparison with typical or atypical antipsychotics for the treatment of schizophrenia. However, there is some evidence that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics, and again this was judged to be very low quality evidence. Large, robust studies are still needed before any firm conclusions can be drawn.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved. Follow-up: 6-12 weeks Pericyazine may increase the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between people receiving pericyazine and people receiving typical antipsychotics, and, data supporting this finding are very limited. RR 1.24 (0.93 to 1.66) Very low Relapse. Follow-up: mean 3 months The outcome was not measured/reported in the included studies. Very low Adverse events For specific reasons - Extrapyramidal side effect. Follow-up: 6-12 weeks Pericyazine may reduce the chance of experiencing the adverse effect or event outcome, but, at present there is only very limited data supporting this finding. RR 0.59 (0.38 to 0.89) Very low Mental state Not reported The outcome was not measured/reported in the included studies. Leaving the study early For specific reasons. Follow-up: 9-12 weeks Pericyazine may reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 0.46 (0.11 to 1.9) Very low Behaviour Not reported The outcome was not measured/reported in the included studies. Economic outcomes Not reported The outcome was not measured/reported in the included studies.

Pericyazine alternative tables

Pericyazine versus atypical antipsychotic for schizophrenia

Summary
On the basis of very low quality evidence we are unable to determine the effects of pericyazine in comparison with typical or atypical antipsychotics for the treatment of schizophrenia. However, there is some evidence that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics, and again this was judged to be very low quality evidence. Large, robust studies are still needed before any firm conclusions can be drawn.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved. Follow-up: mean 6 weeks Pericyazine may reduce the chance of experiencing the global state outcome, 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. RR 0.97 (0.67 to 1.42) Very low Adverse Effects Extrapyramidal symptoms. Follow-up: mean 6 weeks Pericyazine may increase the chance of experiencing the outcome, but, at present there is only very limited data supporting this finding. RR 2.69 (1.35 to 5.36) Very low Mental state Not reported The outcome was not measured/reported in the included studies. Leaving the study early For specific reasons Follow-up: 9-12 weeks Pericyazine may reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 0.46 (0.11 to 1.9) Very low Behaviour Not reported The outcome was not measured/reported in the included studies. Economic outcomes Not reported The outcome was not measured/reported in the included studies.

Perphenazine for schizophrenia

Perphenazine compared with placebo for schizophrenia

Summary
Although perphenazine has been used in randomised 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 in this review were of very low quality evidence. At best we can say that perphenazine showed similar effects and adverse events as several of the other antipsychotic drugs. Since perphenazine is a relatively inexpensive and frequently used compound, further trials are justified to clarify the properties of this classical antipsychotic drug.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Change over time - no better or deterioration - short term clinically defined. Follow-up: 6 weeks Perphenazine may reduce the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.32 (0.13 to 0.78) Very low Mental state Relapse - short term clinical diagnosis. Follow-up: 12 weeks Perphenazine may reduce the chance of experiencing the mental state outcome, 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. RR 0.14 (0.02 to 1.07) Very low Adverse events Death - not reported The outcome was not measured/reported in the included studies. Extrapyramidal adverse effects - dystonia - short term. Follow-up: 12 weeks Perphenazine makes no difference to the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between the two treatments. Data supporting this finding are very limited. RR 1 (0.07 to 15.08) Very low Serious adverse events - not reported The outcome was not measured/reported in the included studies. Economic outcomes Not reported The outcome was not measured/reported in the included studies. Service use and hospitalisation Admission - not reported The outcome was not measured/reported in the included studies.

Perphenazine alternative table

Perphenazine compared with any antipsychotics for schizophrenia

Summary
Although perphenazine has been used in randomised 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 in this review were of very low quality evidence. At best we can say that perphenazine showed similar effects and adverse events as several of the other antipsychotic drugs. Since perphenazine is a relatively inexpensive and frequently used compound, further trials are justified to clarify the properties of this classical antipsychotic drug.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Change over time - no better or deterioration - short and medium term as defined in each study. Follow-up: mean 8 weeks Perphenazine may increase the chance of experiencing the global state outcome, 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. RR 1.04 (0.91 to 1.17) Very low Mental state State - 'no effect'BPRS score reduction. Follow-up: mean 8 weeks Perphenazine may increase the chance of experiencing the mental state outcome, 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. RR 1.24 (0.61 to 2.52) Very low Death Not reported The outcome was not measured/reported in the included studies. Adverse events Extrapyramidal adverse effects dystonia - short term. Follow-up: mean 10 weeks Perphenazine may increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.36 (0.23 to 8.16) Very low Other adverse events: any serious adverse event Short and long term. Follow-up: mean 39 weeks Perphenazine may reduce the chance of experiencing the outcome, 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. RR 0.98 (0.68 to 1.41) Very low Economic outcomes Not reported The outcome was not measured/reported in the included studies. Service use and hospitalisation Admission - not reported The outcome was not measured/reported in the included studies.

Physical health care monitoring for people with serious mental illness

Physical health monitoring compared to no monitoring for people with serious mental illness

Summary
There is still no evidence from randomised trials to support or refute current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.
Measured Outcome Findings in words Findings in numbers Quality of evidence Physical health Failure to identify a disease state and provide appropriate treatment The outcome was not measured/reported in the included studies. Failure to effectively manage a known disease state Quality of life Loss of activities of Daily Living (ADL) skills Adverse event Clinically important adverse effect Death Economic Increase costs of care Social Social isolation as a result of preventable incapacity

Pimozide for schizophrenia or related psychoses

Pimozide versus placebo for schizophrenia or related psychoses

Summary
Although shortcomings in the data are evident, 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. No data support or refute its use for those with delusional disorder.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse medium term (3-12 months) Clinical diagnoses. Follow-up: 1 year Pimozide may reduce the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between people receiving pimozide and people receiving placebo, and, data supporting this finding are very limited. RR 0.22 (0.03 to 1.78) Very low Mental state No improvement medium term (3-12 months) The outcome was not measured/reported in the included studies. Specific symptoms first-rank symptoms medium term (3-12 months) The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal adverse effects: Parkinsonism (rigidity) short term (<3 months) Clinical diagnoses. Follow-up: 12 weeks Pimozide may increase the chance of experiencing the adverse effect or event outcome, 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. RR 5.5 (0.3 to 101.28) Very low Extrapyramidal adverse effects: Parkinsonism (rigidity) medium term (3-12 months) Clinical diagnoses. Follow-up: 6 months Pimozide may increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.33 (0.14 to 12.82) Very low Extrapyramidal adverse effects: Parkinsonism (tremor) medium term (3-12 months) Clinical diagnoses. Follow-up: 6 months Pimozide makes no difference to the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between the two treatments. Data supporting this findings are very limited. RR 1 (0.2 to 4.95) Very low Quality of life No significant change in quality of life/satisfaction medium term (3-12 months) The outcome was not measured/reported in the included studies.

Pimozide alternative tables from same review

Pimozide versus any antipsychotic for schizophrenia or related psychoses

Summary
Although shortcomings in the data are evident, 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. No data support or refute its use for those with delusional disorder.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse medium term (3-12 months) Clinical diagnoses. Follow-up: mean 38 weeks Pimozide probably slightly reduces the chance of experiencing the global state outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.82 (0.57 to 1.17) Moderate Mental state No improvement medium term (3-12 months) As defined in each study. Follow-up: 16 weeks Pimozide may increase the chance of experiencing the mental state outcome, 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. RR 1.09 (0.08 to 15.41) Very low Presence of first-rank symptoms medium term (3-12 months) Clinical diagnoses. Follow-up: 1 years Pimozide may reduce the chance of experiencing the mental state outcome but there is no clear difference between people given pimozide and those receiving any antipsychotic. These findings are based on data of low quality. RR 0.53 (0.25 to 1.11) Low Adverse effects Extrapyramidal adverse effects. Parkinsonism (rigidity) short term (< 3 months) Clinical diagnoses. Follow-up: mean 14 weeks Pimozide may slightly increase the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given pimozide and those receiving any antipsychotic. These findings are based on data of low quality. RR 1.25 (0.37 to 4.17) Low Extrapyramidal adverse effects Parkinsonism (rigidity) medium term (3-12 months) Clinical diagnoses. Follow-up: mean 26 weeks The outcome was not measured/reported in the included studies. Low Extrapyramidal adverse effects Parkinsonism (tremor) medium term (< 3 months) Clinical diagnoses. Follow-up: mean 29 weeks Pimozide may slightly increase the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given pimozide and those receiving any antipsychotic. These findings are based on data of low quality. RR 1.45 (0.68 to 3.09) Low Quality of life No significant change in quality of life/satisfaction medium term (3-12 months) not reported The outcome was not measured/reported in the included studies.

Pimozide + any antipsychotic versus any antipsychotic for schizophrenia or related psychoses

Summary
Although shortcomings in the data are evident, 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. No data support or refute its use for those with delusional disorder.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapsemedium term (3-12 months) Clinical diagnoses. Follow-up: 1 years Pimozide + any antipsychotic may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.28 (0.15 to 0.50) Low Mental state No improvement medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Presence of first-rank symptoms medium term (3-12 months)not reported The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal adverse effects Parkinsonism short term (< 3 months) not reported The outcome was not measured/reported in the included studies. Extrapyramidal adverse effects Parkinsonism medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Quality of life Average change score medium term (3-12 months) Specific Level of Functioning, SLOF (high = better, skewed) The mean quality of life: average change score medium term (3-12 months) in the intervention groups was 0 higher(0 to 0 higher) MD 0 higher (0 to 0 higher)

Pimozide + any antipsychotic versus antipsychotic + placebo for schizophrenia or related psychoses

Summary
Although shortcomings in the data are evident, 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. No data support or refute its use for those with delusional disorder.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse medium term (3-12 months) RR 0.64 (0.37 to 1.1) Mental state No improvement medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Presence of first-rank symptoms medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal adverse effects Parkinsonism short term (< 3 months) not reported The outcome was not measured/reported in the included studies. Extrapyramidal adverse effects Parkinsonism medium term (3-12 months) Extrapyramidal Symptom Rating Scale (ESRS) Follow-up: 12 weeks The outcome was not measured/reported in the included studies. Low Quality of life Average change score medium term (3-12 months) Specific Level of Functioning scale (SLOF)Follow-up: 12 weeks The outcome was not measured/reported in the included studies. Low

Pimozide + any antipsychotic versus antipsychotic + antipsychotic for schizophrenia or related psychoses

Summary
Although shortcomings in the data are evident, 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. No data support or refute its use for those with delusional disorder.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Mental state No improvement medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Presence of first-rank symptoms medium term (3-12 months) not reported The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal adverse effects Parkinsonism (rigidity) short term (< 3 months) Extrapyramidal Symptom Rating Scale (ESRS) Follow-up: 2 months The outcome was not measured/reported in the included studies. Very low Extrapyramidal adverse effects Parkinsonism (tremor) short term (< 3 months) Extrapyramidal Symptom Rating Scale (ESRS) Follow-up: 2 months The outcome was not measured/reported in the included studies. Very low Quality of life Average change score medium term (3-12 months) not reported The outcome was not measured/reported in the included studies.

Depot pipotiazine palmitate and undecylenate for schizophrenia

Pipotiazine palmitate compared to oral antipsychotics for schizophrenia

Summary
Although well-conducted and reported randomised trials are still needed to fully inform practice (no trial data exists reporting hospital and services outcomes, satisfaction with care and economics) pipotiazine palmitate is a viable choice for both clinician and recipient of care.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global impression No important clinical response (immediate by 3 weeks) Pipotiazine palmitate may increase the chance of experiencing the global state outcome 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. RR 2.57 (0.76 to 8.63) Low Global outcome Leaving the study early (up to 5 weeks) Pipotiazine palmitate may increase the chance of experiencing the outcome 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. RR 3.85 (0.46 to 32.22) Low Service outcome Outcome: Not reported Mental state Relapse (longer term by 18 months) Pipotiazine palmitate may slightly increase the chance of experiencing the mental state outcome 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. RR 1.55 (0.76 to 3.18) Low Adverse effects Tardive dyskinesia Pipotiazine palmitate may very slightly increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.03 (0.22 to 4.92) Low Dystonia Pipotiazine palmitate may slightly reduce the chance of experiencing the adverse effect or event outcome 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. RR 0.32 (0.04 to 2.89) Low Quality of life Outcome: Not reported

Pharmacological treatments for psychosis-related polydipsia

Drug treatments compared to placebo for psychosis-related polydipsia

Summary
The trials offer little useful data to the clinician hoping to treat psychosis-related polydipsia with drugs, except that further evaluative studies need to be conducted in this area. Treatment of any sort for psychosis related polydipsia might only be informative within a well designed, conducted and reported randomised study. The two pioneering studies suggest that larger trials, though difficult, would not be impossible with adequate support and co-ordination.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early (drug = oral demeclocycline, by 3 - 6 weeks) Very low Service outcome Outcome: Not reported Mental state Outcome: Not reported Adverse effects With oral demeclocycline orally (by 3-6 weeks) Very low With naloxone infusion (by 3 - 6 weeks) Very low Quality of life Outcome: Not reported

Antipsychotic drugs for non-affective psychosis during pregnancy and postpartum

exclude

Advance treatment directives for people with severe mental illness

Advance directives compared to usual care for people with severe mental illness

Summary
There are too few data available to make definitive recommendations. More intensive forms of advance directive appear to show promise, but currently practice must be guided by evidence other than that derived from randomised trials. More trials are indicated to determine whether higher intensity interventions, such as joint crisis planning, have an effect on outcomes of clinical relevance.
Measured Outcome Findings in words Findings in numbers Quality of evidence Overall psychiatric admissions Outcome: Advance directives may reduce the chance of experiencing the outcome but there is no clear difference between people given advance directives and those receiving usual care for people with severe mental illness. These findings are based on data of low quality. RR 0.69 (0.45 to 1.04) Low Global outcome Criminal justice contacts - arrests On average, people receiving advance direcitves scored 0.1 lower than people treated with usual care. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 0.1 lower (0.32 lower to 0.12 higher) Moderate Service outcome Compliance with mental health treatment On average, people receiving advance direcitves scored 0.1 lower than people treated with usual care. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 0.1 lower (0.62 lower to 0.42 higher) Moderate Mental state Outcome: Not reported Adverse event Suicide Advance directives may very slightly reduce the chance of experiencing the outcome, but, there is no clear difference between people given advance directives and those receiving usual care for people with severe mental illness. These findings are based on data of low quality. RR 0.49 (0.05 to 5.26) Low Self harm Advance directives may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given advance directives and those receiving usual care for people with severe mental illness. These findings are based on data of low quality. RR 0.14 (0.02 to 1.13) Low Quality of life Outcome: Not reported

Supported employment for adults with mental illness

Supported employment versus other vocational approaches for adults with severe mental illness

Summary
The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.
Measured Outcome Findings in words Findings in numbers Quality of evidence Employment Obtained any job during the study (high=better)Follow-up: mean 18 months Supported employment may increase the chance of obtaining a job, but, at present there is only very limited data supporting this finding. RR 2.62 (2.18 to 3.16) Very low Days in competitive employment (primary outcome) - long term. Follow-up: 24 months On average, people receiving supported employment scored 71 days higher than people treated with other vocational approaches. The meaning of this in day-to-day care is unclear. MD 70.63 higher (43.22 to 98.04 higher) Very low Days in any form of paid employment - long term. Follow-up: mean 21 months On average, people receiving supported employment scored 85 days higher than people treated with other vocational approaches. The meaning of this in day-to-day care is unclear. MD 84.94 higher (51.99 to 117.89 higher) Very low Job tenure for competitive employment (weeks) - long term. Follow-up: 24 months On average, people receiving supported employment scored 10 weeks higher than people treated with other vocational approaches. The meaning of this in day-to-day care is unclear. MD 9.86 higher (5.36 to 14.36 higher) Very low Job tenure for any paid employment (weeks) - long term. Follow-up: mean 22 months On average, people receiving supported employment scored 4 weeks higher than people treated with other vocational approaches, but there was no clear difference between the groups. The meaning of this in day-to-day care is unclear. MD 3.86 higher (5.66 lower to 13.38 higher) Very low Time (days) to first competitive employment Long term. Follow-up: 24 months On average, people receiving supported employment scored 162 days lower than people treated with other vocational approaches. The meaning of this in day-to-day care is unclear. MD 161.6 lower (225.73 to 97.47 lower) Very low

Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness

Individual psychodynamic psychotherapy versus medication for schizophrenia and severe mental illness

Summary
Current data do not support the use of psychodynamic psychotherapy techniques for hospitalised people with schizophrenia. If psychoanalytic therapy is being used for people with schizophrenia there is an urgent need for trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Committed suicide by three years Outcome: Individual psychodynamic psychotherapy may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given individual psychodynamic psychotherapy and those receiving medication. These findings are based on data of low quality. RR 0.52 (0.05 to 5.56) Low Global impression Not able to be discharged (long term) Individual psychodynamic psychotherapy may increase the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 8.35 (2.03 to 34.3) Low Given medication during 12 months to three years follow up - by 12 months Individual psychodynamic psychotherapy may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.64 (0.5 to 0.81) Low Given medication during 12 months to three years follow up - by three years Individual psychodynamic psychotherapy may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.85 (0.75 to 0.96) Low

Psychoeducation for schizophrenia

Any form of psychoeducation compared with standard care for schizophrenia

Summary
Psychoeducation does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay in these hospital-based studies of limited quality. The true size of effect is likely to be less than demonstrated in this review - but, nevertheless, some sort of psychoeducation could be clinically effective and potentially cost beneficial. It is not difficult to justify better, more applicable, research in this area aimed at fully investigating the effects of this promising approach. Note: the 27 new citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Compliance Not compliant with medication. Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the adherence with treatment outcome, but, at present there is only very limited data supporting this finding. RR 0.48 (0.31 to 0.75) Very low With follow-up - loss to follow-up for any reason - long term (by 5 years or more) Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the adherence with treatment outcome, 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. RR 0.77 (0.48 to 1.23) Very low With follow-up - received intervention but left the study early - long term. Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the adherence with treatment outcome but there is no clear difference between people given any form of psychoeducation and those receiving standard care. These findings are based on data of low quality. RR 0.63 (0.38 to 1.04) Low Relapse Relapse for any reason - long term. Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the global state (relapse) outcome. Data are based on low quality evidence. RR 0.73 (0.62 to 0.85) Low Relapse with readmission - long term. Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the global state (relapse) outcome. Data are based on low quality evidence. RR 0.71 (0.56 to 0.89) Low Satisfaction with mental health Binary outcome - medium term - unsatisfied. Follow-up: 12 months Any form of psychoeducation may reduce the chance of experiencing the satisfaction with health outcome. Data are based on low quality evidence. RR 0.4 (0.17 to 0.96) Low Adverse event: Death Long term. Follow-up: 12 months Any form of psychoeducation may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given any form of psychoeducation and those receiving standard care. These findings are based on data of low quality. RR 1.39 (0.24 to 8.11) Low

Psychosocial interventions for people with both severe mental illness and substance misuse

Integrated models of care compared to treatment as usual for both severe mental illness and substance misuse

Summary
We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Lost to treatment Follow-up: mean 36 months Integrated models of care may very slightly increase the chance of experiencing the treatment outcome, but, there is no clear difference between people given integrated models of care and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 1.09 (0.82 to 1.45) Low Death Follow-up: mean 36 months Integrated models of care may very slightly increase the chance of experiencing the adverse event or effect (death) outcome, but, there is no clear difference between people given integrated models of care and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 1.18 (0.39 to 3.57) Low Alcohol use Not in remission Follow-up- mean 36 months Integrated models of care may slightly increase the chance of experiencing the outcome but there is no clear difference between people given integrated models of care and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 1.15 (0.84 to 1.56) Low Drug (non-alcohol) use Not in remission. Follow-up- mean 36 months Integrated models of care may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given integrated models of care and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 0.89 (0.63 to 1.25) Low Mental state Days of hospitalisation The outcome was not measured/reported in the included studies. Global Assessment of Functioning GAF scale of 1 - 100 Follow-up: mean 12 months On average, people treated with integrated models of care scored 0.7 higher compared with people receiving treatment as usual, but, there was no clear difference between the two groups and the meaning of this in day-to-day care is not clear. This finding is based on data of low quality. MD 0.7 higher (2.07 lower to 3.47 higher) Low General life satisfaction Quality of Life Interview section, scale of 1 to 7. Follow-up: mean 12 months On average, people treated with integrated models of care scored 0.02 higher compared with people receiving treatment as usual, but, there was no clear difference between the two groups and the meaning of this in day-to-day care is not clear. This finding is based on data of moderate quality. MD 0.02 higher (0.28 lower to 0.32 higher) Moderate

Alternative tables from same review

Non-integrated models of care or intensive case management compared to treatment as usual for both severe mental illness and substance misuse

Summary
We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Lost to treatment Follow-up: mean 12 months Non-integrated models of care or intensive case management may increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 1.21 (0.73 to 1.99) Very low Death Not measured The outcome was not measured/reported in the included studies. Alcohol use C-DIS-R computer program for Diagnostic Interview Schedule Average score. Follow-up- mean 12 months The mean alcohol use in the intervention groups was 0 higher. MD 0 higher (0 to 0 higher) Very low Drug (non-alcohol) useC-DIS-R computer program for Diagnostic Interview Schedule Average score. Follow-up- mean 12 months The mean drug (non-alcohol) use in the intervention groups was 0 higher. MD 0 higher (0 to 0 higher) Very low Mental state Schizophrenia symptoms on C-DIS-R computer program for Diagnostic Interview Schedule: average score. Follow-up: mean 12 months The mean mental state in the intervention groups was 0 higher. MD 0 higher (0 to 0 higher) Very low Global assessment of functioning Role Functioning Scale. Follow-up: mean 12 months The mean global assessment of functioning in the intervention groups was 0.7 higher. MD 0.7 higher (1.56 lower to 2.96 higher) Very low General life satisfactionQuality of Life Interview section, scale of 1 to 7Follow-up Mean 12 months The mean general life satisfaction in the intervention groups was 0 higher. MD 0 higher (0 to 0 higher) Very low

Cognitive behaviour therapy + motivational interviewing compared to treatment as usual for both severe mental illness and substance misuse

Summary
We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Lost to treatment Follow-up: mean 12 months Cognitive behaviour therapy + motivational interviewing may very slightly reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome but there is no clear difference between people given cognitive behaviour therapy + motivational interviewing and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 0.99 (0.62 to 1.59) Low Death Follow-up: mean 12 months Cognitive behaviour therapy + motivational interviewing may very slightly reduce the chance of experiencing the adverse event or effect (death) outcome but there is no clear difference between people given cognitive behaviour therapy + motivational interviewing and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 0.72 (0.22 to 2.41) Low Alcohol use Estimated daily consumption in previous month. Follow-up: mean 12 months The outcome was not measured/reported in the included studies. Drug (non-alcohol) use Average number of different drugs used during the past month measured by the Opiate Treatment Index. Follow-up: mean 6 months The mean drug (non-alcohol) use in the intervention groups was 0.19 higher (0.22 lower to 0.6 higher) Low Mental state Relapse at 3 months after 9 months of treatment. Follow-up: mean 12 months Cognitive behaviour therapy + motivational interviewing may reduce the chance of experiencing the mental state outcome, 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. RR 0.5 (0.24 to 1.04) Very low Global Assessment of Functioning GAF scale of 1- 100Follow-up: mean 12 months The mean Global Assessment of Functioning in the intervention groups was 1.24 higher. MD 1.24 higher (1.86 lower to 4.34 higher) Very low General life satisfaction Brief Quality of Life ScaleFollow-up Mean 6 months The mean general life satisfaction in the intervention groups was 0.58 higher. MD 0.58 higher (0 to 1.16 higher) Low

Cognitive behaviour therapy compared to treatment as usual for both severe mental illness and substance misuse

Summary
We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.
Measured Outcome Findings in words Findings in numbers Quality of evidence Lost to treatment Follow-up: mean 3 months Cognitive behaviour therapy may very slightly increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, but, there is no clear difference between people given cognitive behaviour therapy and those receiving treatment as usual for both severe mental illness and substance misuse. These findings are based on data of low quality. RR 1.12 (0.44 to 2.86) Low Death Outcome: The outcome was not measured/reported in the included studies. Alcohol use Outcome: The outcome was not measured/reported in the included studies. Low Drug (non-alcohol) use Cannabis. Percentage of participants who used cannabis in last 4 weeks. Follow-up- mean 6 months Cognitive behaviour therapy may increase the chance of experiencing the outcome, 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. RR 1.3 (0.79 to 2.15) Very low Mental state General symptoms on Brief Psychiatric Rating Scale. Follow-up: mean 6 months The mean mental state in the intervention groups was 0.52 higher. MD 0.52 higher (0.78 lower to 1.82 higher) Low Global assessment of functioning The Social and Occupational Functioning Scale (SOFAS): scale of 1 to 100 Follow-up: mean 6 months The mean global assessment of functioning in the intervention groups was 4.7 lower. MD 4.7 lower (14.52 lower to 5.12 higher) Very low General life satisfaction Outcome: The mean general life satisfaction in the intervention groups was 0 higher. MD 0 higher (0 to 0 higher)

11 SoF in total in this review

Antidepressants for people with both schizophrenia and depression

Any antidepressant and antipsychotic compared to placebo and antipsychotic for people with both schizophrenia and depression

Summary
Overall, the literature was of poor quality, and only a small number of trials made useful contributions. Though our results provide some evidence to indicate that antidepressants may be beneficial for people with depression and schizophrenia, the results, at best, are likely to overestimate the treatment effect, and, at worst, could merely reflect selective reporting of statistically significant results and publication bias. At present, there is no convincing evidence to support or refute the use of antidepressants in treating depression in people with schizophrenia. We need further well-designed, conducted and reported research to determine the best approach towards treating depression in people with schizophrenia. Note: the 71 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.
Measured Outcome Findings in words Findings in numbers Quality of evidence No important clinical response Outcome: Any antidepressant + antipsychotic probably reduces the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 0.62 (0.48 to 0.80) Moderate Global outcome Leaving the study early before 12 weeks Any antidepressant + antipsychotic may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given any antidepressant + antipsychotic and those receiving placebo + antipsychotic for people with both schizophrenia and depression. These findings are based on data of low quality. RR 1.30 (0.84 to 2.01) Low Service outcome Outcome: Not reported Mental state People whose condition was designated 'stable' (BPRS total endpoint, high = poor) On average, people receiving any antidepressant + antipsychotic scored 1.16 lower. There was no clear difference between the two groups. The meaning of that in day-to-day care remains unclear. MD 1.16 lower (5.18 lower to 2.87 higher) Low Adverse effects Any side effects Any antidepressant + antipsychotic may increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.86 (0.78 to 4.41) Very low Extrapyramidal effects with clinically significant severity Any antidepressant + antipsychotic may reduce the chance of experiencing the adverse effect or event outcome. Data are based on low quality evidence. RR 0.39 (0.16 to 0.96) Low Quality of life Outcome: Not reported

Pyridoxal 5 phosphate for neuroleptic-induced tardive dyskinesia

Pyridoxal 5 phosphate (vitamin b6) compared with placebo for neuroleptic-induced tardive dyskinesia

Summary
Pyridoxal 5 phosphate may have some benefits in reducing the severity of tardive dyskinesia symptoms among individuals with schizophrenia. However, the quality of evidence supporting the effectiveness of pyridoxal 5 phosphate in treating tardive dyskinesia is low, based on few studies, short follow-up periods, small sample sizes and inadequate adherence to standardised reporting guidelines for randomised controlled trials among the included studies.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinical efficacy Improvement (> 40%) in ESRS scores from baseline. ESRS Follow-up: mean 17.5 weeks Pyridoxal phosphate (vitamin b) may cause little increase to the chance of experiencing the global state (significant response) outcome when compared to placebo. Data are based on low quality evidence. RR 19.97 (2.87 to 139.19) Low Global Other adverse effects than tardive dyskinesia. Self-report by participants. Follow-up: mean 17.5 weeks Pyridoxal phosphate (vitamin b) increase the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between people given pyridoxal phosphate (vitamin b) and those receiving placebo for neuroleptic-induced tardive dyskinesia. This finding is based on data of low quality. RR 3.97 (0.2 to 78.59) Low Discontinuation of Vitamin B6 Follow-up: mean 17.5 weeks Pyridoxal phosphate (vitamin b) increase the chance of experiencing the global state outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of low quality. RR 8.72 (0.51 to 149.75) Low Tardive dyskinesia Deterioration in tardive dyskinesia symptoms. ESRS Follow-up- mean 17.5 weeks Pyridoxal phosphate (vitamin b) may very slightly increase the chance of experiencing the outcome, but, there is no clear difference between people given pyridoxal phosphate (vitamin b) and those receiving placebo for neuroleptic-induced tardive dyskinesia. These findings are based on data of low quality. RR 0.16 (0.01 to 3.14) Low General mental state Positive psychiatric symptom score. PANSS. Scale from: 7 to 49. Follow-up: 9 weeks On average, people receiving pyridoxal phosphate (vitamin b) scored 1.50 lower than people treated with placebo for neuroleptic-induced tardive dyskinesia. 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. MD 1.50 lower (4.80 lower to 1.80 higher) Low Negative psychiatric symptoms. PANSS. Scale from: 7 to 49. Follow-up: 9 weeks On average, people receiving pyridoxal phosphate (vitamin b) scored 1.10 lower than people treated with placebo for neuroleptic-induced tardive dyskinesia. 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. MD 1.10 lower (5.92 lower to 3.72 higher) Low

Quetiapine versus typical antipsychotic medications for schizophrenia

Quetiapine compared to typical antipsychotics for schizophrenia

Summary
Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms and general psychopathology. There are no clear differences in terms of the treatment of negative symptoms. However, it causes fewer adverse effects in terms of abnormal ECG, extrapyramidal effects, abnormal prolactin levels and weight gain.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinical significant response as defined by the individual studies Quetiapine may decrease the chance of experiencing no clinical significant response, but, there is no clear difference between people given quetiapine and those receiving typical antipsychotics. These findings are based on data of moderate quality. RR 0.96 (0.75 to 1.23 ) Moderate Leaving the study early Due to any reason Quetiapine may decrease the chance of leaving the study early, but, there is no clear difference between people given quetiapine and those receiving typical antipsychotics. These findings are based on data of moderate quality. RR 0.91 (0.81 to 1.01 ) Moderate Positive symptoms PANSS positive subscore On average, people receiving quetiapine scored 0.02 higher than people treated with typical antibiotics. 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. MD 0.02 higher (0.39 lower to 0.43 higher) Moderate Negative symptoms PANSS negative subscore On average, people receiving quetiapine scored 0.82 lower than people treated with typical antibiotics. The meaning of this in day-to-day care is unclear. This finding is based on data of moderate quality. MD 0.82 lower (1.59 to 0.04 lower) Moderate Cognitive function Average endpoint scores as defined by the original studies On average, people receiving quetiapine scored 1.55 higher than people treated with typical antibiotics. 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 very limited quality. MD 1.55 higher (0.62 lower to 3.72 higher) Very low Extrapyramidal effects Outcome: Quetiapine may reduce the chance of experiencing extrapyramidal effects. This finding is based on data of moderate quality. RR 0.17 (0.09 to 0.32 ) Moderate Prolactin levelAverage level in ng/mL Outcome: On average, people receiving quetiapine scored 1.55 higher than people treated with typical antibiotics. 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 very limited quality. MD 16.20 lower (23.34 to 9.07 lower) Moderate

Risperidone versus other atypical antipsychotics for schizophrenia

Risperidone compared to olanzapine for schizophrenia

Summary
Risperidone seems to produce somewhat more extrapyramidal side effects and clearly more prolactin increase than most other SGAs. It may also differ from other compounds in effectiveness and 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. Further large trials, especially comparing risperidone with those other new drugs for which only a few RCTs are available, are needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No clinically significant response (as defined by the original studies) Risperidone probably causes little or no increase to the chance of experiencing the global state outcome when compared to olanzapine, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.06 (0.99 to 1.13) Moderate Global outcome Leaving the study early due to any reason Risperidone probably slightly increases the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 1.14 (1.07 to 1.21) Moderate Service outcome Number of patients re-hospitalised (short term up to 12 weeks) Risperidone may very slightly increase the chance of experiencing the outcomes to do with how much hospital/community care is used, but, there is no clear difference between people given risperidone and those receiving olanzapine. These findings are based on data of low quality. RR 1.35 (0.41 to 4.40) Low Mental state Average PANSS endpoint score (high = poor, short term up to 12 weeks) On average, people receiving risperidone scored 0.97 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 low quality. MD 0.97 higher (1.1 lower to 3.05 higher) Low Adverse effects At least one adverse effect Risperidone may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given risperidone and those receiving olanzapine. These findings are based on data of low quality. RR 0.96 (0.88 to 1.03) Low Suicide Risperidone makes no difference to the adverse effect or event outcome, but, at present it is not possible to be confident about the difference between the two treatments. RR 3.11 (0.13 to 75.59) Low Quality of life Average QLS scale endpoint score - (high = poor, long term over 26 weeks) On average, people receiving risperidone scored 0.97 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. MD 0.97 higher (1.1 lower to 3.05 higher) Moderate

Atypical antipsychotics for people with both schizophrenia and depression

Atypical compared to typical antipsychotics for people with both schizophrenia and depression

Summary
There are too few data to guide patients, carers, clinicians or policy makers. Current practice has to be guided by evidence other than that derived from randomised trials and more trials in this important area are indicated.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Outcome: Not reported Service outcome Outcome: Not reported Mental state No important change (based on > 50% reduction in Kay's score) Atypical may slightly reduce the chance of experiencing the mental state outcome but there is no clear difference between people given atypical and those receiving typical antipsychotics for people with both schizophrenia and depression. These findings are based on data of low quality. RR 0.91 (0.81 to 1.03) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Intensive case management for severe mental illness

Intensive case management versus standard care for severe mental illness

Summary
Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital. However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach. We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
Measured Outcome Findings in words Findings in numbers Quality of evidence Service use Average number of days in hospital per month - by about 24 months On average, people receiving intensive case managing spent about 1 day less in hospital compared with people receiving standard care. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is not clear. This finding is based on data of low quality. MD 0.86 lower (1.37 lower to 0.34 lower) Low Adverse event: Death Suicide - by long term Intensive case management may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given intensive case management and those receiving standard care for severe mental illness. These findings are based on data of low quality. RR 0.68 (0.31 to 1.51) Low Global state 1. Relapse - by long term No data available Leaving the study early - by long term Intensive case management may reduce the chance of experiencing the global state outcome when compared with standard care for severe mental illness. Data are based on low quality evidence. RR 0.68 (0.58 to 0.79) Low Social functioning Employment status (various measurements) - by long term - not employed at the end of the trial Intensive case management may reduce the chance of experiencing functioning (in day-to-day life) outcome, but, at present it is not possible to be confident about the difference between people given intensive case management and those receiving standard care for severe mental illness and data supporting this finding are very limited. RR 0.7 (0.49 to 1) Very low Mental state Not improved to an important extent - by long term No data available

Alternative table from same review

Intensive case management versus non-intensive case management for severe mental illness

Summary
Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital. However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach. We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
Measured Outcome Findings in words Findings in numbers Quality of evidence Service use Average number of days in hospital per month - by about 24 months On average, people receiving intensive case managing spent about 0.08 days less in hospital compared with people receiving non-intenstve case managing. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is not clear. This finding is based on data of moderate quality. MD 0.08 lower (0.37 lower to 0.21 higher) Moderate Average number of admissions (skewed data - sample size ≧ 200) - by long term On average, people receiving intensive case managing experienced 0.18 less admissions to hospital compared with people receiving non-intenstve case managing. There was no clear difference between the groups, and, at present the meaning of this in day-to-day care is not clear. This finding is based on data of moderate quality. MD 0.18 lower (0.41 lower to 0.05 higher) Moderate Adverse event: Death Suicide - by long term Intensive case management may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given intensive case management and those receiving non-intensive case management for severe mental illness. These findings are based on data of low quality. RR 0.88 (0.27 to 2.84) Low Global state Relapse - by long term No data available Leaving the study early - by long term Intensive case management may cause little or no reduction to the chance of experiencing the global state outcome when compared with non-intensive case management for severe mental illness. Data are based on low quality evidence. RR 0.7 (0.52 to 0.95) Low Social functioning Employment status - by medium term - spent > 1 day employed Intensive case management may increase the chance of experiencing functioning (in day-to-day life) outcome, but, at present it is not possible to be confident about the difference between people given intensive case management and those receiving non-intensive case management for severe mental illness and data supporting this finding are very limited. RR 1.46 (0.45 to 4.74) Very low Mental state Not improved to an important extent - by long term No data available

Nicotine for schizophrenia

exclude no data

Seclusion and restraint for serious mental illnesses

exclude, no SoF

Sertindole versus other atypical antipsychotics for schizophrenia

Sertindole compared to risperidone for schizophrenia

Summary
Sertindole may induce fewer movement disorders, but more cardiac effects, weight change and male sexual dysfunction than risperidone. However these data are based on only two studies and are too limited to allow firm conclusions. Nothing can be said about the effects of sertindole compared with second generation antipsychotics other than risperidone. There are several relevant trials underway or completed and about to report.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state No significant response as defined by original study (short term up to 12 weeks) Sertindole may slightly reduce the chance of experiencing the global state outcome but there is no clear difference between people given sertindole and those receiving risperidone. These findings are based on data of low quality. RR 0.88 (0.71 to 1.08) Low Global outcome No clinically important change - as defined by original study (short term up to 12 weeks) Sertindole may slightly reduce the chance of experiencing the outcome but there is no clear difference between people given sertindole and those receiving risperidone. These findings are based on data of low quality. RR 0.81 (0.59 to 1.10) Low Service outcome Outcome: Not reported Mental state No clinically important change (<50% PANSS total score reduction, short term up to 12 weeks) Sertindole may slightly reduce the chance of experiencing the mental state outcome but there is no clear difference between people given sertindole and those receiving risperidone. These findings are based on data of low quality. RR 0.88 (0.71 to 1.08) Low Adverse effects At least one adverse effect Sertindole probably causes little or no increase to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.03 (0.95 to 1.11) Moderate Adverse events Death - suicide Sertindole may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given sertindole and those receiving risperidone. These findings are based on data of low quality. RR 0.30 (0.01 to 7.34) Low Quality of life Outcome: Not reported

Management of sexual dysfunction due to antipsychotic drug therapy

Adjunctive treatment - specific: Sildenafil versus placebo for management of sexual dysfunction due to antipsychotic drug therapy

Summary
We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Sexual function Subjective assessment (number of erections) Follow-up: 2 weeks On average, people receiving sildenafil had 3.2 more erections than people receiving placebo. There was a 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. MD 3.2 higher (1.83 to 4.57 higher) Low Objective assessment (Global efficacy questionnaire, improved erections) Follow-up: 2 weeks Fill in findings in words manually OR 11.76 (6.54 to 21.13 ) Low Leaving the study early Follow-up: 2 weeks Sildenafil may reduce the chance of experiencing the treatment outcome, 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. RR 0.33 (0.01 to 7.62) Very low Quality of life Not reported The outcome was not measured/reported in the included studies. Adverse effects Death The outcome was not measured/reported in the included studies. Psychotic symptoms The outcome was not measured/reported in the included studies. Extrapyramidal symptoms The outcome was not measured/reported in the included studies.

Alternative tables from same review

Adjunctive treatment - non-specific: selegiline versus placebo for management of sexual dysfunction due to antipsychotic drug therapy

Summary
We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Sexual function Subjective assessment (Aizenburg's scale) Follow-up: 3 weeks On average, people receiving selegiline scored 0.4 lower than people receiving placebo. 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 very limited quality. MD 0.4 lower (3.95 lower to 3.15 higher) Very low Leaving the study early Follow-up: 3 weeks The outcome was not measured/reported in the included studies. Very low Quality of life Not reported The outcome was not measured/reported in the included studies. Adverse effects Death. Not reported The outcome was not measured/reported in the included studies. Psychopathology (PANSS) Follow-up: 3 weeks On average, people receiving selegiline scored 0.5 higher in psychopathology than people receiving placebo. 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 very limited quality. MD 0.50 higher (0.61 lower to 1.61 higher) Very low Extrapyramidal symptoms (Simpson-Angus) Follow-up: 3 weeks On average, in extrapyramidal symptoms people receiving selegiline scored 0.9 lower than people receiving placebo. 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 very limited quality. MD 0.9 lower (3.88 lower to 2.08 higher) Very low

Switching antipsychotic: to quetiapine versus maintenance risperidone for management of sexual dysfunction due to antipsychotic drug therapy

Summary
We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Sexual function Subjective assessment (ASEX scale)Follow-up: 6 weeks The mean sexual function in the intervention groups was 2.02 lower MD (5.79 lower to 1.75 higher) Very low Subjective assessment (prolactin levels, ng/ml)Follow-up: 6 weeks The mean prolactin levels (ng/ml) in the intervention groups was 13.6 lower MD (25.76 to 1.44 lower) Very low Leaving the study early Follow-up: 6 weeks Switching antipsychotic: to quetiapine may increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 2.2 (0.45 to 10.74) Very low Quality of life Not reported The outcome was not measured/reported in the included studies. Adverse effects Death. Not reported The outcome was not measured/reported in the included studies. Psychopathology (PANSS) Follow-up: 6 weeks The mean psychopathology in the intervention groups was 0.6 lower (4.35 lower to 3.15 higher) Very low Extrapyramidal symptoms. Not reported The outcome was not measured/reported in the included studies.

Switching antipsychotic: to olanzapine versus maintenance risperidone/fga for management of sexual dysfunction due to antipsychotic drug therapy

Summary
We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Sexual function Subjective assessment (GISF) Follow-up: 4 months The mean sexual function in the intervention groups was 0.8 lower MD (1.55 to 0.05 lower) Low Objective assessment (prolactin levels, ng/ml) Follow-up: 4 months The mean prolactin levels (ng/ml) in the intervention groups was 30.84 lower MD (47.46 to 14.22 lower) Low Leaving the study early Follow-up: 4 months Switching antipsychotic: to olanzapine may increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 2.25 (0.79 to 6.43) Very low Quality of life Not reported The outcome was not measured/reported in the included studies. Adverse effects Death. Not reported The outcome was not measured/reported in the included studies. Psychopathology - various scales. Follow-up: 4 months The outcome was not measured/reported in the included studies. Very low Extrapyramidal symptoms - various scales. Follow-up: 4 months The outcome was not measured/reported in the included studies. Very low

Smoking cessation advice for people with serious mental illness

Smoking cessation advice versus standard care for people with serious mental illness

Summary
People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.
Measured Outcome Findings in words Findings in numbers Quality of evidence Raised awareness of common problems associated with smoking Outcome: No trials met the inclusion criteria and therefore no data for this series of important outcomes. Reduction in smoking Outcome: Healthy days Outcome: Clinically important adverse effect Outcome: Economic Outcome Outcome: Outcome:

Social skills programmes for schizophrenia

Social skills versus standard care for schizophrenia

Summary
Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.
Measured Outcome Findings in words Findings in numbers Quality of evidence Social functioning Various scales. Follow-up: 8-52 weeks The outcome was not measured/reported in the included studies. Very low Relapse Follow-up: 6-12 months Social skills may reduce the chance of experiencing the global state (relapse) outcome when compared to standard care, but, at present there is only very limited data supporting this finding. RR 0.52 (0.34 to 0.79) Very low Rehospitalisation Follow-up 12 months Social skills may reduce the chance of experiencing the outcome, but, at present there is only very limited data supporting this finding. RR 0.53 (0.3 to 0.93) Very low Mental state General symptoms (BPRS) Follow-up: 12 weeks On average, people receiving social skills training scored 4.01 lower than people receiving standard care. There was a clear difference between the groups. The meaning of this in day-to-day care is unclear. This finding is based on data of very limited quality. MD 4.01 lower (7.52 to 0.50 lower) Very low Global state Not clinically improved.CGIFollow-up: 6 months Social skills may reduce the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 0.29 (0.12 to 0.68) Very low General functioning MRSSFollow-up: 8 weeks On average, people receiving social skills training scored 10.6 lower than people receiving standard care. There was a clear difference between the groups. The meaning of this in day-to-day care is unclear. This finding is based on data of very limited quality. MD 10.6 lower (17.47 to 3.73 lower) Very low Quality of life GWB. Scale from: 10 to 40.Follow-up: 8 weeks On average, people receiving social skills training scored 7.6 lower than people receiving standard care. There was a clear difference between the groups. The meaning of this in day-to-day care is unclear. This finding is based on data of very limited quality. MD 7.6 lower (12.18 to 3.02 lower) Very low

Alternative tables from same review

Social skills versus discussion control for schizophrenia

Summary
Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.
Measured Outcome Findings in words Findings in numbers Quality of evidence Social functioning Various scales. Follow-up: 6 months The outcome was not measured/reported in the included studies. Very low Relapse Follow-up: 6 months Social skills may increase the chance of experiencing the global state (relapse) outcome, 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. RR 2.12 (0.44 to 10.1) Very low Global state GAS Follow-up: 6 months On average, people receiving social skills scored 4.5 higher than people treated with discussion control. 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. MD 4.5 higher (1.2 lower to 10.2 higher) Very low Mental state General symptoms. Follow-up: 6 months On average, people receiving social skills scored 0.22 higher than people treated with discussion control. 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. MD 0.22 higher (4.05 lower to 4.49 higher) Very low Quality of life QLS Follow-up: 6 months On average, people receiving social skills scored 3.7 higher than people treated with discussion control. 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. MD 3.7 higher (6.47 lower to 13.87 higher) Very low

Sulpiride versus placebo for schizophrenia

Sulpiride compared to placebo for schizophrenia

Summary
Sulpiride may be an effective antipsychotic drug but evidence of its superiority over placebo from randomised trials is very limited. Practice will have to use evidence from sources other than trials until better evidence is generated.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Clinically significant response in global state - by long term - not measured The outcome was not measured/reported in the included studies. Mental state Average score for positive symptoms (skewed) - by short term. Manchester Scale, positive subset endpoint. Follow-up: 12 weeks The outcome was not measured/reported in the included studies. Very low Average score for negative symptoms - by short term. Manchester Scale, negative subset endpoint. Scale from: 0 to 20. Follow-up: 12 weeks On average, people receiving sulpiride scored 0.3 lower than people treated with placebo. 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. MD 0.3 lower (1.66 lower to 1.06 higher) Very low Average score for depressive and anxious symptoms - by medium term - not measured The outcome was not measured/reported in the included studies. Quality of life Average score - by long term - not measured The outcome was not measured/reported in the included studies. Severe adverse effects Medium term - not reported The outcome was not measured/reported in the included studies. Safety assessments Medium term - not measured The outcome was not measured/reported in the included studies.

Supportive therapy for schizophrenia

Supportive therapy versus standard care for schizophrenia

Summary
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse. Follow-up: 2 years Supportive therapy may reduce the chance of experiencing the global state outcome, 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. RR 0.96 (0.44 to 2.11) Very low Service outcomes Hospitalisation. Follow-up: 6 months Supportive therapy makes no difference to the outcome, but, at present it is not possible to be confident about the difference between the two treatments. RR 1 (0.07 to 15.08) Very low Mental state No clinically important improvement. Follow-up: 1 to 2 years Supportive therapy may reduce the chance of experiencing the mental state outcome, 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. RR 0.95 (0.82 to 1.11) Very low Leaving the study early Follow-up: 10 weeks to 2 years Supportive therapy may reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 0.86 (0.53 to 1.4) Very low General functioning GAS Follow-up: 1 years On average, people receiving supportive therapy scored 0.3 lower than people treated with standard care. 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. MD 1.4 higher (5.09 lower to 7.89 higher) Very low Satisfaction with treatment Recipient of care not satisfied with treatment. Follow-up: 1 years Supportive therapy may increase the chance of experiencing the satisfaction with treatment outcome, 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. RR 1.83 (0.75 to 4.47) Very low Quality of life WBS On average, people receiving supportive therapy scored 2.73 lower than people treated with standard care. 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. MD 2.73 lower (6.04 lower to 0.58 higher) Very low

Alternative tables from same review

Supportive therapy versus any other psychological or psychosocial treatment for schizophrenia

Summary
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse. Follow-up: 2 to 3 years Supportive therapy may increase the chance of experiencing the global state outcome, 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. RR 1.19 (0.66 to 2.16) Very low Service outcomes Hospitalisation. Follow-up: 12 weeks to 2 years Supportive therapy may increase the chance of experiencing the outcome, but, at present there is only very limited data supporting this finding. RR 1.82 (1.11 to 2.99) Very low Mental state No clinically important improvement. Follow-up: 1 to 2 years Supportive therapy may increase the chance of experiencing the mental state outcome, but, at present there is only very limited data supporting this finding. RR 1.27 (1.04 to 1.54) Very low Leaving the study early Follow-up: 10 weeks to 3 years Supportive therapy probably causes little or no increase to the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.03 (0.87 to 1.21) Moderate General functioning GAF and GAS Follow-up: 12 to 18 months The outcome was not measured/reported in the included studies. Very low Satisfaction with treatment Recipient of care not satisfied with treatment. Follow-up: 1 years Supportive therapy may increase the chance of experiencing the satisfaction with treatment outcome, but, at present there is only very limited data supporting this finding. RR 3.19 (1.01 to 10.07) Very low Quality of life QLS On average, people receiving supportive therapy scored 0.07 lower than people treated with any other psychological or psychosocial treatment. 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. MD 0.07 lower (21.11 lower to 20.97 higher) Very low

Supportive therapy versus cognitive behavioural therapy for schizophrenia

Summary
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse. Follow-up: 2 to 3 years Supportive therapy may increase the chance of experiencing the global state outcome, 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. RR 1.1 (0.51 to 2.41) Very low Service outcomes Hospitalisation Follow-up: 12 weeks to 18 months Supportive therapy may increase the chance of experiencing the outcome, 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. RR 1.6 (0.85 to 3) Very low Mental state No clinically important improvement. Follow-up: 1 to 2 years Supportive therapy may increase the chance of experiencing the mental state outcome, 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. RR 1.23 (0.89 to 1.70) Very low Leaving the study early Follow-up: 10 weeks to 3 years Supportive therapy probably causes little or no increase to the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.05 (0.77 to 1.44) Moderate General functioning GAF and GAS The outcome was not measured/reported in the included studies. Very low Satisfaction with treatment Recipient of care not satisfied with treatment. Follow-up: 1 years Supportive therapy may increase the chance of experiencing the satisfaction with treatment outcome, but, at present there is only very limited data supporting this finding. RR 3.19 (1.01 to 10.07) Very low Quality of life RSES Follow-up: 12 weeks The mean quality of life in the intervention groups was 1.7 lower MD (5.19 lower to 1.79 higher) Very low

Supportive therapy versus family therapy for schizophrenia

Summary
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse. Follow-up: 2 to 3 years The outcome was not measured/reported in the included studies. Very low Service outcomes Hospitalisation. Follow-up: 2 years Supportive therapy may increase the chance of experiencing the outcome, 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. RR 1.93 (0.89 to 4.17) Very low Mental state Episode of affective symptoms Supportive therapy may increase the chance of experiencing the mental state outcome, 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. RR 1.71 (0.82 to 3.6) Very low Leaving the study early Outcome: Supportive therapy may increase the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 1.27 (0.56 to 2.89) Very low General functioning No paid work Supportive therapy may reduce the chance of experiencing the functioning (in day-to-day life) outcome, 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. RR 0.96 (0.57 to 1.63) Very low Satisfaction with treatment Not reported The outcome was not measured/reported in the included studies. Quality of life Not reported The outcome was not measured/reported in the included studies.

Supportive therapy versus psychoeducation for schizophrenia

Summary
There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Relapse - not reported The outcome was not measured/reported in the included studies. Service outcomes Hospitalisation. Follow-up: 6 months Supportive therapy may reduce the chance of experiencing the outcome, 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. RR 0.48 (0.05 to 4.93) Very low Mental state No clinically important improvement. Follow-up: 6 months Supportive therapy may increase the chance of experiencing the mental state outcome, 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. RR 1.61 (0.96 to 2.68) Very low Leaving the study early Follow-up: 6 months Supportive therapy may reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 0.57 (0.21 to 1.54) Very low General functioning Not reported The outcome was not measured/reported in the included studies. Satisfaction with treatment Not reported The outcome was not measured/reported in the included studies. Quality of life QLS The mean quality of life in the intervention groups was 0.07 lower MD (21.11 lower to 20.97 higher) Very low

Vitamin E for neuroleptic-induced tardive dyskinesia

Vitamin e compared with placebo for antipsychotic-induced tardive dyskinesia

Summary
Small trials of limited quality suggest that vitamin E may protect against deterioration of TD. There is no evidence that vitamin E improves symptoms of this problematic and disfiguring condition once established. New and better trials are indicated in this under-researched area, and, of the many adjunctive treatments that have been given for TD, vitamin E would be a good choice for further evaluation.
Measured Outcome Findings in words Findings in numbers Quality of evidence Tardive dyskinesia Not improved to a clinically important extent. Follow-up- up to 1 year Vitamin E may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given vitamin E and those receiving placebo for antipsychotic-induced tardive dyskinesia. These findings are based on data of low quality. RR 0.95 (0.89 to 1.01) Low Deterioration of symptoms. Follow-up- up to 1 year Vitamin E may reduce the chance of experiencing the outcome. Data are based on low quality evidence. RR 0.23 (0.07 to 0.76) Low Adverse effect Any. Follow-up- up to 1 year Vitamin E may increase the chance of experiencing the adverse effect or event outcome, 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. RR 1.21 (0.35 to 4.15) Very low Extrapyramidal symptoms measured by Simpson-Angus Scale (low=better) Follow-up- up to 1 year On average, people receiving Vitamin E scored 1.1 points higher compared with people receiving placebo. There was no clear difference between the groups and data supporting this finding are of very limited quality. The meaning of this in day-to-day care is not clear. MD 1.1 higher (1.02 lower to 3.22 higher) Very low Acceptability of treatment Measured by participants leaving the study early. Follow-up: up to 1 year Vitamin E may increase the chance of experiencing the global state (acceptability of treatment) outcome, 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. RR 1.07 (0.64 to 1.80) Very low Social confidence Social inclusion, social networks The outcome was not measured/reported in the included studies.

Thioridazine for schizophrenia

Thioridazine compared to atypical antipsychotic for schizophrenia

Summary
Although there are shortcomings, there appears to be enough consistency over different outcomes and periods to confirm that thioridazine is an antipsychotic of similar effectiveness to other commonly used antipsychotics for people with schizophrenia. Its adverse events profile is similar to that of other drugs, but it may have a lower level of extrapyramidal problems and higher level of ECG changes. We would advocate the use of alternative drugs, but if its use in unavoidable, cardiac monitoring is justified.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Not improved or worse (short term up to 12 weeks) Thioridazine may very slightly increase the chance of experiencing the global state outcome, but, there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 1.00 (0.81 to 1.25) Low Global outcome Death - by 6 weeks (suicide) Thioridazine may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 0.34 (0.01 to 8.27) Low Service outcome Outcome: Not reported Mental state No important change (50% drop on BPRS or LOCF by 6 weeks) Thioridazine may reduce the chance of experiencing the mental state outcome but there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 0.50 (0.18 to 1.40) Low Adverse effects Anticholinergic - hypotension - 3 months Thioridazine may slightly increase the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 1.58 (0.84 to 2.95) Low Anticholinergic - dry mouth - 3 months Thioridazine may increase the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 2.00 (0.22 to 18.33) Low Movement disorders - extrapyramidal symptoms - 3 months Thioridazine may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given thioridazine and those receiving atypical antipsychotic. These findings are based on data of low quality. RR 1.22 (0.54 to 2.76) Low

Token economy for schizophrenia

Token economy compared to standard care for schizophrenia

Summary
The token economy approach may have effects on negative symptoms 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 well designed, conducted and reported randomised trials.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global outcome Leaving the study early (medium term up to 6 months) Token economy may increase the chance of experiencing the outcome, 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. RR 1.20 (0.44 to 3.29) Very low Service outcome Outcome: Not reported Mental state Average SANS endpoint scale scores (high=poor, short term up to 8 weeks) On average, people receiving token economy scored 13.79 lower than people treated with standard care. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. This finding is based on data of low quality. MD 13.79 lower (16.41 lower to 11.16 lower) Low Adverse event Outcome: Not reported Quality of life Outcome: Not reported

Transcranial magnetic stimulation (TMS) for schizophrenia

Temporoparietal TMS compared to sham TMS for schizophrenia

Summary
Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication. The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinical improvement in global state CGI Follow-up: after treatment Temporoparietal TMS may increase the chance of experiencing the clinical improvement outcome, but, at present it is not possible to be confident about the difference between the two treatments. This finding is based on data of very limited quality. RR 7 (0.38 to 128.33) Low Global state Score. CGI Follow-up: after treatment to 30 days On average, people receiving temporoparietal TMS scored 0.5 lower compared to people receiving sham TMS. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is based on data of low quality. MD 0.5 lower (0.76 to 0.23 lower) Low Mental state PANSS Follow-up: after treatment to 30 days On average, people receiving temporoparietal TMS scored 6.09 lower compared to people receiving sham TMS. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is based on data of low quality. MD 6.09 lower (10.95 to 1.22 lower) Low Cognitive state Various measures. Follow-up: after treatment The outcome was not measured/reported in the included studies. Low Adverse effects General or specific. Follow-up: after treatment to 30 days The outcome was not measured/reported in the included studies. Low Leaving the study early Temporoparietal TMS may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given temporoparietal TMS and those receiving sham TMS. These findings are based on data of low quality. RR 0.78 (0.46 to 1.32) Low Satisfaction with care Not reported The outcome was not measured/reported in the included studies.

Alternative tables from same review

Temporoparietal TMS compared to standard treatment for schizophrenia

Summary
Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication. The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinical improvement in global state CGI Follow-up: after treatment Temporoparietal TMS may increase the chance of experiencing the global state (clinical improvement) outcome but there is no clear difference between people given temporoparietal TMS and those receiving standard treatment. These findings are based on data of low quality. RR 1.19 (0.91 to 1.57) Low Global state Score - not reported The outcome was not measured/reported in the included studies. Mental state Not reported The outcome was not measured/reported in the included studies. Cognitive state Not reported The outcome was not measured/reported in the included studies. Adverse effects General or specific - not reported The outcome was not measured/reported in the included studies. Leaving the study early. Follow-up: after treatment Temporoparietal TMS may reduce the chance of experiencing the adverse effect or event outcome, 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. RR 0.33 (0.08 to 1.46) Very low Satisfaction with care Not reported The outcome was not measured/reported in the included studies.

Prefrontal tms compared to sham TMS for schizophrenia

Summary
Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication. The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinical improvement in global state Not reported The outcome was not measured/reported in the included studies. Global state Score. Various scales. Follow-up: after treatment The outcome was not measured/reported in the included studies. Mental state PANSS Follow-up: after treatment The outcome was not measured/reported in the included studies. Very low Cognitive state Various measures. Follow-up: after treatment to 6 weeks The outcome was not measured/reported in the included studies. Low Adverse effects General or specific. Follow-up: after treatment The outcome was not measured/reported in the included studies. Low Leaving the study early. Follow-up: after treatment to 2 weeks Prefrontal TMS may very slightly increase the chance of experiencing the adverse effect or event outcome, but, there is no clear difference between people given prefrontal TMS and those receiving sham TMS. These findings are based on data of low quality. RR 1.19 (0.56 to 2.5) Low Satisfaction with care Not reported The outcome was not measured/reported in the included studies.

Prefrontal tbs TMS compared to sham tms for schizophrenia

Summary
Based on this review, there is insufficient evidence to support or refute the use of TMS to treat symptoms of schizophrenia. Although some evidence suggests that TMS, and in particular temporoparietal TMS, may improve certain symptoms (such as auditory hallucinations and positive symptoms of schizophrenia) compared to sham TMS, the results were not robust enough to be unequivocal across the assessment measures used. There was insufficient evidence to suggest any added benefit with TMS used as an adjunctive therapy to antipsychotic medication. The overall quality of evidence was graded as very low due to risk of bias, and this was accompanied by an imprecision in estimates due to the relatively small number of participants in the studies. Thus, consideration is required in improving the quality of trial processes, as well as the quality of reporting of ongoing and future TMS trials, so as to facilitate accurate future judgements in assessing risk of bias. Differences in TMS techniques in relation to stimulation intensity, stimulation length, brain areas stimulated and variations in the design of sham TMS all contributed to the heterogeneity of study findings and limited the interpretation and applicability of the results. In addition, the trials assessed their outcomes with a variety of scales, and usable data were limited. Therefore, to better evaluate the treatment effects of TMS in people with schizophrenia, we favour the use of standardised treatment protocols and outcome measures.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinical improvement in global state Follow-up: after treatment Prefrontal tbs TMS makes no difference to the global state (clinical improvement) outcome, but, at present it is not possible to be confident about the difference between the two treatments. RR 4.06 (0.21 to 77.37) Very low Global state Score - not reported The outcome was not measured/reported in the included studies. Mental state PANSS Follow-up: after treatment On average, people receiving prefrontal tbs TMS scored 5.71 lower than people receiving sham TMS. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is based on data of low quality. MD 5.71 lower (9.32 to 2.1 lower) Low Cognitive state Various measures. Follow-up: after treatment The outcome was not measured/reported in the included studies. Low Adverse effects General or specific. Follow-up: after treatment The outcome was not measured/reported in the included studies. Low Leaving the study early Prefrontal tbs TMS may slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given prefrontal tbs TMSs and those receiving sham TMS. These findings are based on data of low quality. RR 0.36 (0.07 to 1.74) Low Satisfaction with care Not reported The outcome was not measured/reported in the included studies.

Trifluoperazine versus placebo for schizophrenia

Trifluoperazine versus placebo for schizophrenia

Summary
Our results agree with existing evidence that compared to placebo, trifluoperazine is an effective antipsychotic for people with schizophrenia. Furthermore, our review provides supportive evidence that trifluoperazine increases the risk of extrapyramidal adverse effects. Although the effect sizes against placebo are similar to those observed with other agents, they are based on data from many small, pre-CONSORT trials with generally either a low or very low GRADE evidence that has limited implication for clinical practice. Large, independent trials are needed that adhere to the CONSORT statement to compare trifluoperazine with placebo used in the treatment of schizophrenia and schizophrenia-like illnesses.
Measured Outcome Findings in words Findings in numbers Quality of evidence Global state Clinical improvement - medium term. As defined by each study. Follow-up: mean 19 weeks Trifluoperazine may slightly increase the chance of experiencing the global state outcome when compared to placebo. Data are based on low quality evidence. RR 4.61 (1.54 to 13.84) Low Relapse or worsening - medium term. Numbers of participants experiencing relapse/worsening. Follow-up: mean 5 months Trifluoperazine may reduce the chance of experiencing the global state outcome. Data are based on low quality evidence. RR 0.34 (0.23 to 0.49) Low Mental state Any clinically significant response in psychotic symptoms (as defined by each study) - medium term. Numbers of participants experiencing 'intensified symptoms' Follow-up: mean 16 weeks Trifluoperazine may increase the chance of experiencing the mental state outcome, 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. RR 1.05 (0.54 to 2.05) Very low Leaving the study early Any reason - medium term. Number of participants leaving the studies early. Follow-up: mean 5 months Trifluoperazine may reduce the chance of experiencing the finding treatment unacceptable or being withdrawn from treatment outcome, 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. RR 0.67 (0.38 to 1.19) Very low Severe adverse effects Short term. Numbers of participants leaving the studies due to severe adverse effects. Follow-up: mean 2 months Trifluoperazine may increase the chance of experiencing the outcome, 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. RR 1.31 (0.22 to 7.8) Very low Behaviour Any clinically significant agitation or distress - medium term. As defined by each study. Follow-up: 4 months Trifluoperazine may increase the chance of experiencing the behaviour outcome, 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. RR 2 (0.19 to 20.72) Very low Economic outcomes Outcome: The outcome was not measured/reported in the included studies.

Valproate for schizophrenia

Valproate + antipsychotics compared to antipsychotics + placebo or antipsychotics alone for schizophrenia

Summary
There is limited evidence, based on a number of trials, 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. However, this evidence was entirely based on open RCTs. Moreover, valproate was associated with a number of adverse events among which sedation and dizziness appeared significantly more frequently than in the control groups. Further randomised studies which are blinded are necessary before any clear recommendation can be made. Ideally these would focus on people with schizophrenia and aggression, on those with treatment-resistant forms of the illness and on those with schizoaffective disorders.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinically significant response Important change - as defined by the studies When compared to antipsychotics + placebo or antipsychotics alone, valproate + antipsychotics probably increases the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 1.31 (1.16 to 1.47) Moderate Global outcome Leaving the study early for any reason Valproate + antipsychotics probably slightly reduces the chance of experiencing the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 0.76 (0.47 to 1.24) Moderate Service outcome Use of additional medication for sedation at least once Valproate + antipsychotics may increase the chance of experiencing the outcomes to do with how much hospital/community care is used, 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. RR 3.65 (0.11 to 122.31) Very low Mental state Clinical response - mean change score PANSS total (high = poor) On average, people receiving valproate + antipsychotics scored 5.85 lower than people treated with antipsychotics + placebo or antipsychotics alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. MD 5.85 lower (7.8 lower to 3.91 lower) Moderate Adverse events Abnormal liver function/increase in alanine transaminase/gamma-glutamyl transpeptidase Valproate + antipsychotics probably causes little or no increase to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.26 (0.72 to 2.22) Moderate Nausea Valproate + antipsychotics probably causes little or no increase to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.22 (0.80 to 1.86) Moderate Quality of life Outcome: Not reported

Voxel-based morphometry for separation of schizophrenia from other types of psychosis in first episode psychosis

no data

Ziprasidone versus other atypical antipsychotics for schizophrenia

Ziprasidone compared to risperidone for schizophrenia

Summary
Ziprasidone may be a slightly less effective antipsychotic drug than amisulpride, olanzapine and risperidone. Its main advantage is the low propensity to induce weight gain and associated adverse effects. However, the high overall rate of participants leaving the studies early limits the validity of any findings.
Measured Outcome Findings in words Findings in numbers Quality of evidence No clinically significant response As defined by the original studies Ziprasidone may very slightly reduce the chance of experiencing the outcome but there is no clear difference between people given ziprasidone and those receiving risperidone. These findings are based on data of low quality. RR 0.98 (0.89 to 1.07) Low Global outcome Leaving the study early for any reason Ziprasidone probably slightly increases the chance of experiencing the outcome. Data are based on moderate quality evidence. RR 1.11 (1.02 to 1.20) Moderate Service use Number of patients re-hospitalised Ziprasidone may very slightly increase the chance of experiencing the outcomes to do with how much hospital/community care is used, but, there is no clear difference between people given ziprasidone and those receiving risperidone. These findings are based on data of low quality. RR 1.14 (0.82 to 1.59) Low Mental state General mental state (less than 50% PANSS total reduction, short term up to 12 weeks) Ziprasidone may very slightly reduce the chance of experiencing the mental state outcome but there is no clear difference between people given ziprasidone and those receiving risperidone. These findings are based on data of low quality. RR 0.98 (0.89 to 1.07) Low Adverse effects At least one adverse effect Ziprasidone may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given ziprasidone and those receiving risperidone. These findings are based on data of low quality. RR 0.93 (0.86 to 1.02) Low Suicide Ziprasidone probably causes little or no increase to the chance of experiencing the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence. RR 1.52 (0.14 to 16.52) Moderate Quality of life Outcome: Not reported

Zotepine versus other atypical antipsychotics for schizophrenia

Zotepine versus clozapine for schizophrenia (all short term outcomes)

Summary
The evidence base around zotepine is insufficient to provide firm conclusions on its absolute or relative effects. This is despite it being in use in Austria, France, Germany, Japan and the UK.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state Average score (BPRS total, high=poor) Brief Psychiatric Rating Scale. Scale from: 0 to 126. Follow-up: 12 weeks On average, people receiving Zotepine scored 6 higher compared with people receiving clozapine. There was a clear difference between the groups, but, the meaning of this in day-to-day care is not clear. This finding is based on data of very limited quality. MD 6 higher (2.17 to 9.83 higher) Very low Global state No clinically important response (as defined by the original studies) clinical assessment. Follow-up: 12 weeks Zotepine may increase the chance of experiencing the global state outcome, but, at present there is only very limited data supporting this finding. RR 8.23 (1.14 to 59.17) Very low Adverse effects Extrapyramidal effects - use of antiparkinson medication Zotepine may increase the chance of experiencing the adverse effect or event outcome, but, at present there is only very limited data supporting this finding. RR 20.96 (2.89 to 151.9) Very low Behaviour No clinically important response (as defined by the original studies) The outcome was not measured/reported in the included studies.

Alternative tables from same review

Zotepine versus risperidone for schizophrenia (all short term outcomes)

Summary
The evidence base around zotepine is insufficient to provide firm conclusions on its absolute or relative effects. This is despite it being in use in Austria, France, Germany, Japan and the UK.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state Average endpoint score (BPRS total, high=poor) - vs 4mg Risperidone. Scale from: 0 to 129. Follow-up: 12 weeks On average, people receiving zotepine scored 1.4 higher than people treated with risperidone. 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 very limited quality. MD 1.4 higher (9.82 lower to 12.62 higher) Very low Average endpoint score (BPRS total, high=poor) - vs 8 mg Risperidone. Scale from: 0 to 129. Follow-up: 12 weeks On average, people receiving zotepine scored 1.3 lower than people treated with risperidone. 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 very limited quality. MD 1.3 lower (12.95 lower to 10.35 higher) Very low Global state No clinically important response (as defined by the original studies) The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal effects - use of antiparkinson medication - vs 4mg risperidone. Follow-up: 12 weeks Zotepine may increase the chance of experiencing the adverse effect or event outcome, 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. RR 6 (0.79 to 45.42) Very low Extrapyramidal effects - use of antiparkinson medication - vs 8mg risperidone. Follow-up: 12 weeks Zotepine may increase the chance of experiencing the adverse effect or event outcome, 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. RR 3 (0.69 to 13.12) Very low Behaviour No clinically important response (as defined by the original studies) The outcome was not measured/reported in the included studies.

Zotepine versus remoxipride for schizophrenia (all short term outcomes)

Summary
The evidence base around zotepine is insufficient to provide firm conclusions on its absolute or relative effects. This is despite it being in use in Austria, France, Germany, Japan and the UK.
Measured Outcome Findings in words Findings in numbers Quality of evidence Mental state Average endpoint score (BPRS total, high=poor) Scale from: 0 to 129. Follow-up: 12 weeks On average, people receiving zotepine scored 5.7 higher than people treated with remoxipride. 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 very limited quality. MD 5.7 higher (4.13 lower to 15.53 higher) Very low Global state No clinically important response (as defined by the original studies) The outcome was not measured/reported in the included studies. Adverse effects Extrapyramidal effects - use of antiparkinson medication. Follow-up: 12 weeks Zotepine may very slightly reduce the chance of experiencing the adverse effect or event outcome but there is no clear difference between people given zotepine and those receiving remoxipride. These findings are based on data of low quality. RR 0.97 (0.41 to 2.29) Low Behaviour No clinically important response (as defined by the original studies) The outcome was not measured/reported in the included studies.

Zuclopenthixol versus placebo for schizophrenia

Zuclopenthixol dihydrochloride versus placebo for schizophrenia

Summary
For people with schizophrenia this review shows that zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for zuclopenthixol decanoate or zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinically significant response on global state As defined by each of the studies, Improvement (CGI) - short term Zuclopenthixol dihydrochloride may increase the chance of experiencing the outcome, but, at present there is only very limited data supporting this finding. RR 2.57 (1.06 to 6.2) Very low Relapse As defined by the studies No studies reported these important outcomes Clinically significant response on psychotic symptoms As defined by each of the studies. Adverse effects Sedation Zuclopenthixol dihydrochloride may increase the chance of experiencing the adverse effect or event outcome, but, at present there is only very limited data supporting this finding. RR 4.67 (1.23 to 17.68) Very low Leaving the study early Outcome: Zuclopenthixol dihydrochloride may reduce the chance of experiencing the treatment outcome, 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. RR 0.93 (0.06 to 13.54) Very low Average change in quality of life/satisfaction Outcome: No studies reported these important outcomes Significant change in quality of life/satisfaction As defined by each of the studies

Alternative tables from same review

Zuclopenthixol acetate versus placebo for schizophrenia

Summary
For people with schizophrenia this review shows that zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for zuclopenthixol decanoate or zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinically significant response on global state Outcome: No studies reported any of these important outcomes Relapse As defined by the studies Clinically significant response on psychotic symptoms As defined by each of the studies. Other adverse effects General and specific Leaving the study early Outcome: Average change in quality of life/satisfaction Outcome: Significant change in quality of life/satisfaction As defined by each of the studies

Zuclopenthixol decanoate versus placebo for schizophrenia

Summary
For people with schizophrenia this review shows that zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia. The review provides some trial evidence that, if taking zuclopenthixol dihydrochloride, people may experience some adverse effects and sedation compared with placebo. However this evidence is of very low quality and with some significant sources of bias. There are no data for zuclopenthixol decanoate or zuclopenthixol acetate. For clinicians, the available trial data on the absolute effectiveness of zuclopenthixol dihydrochloride do support its use but the limited nature of the data and significant sources of bias make conclusions hard to draw. Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use.
Measured Outcome Findings in words Findings in numbers Quality of evidence Clinically significant response on global state Outcome: No studies reported any of these important outcomes Relapse As defined by the studies Clinically significant response on psychotic symptoms As defined by each of the studies Other adverse effects General and specific Leaving the study early Outcome: Average change in quality of life/satisfaction Outcome: Significant change in quality of life/satisfaction As defined by each of the studies