Chlorpromazine versus placebo for schizophrenia

Abstract

Background Chlorpromazine, formulated in the 1950s, remains a benchmark treatment for people with schizophrenia. Objectives To review the effects of chlorpromazine compared with placebo, for the treatment of schizophrenia. Search methods We searched the Cochrane Schizophrenia Group's Trials Register (15 May 2012). We also searched references of all identified studies for further trial citations. We contacted pharmaceutical companies and authors of trials for additional information. Selection criteria We included all randomised controlled trials (RCTs) comparing chlorpromazine with placebo for people with schizophrenia and nonaffective serious/chronic mental illness irrespective of mode of diagnosis. Primary outcomes of interest were death, violent behaviours, overall improvement, relapse and satisfaction with care. Data collection and analysis We independently inspected citations and abstracts, ordered papers, re-inspected and quality assessed these. We analysed dichotomous data using risk ratio (RR) and estimated the 95% confidence interval (CI) around this. We excluded continuous data if more than 50% of participants were lost to follow-up. Where continuous data were included, we analysed this data using mean difference (MD) with a 95% confidence interval. We used a fixed-effect model. Main results We inspected over 1100 electronic records. The review currently includes 315 excluded studies and 55 included studies. The quality of the evidence is very low. We found chlorpromazine reduced the number of participants experiencing a relapse compared with placebo during six months to two years follow-up (n=512, 3 RCTs, RR 0.65 CI 0.47 to 0.90), but data were heterogeneous. No difference was found in relapse rates in the short, medium or long term over two years, although data were also heterogeneous. We found chlorpromazine provided a global improvement in a person's symptoms and functioning (n=1164, 14 RCTs, RR 0.71 CI 0.58 to 0.86). Fewer people allocated to chlorpromazine left trials early (n=1831, 27 RCTs, RR 0.64 CI 0.53 to 0.78) compared with placebo. There are many adverse effects. Chlorpromazine is clearly sedating (n=1627, 23 RCTs, RR 2.79 CI 2.25 to 3.45), it increases 1 Chlorpromazine versus placebo for schizophrenia (Review)

Histological effects of pre-exposure prophylactic consumption of sulfa drugs on Liver and Kidney of albino Wister rats (Rattus novergicus).

“…The weight gain reported by [18] was observed in animals in the control groups. The low dose treatment animals show a negligible weight loss while the high dose treatment animals showed an appreciable loss in weight.…”

Structural neuroimaging in psychosis: a systematic review and economic evaluation

“…62 For example, 39% of people diagnosed with schizophrenia do not respond after up to 8 weeks of chlorpromazine treatment. 63 Patients who are resistant to treatment should be distinguished from those who initially respond to treatment and then deteriorate. CT or MRI scanning may be used in these situations to determine whether an intra-cranial lesion may be a cause of treatment resistance.…”

A systematic review of atypical antipsychotic drugs in schizophrenia

“…The four Cochrane reviews 4,5,13,14 that had already been completed before the commencement of this review were assessed for aspects of methodological quality. All four clearly set out inclusion criteria for studies but some may have been a little too inclusive.…”

“…About 30% of individuals complying with conventional antipsychotic treatment regimens derive little or no benefit in terms of symptom control or reduction, while another 30% gain only partial relief. 9 In a systematic review of the effects of chlorpromazine versus placebo, 4 it was confirmed that chlorpromazine was effective in reducing relapse over a period of 6 months-2 years and in improving global state (although placebo response rate was 40%); however, the drug was associated with sedation, acute movement disorders, parkinsonism, hypotension and weight gain. A systematic review of haloperidol versus placebo 5 confirmed that haloperidol was also effective in improving global state but was associated with dystonia, akathisia and parkinsonism.…”

“…hallucinations, delusions) and in moderating acute episodes of schizophrenia in clinical trials. 4,5 However, they appear to have little effect on the negative symptoms (poverty of speech, lack of motivation, apathy and inability to express emotions 6 ), which are very disabling and which may respond better to atypical antipsychotic drugs, 7 although this has not as yet been adequately established. 8 In addition, long-term use of conventional antipsychotic drugs is associated with a high risk of debilitating neurological sideeffects, notably tardive dyskinesia, as well as shorter-term effects such as akathisia and dystonia.…”