Schizophrenia – Related resources

Cochrane reviews

Pharmacological treatments

• Risperidone may be somewhat more effective than quetiapine and ziprasidone, but somewhat less effective than clozapine and olanzapine in schizophrenia. Risperidone may cause more frequent movement disorders and more prolactin increase compared to most other second-generation ("atypical") antipsychotics. .
• Trifluoperazine might possibly be an effective antipsychotic in schizophrenia, even though increasing the risk of extrapyramidal adverse effects, but the evidence is insufficient .
• There is no evidence to guide the choice of antipsychotic medication for elderly people with schizophrenia .
• Glutamatergic drugs glycine and D-serine may have limited effect on negative symptoms of schizophrenia when added to regular antipsychotic medication .
• Haloperidol in low doses (3-7.5 mg/day) appears to have similar effectiveness as higher doses with a lower rate of adverse effects .
• Haloperidol may be a potent antipsychotic drug but with a high prospensity to cause adverse effects in schizophrenia . Amisulpride is an effective "atypical" antipsychotic drug for schizophrenia .
• Lamotrigine may have a small positive effect on the symptoms of schizophrenia but the evidence is weak . Long acting oral antipsychotic penfluridol appears to have similar effects and adverse effects compared to other typical antipsychotics (oral and depot) .
• There seems to be no differences between perazine and other antipsychotics concerning efficacy or safety in schizophrenia, although the evidence is insufficient .
• Oral zuclopenthixol may have some clinical advantage over other older antipsychotic drugs at least in the short term and remains a choice if older generation drugs are indicated . Haloperidol decanoate may have a substantial effect in improving the symptoms and behaviour associated with schizophrenia in comparison to placebo, but data are remarkably sparse. Flupenthixol decanoate is as effective as other depot neuroleptics .
• Risperidone and olanzapine have similar efficacy in the treatment of schizophrenia. Risperidone is associated with movement disorders and sexual dysfunction, while olanzapine causes rapid weight gain which can be considerable.
• Adjunctive estrogen with or without progesterone does not appear to offer advantages over placebo for the treatment of schizophrenia .
• There is no evidence on the effect of adjunctive dehydroepiandrosterone (DHEA) for the treatment of schizophrenia .
• Carbamazepine may not be useful for treatment or augmentation of antipsychotic treatment of schizophrenia .
• Pimozide may be as effective as other commonly used typical antipsychotic treatments .
• In the treatment of schizophrenia, loxapine appears to have very similar effects to typical and atypical drugs and its intramuscular preparation may be as acutely sedating as IM haloperidol or thiothixene .
• There is insufficient evidence on the effects of atypical antipsychotics for people with both schizophrenia and depression .
• Haloperidol and chlorpromazine may be similarly effective for treatment of schizophrenia, but haloperidol seems to be associated with more extrapyramidal side effects while hypotension seems to occur more frequently when chlorpromazine is used .
• In the treatment of schizophrenia, oral paliperidone may be more effective than placebo and at doses greater than 6 mg per day may be comparable in efficacy to oral olanzapine 10 mg per day in short-term studies .
• Sulpiride seems not to be effective in patients with schizophrenia but the evidence is insufficient .
• In schizophrenia amisulpride seems to be as efficacious as olanzapine and risperidone but more efficacious than ziprasidone, although the evidence in insufficient .
• Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms and general psychopathology in schizophrenia. It may be slightly less effective than olanzapine and risperidone but may induce less adverse effects than typical antipsychotics and less movement disorders than studied atypical antipsychotics .
• Bupropion appears toincrease smoking abstinence rates in smokers with schizophrenia without jeopardising their mental state .
• Varenicline may be effective for smoking cessation in individuals with schizophrenia compared to placebo .
• Zotepine might possibly be as efficient as risperidone and remoxipride but less effective than clozapine in schizophrenia, although the evidence is insufficient.
• In schizophrenia levomepromazine seems to be as efficient as chlorpromazine while causing less extrapyramidal side effects than haloperidol and chlorpromazine, although the evidence is insufficient .
• Switching antipsychotic medication from olanzapine to aripiprazole or quetiapine in patients with weight gain or metabolic adverse effects may result in weight loss and improvement in glucose and lipid metabolism .
• Acetylcholinesterase inhibitors in combination with antipsychotics might possibly be effective on a few domains of mental state and cognition in patients with schizophrenia, although the evidence is insufficient .
• Paliperidone palmitate appears to be more effective than placebo and roughly equivalent to risperidone long-acting injection in short-term studies in schizophrenia .
• Sildenafil might possibly be a useful option for antipsychotic-induced sexual dysfunction in men with schizophrenia, although the evidence is insufficient .
• Thioridazine is an antipsychotic of similar efficacy to other commonly used neuroleptics for people with schizophrenia, and it may have a lower level of extrapyramidal problems, but it is associated with the cardiac arrhythmia, torsades de pointe.
• Aripiprazole may be equally effective with typical and atypical antipsychotics in schizophrenia, and it may be more tolerable due to its favourable adverse effects profile .
• Chlorpromazine may be effective in schizophrenia, but is probably sedating, prone to cause a variety of movement problems and increased weight .
• Fluphenazine and low-potency antipsychotics might possibly be equally effective in schizophrenia, although the evidence is insufficient .

Non-pharmacological treatments

• Acute day hospitals appear to be as effective as inpatient care in treating acutely ill psychiatric patients .
• Electroconvulsive therapy (ECT) appears to produce global improvement for people with schizophrenia at least in the short term. ECT combined to antipsychotic drugs appears superior to antipsychotics alone .
• Home crisis treatment coupled with an ongoing home care package appears to be effective and acceptable to patients and family .
• There is insufficient evidence on the possible benefits of hypnosis for people with schizophrenia. The therapy as such seems acceptable for the patients .
• There is no evidence on the effectiveness of distraction techniques in the treatment of schizophrenia-associated hallucinations .
• Compliance therapy may not have an effect on compliance, attitude to treatment or mental state in people with schizophrenia .
• Music therapy combined with standard care may help people with schizophrenia to improve their global state, negative symptoms, depression, anxiety, and social functioning over the short- to medium-term .
• Evidence is insufficient to determine the efficacy of acupuncture in the treatment of schizophrenia .
• Life skills programmes may not be more effective than standard care or support group for people with chronic mental illnesses .
• There is no evidence on the effects of art therapy as an adjunctive treatment for schizophrenia .
• Social skills training may improve the social skills of people with schizophrenia and reduce relapse rates .
• Supportive therapy may not be more effective than other forms of psychological intervention in the treatment of schizophrenia. For some outcomes, including hospitalisation, general mental state and affective symptoms, other therapies may offer advantages over supportive therapy .
• Psychodynamic therapy might possibly have no positive effect in schizophrenia, although the evidence is insufficient.
• Intensive case management (ICM) appears to reduce hospitalisation, increase retention in care and improve social functioning in severe mental illness compared to standard care, although its effect on mental state and quality of life remains unclear. However, its benefit on top of a less formal non-ICM approach appears not to be clear .
• In serious mental illness physical healthcare advice might possibly improve health-related quality of life in the mental but not in physical component, although the evidence is insufficient .
• Regular exercise as adjunctive therapy seems to improve the physical and mental health and well-being of the patients with schizophrenia, although the evidence is insufficient .

Other evidence summaries

• Both conventional and newer antipsychotics appear to be associated with weight gain, which appears to be 3- to 4-fold greater in patients with first-episode psychosis compared to patients with chronic psychotic disorders .

• Second-generation antipsychotic drugs appear be more effective than first-generation antipsychotics in treating schizophrenia patients. They appear also to result in fewer extrapyramidal side effects, but induce weight gain

Literature

• Byrne P. Managing the acute psychotic episode. BMJ 2007 Mar 31;334(7595):686-92.
• van Os J, Kapur S. Schizophrenia. Lancet 2009 Aug 22;374(9690):635-45.