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Ziprasidone for schizophrenia and severe mental illness
A Bagnall1, R A Lewis, M L Leitner
1NHS Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK, YO10 5DD. amb13@york.ac.uk
The Cochrane Database of Systematic Reviews
|October 18, 2000
Summary
Ziprasidone may be an effective antipsychotic for schizophrenia, showing similar efficacy to haloperidol but with fewer movement disorders. However, it causes more nausea and vomiting, and long-term data are limited.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Trials
Background:
- Typical antipsychotics are first-line treatments for schizophrenia.
- Atypical antipsychotics, like ziprasidone, are increasingly used and may offer improved tolerability.
- Ziprasidone is a newer atypical antipsychotic with high serotonin receptor affinity.
Purpose of the Study:
- To evaluate the efficacy and safety of ziprasidone compared to placebo, typical, and other atypical antipsychotics for schizophrenia.
- To assess adverse effect profiles, including movement disorders and gastrointestinal issues.
Main Methods:
- Comprehensive electronic database searches (e.g., MEDLINE, EMBASE, PsycLIT) from 1966 to 1999.
- Inclusion of all randomized controlled trials comparing ziprasidone to other treatments for schizophrenia-like psychoses.
- Independent assessment of study quality and data extraction, with exclusion of studies with >50% loss to follow-up.
Main Results:
- Ziprasidone demonstrated comparable efficacy to haloperidol in improving mental state, with a risk ratio of 0.8 (CI 0.7-0.9) versus placebo.
- Ziprasidone was associated with significantly fewer movement disorders compared to haloperidol (RR 0.4, CI 0.2-0.6).
- However, ziprasidone caused more nausea and vomiting (RR 2.1, CI 1.2-3.8) and injection site pain (RR 5.3, CI 1.3-22) with its intramuscular form.
Conclusions:
- Ziprasidone shows potential as an effective antipsychotic with a lower risk of extrapyramidal side effects than haloperidol.
- Increased incidence of nausea, vomiting, and injection site pain are notable adverse effects.
- Limited current data necessitate well-designed, long-term randomized trials to establish ziprasidone's role in routine clinical practice.