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Chlorpromazine versus placebo for schizophrenia
B Thornley1, J Rathbone, C E Adams
1Assertive Outreach Team, Whitney, Oxfordshire, UK. ben-and-allison@thornley2000.fsnet.co.uk
The Cochrane Database of Systematic Reviews
|June 14, 2003
Summary
Chlorpromazine effectively reduces schizophrenia relapse and improves symptoms, but causes significant side effects like sedation and movement disorders. This review quanties its benefits and risks, supporting informed clinical decisions.
Area of Science:
- Psychiatry and Clinical Neuroscience
- Pharmacological Treatments
- Evidence-Based Medicine
Background:
- Chlorpromazine, developed in the 1950s, is a foundational treatment for schizophrenia.
- Its continued use necessitates a thorough evaluation of its efficacy and safety profile.
Purpose of the Study:
- To systematically evaluate the effects of chlorpromazine compared to placebo in schizophrenia treatment.
- To quantify the impact of chlorpromazine on relapse rates, overall improvement, and adverse events.
Main Methods:
- Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases including Cochrane Schizophrenia Group Register, MEDLINE, EMBASE, PsycLIT, and Biological Abstracts.
- Included RCTs comparing chlorpromazine with placebo for schizophrenia and serious chronic mental illness.
Main Results:
- Chlorpromazine significantly reduced relapse rates (RR 0.65, NNT 3) and improved global functioning (RR 0.76, NNT 7) over 6 months to 2 years.
- Common adverse effects included sedation (NNH 6), acute movement disorders (NNH 24), parkinsonism (NNH 10), and hypotension with dizziness (NNH 12).
- Weight gain was also a significant adverse effect (NNH 3).
Conclusions:
- Chlorpromazine remains a benchmark treatment for schizophrenia, with quantified benefits in reducing relapse and improving symptoms.
- The drug is associated with numerous adverse effects, necessitating careful consideration in clinical practice.
- This evidence supports informed decision-making for clinicians, patients, and caregivers regarding chlorpromazine use.