Atypical neuroleptics in acute schizophrenia: a double-blind comparative study of remoxipride and haloperidol

In the present double-blind study comprising 6 weeks, remoxipride was compared with haloperidol in acute schizophrenic patients (DSM-III). Symptoms assessment was performed using the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions (CGI) and the Present State Examination (PSE). Extrapyramidal Symptoms (EPS) were assessed using the Simpson and Angus scale. Side effects were also recorded both by spontaneous reports and by active questioning. Seventy-one patients entered the study, 36 in the remoxipride group and 35 in the haloperidol group. There were 10 dropouts, 4 in the remoxipride group and 6 patients in the haloperidol group. The PSE profile revealed a similar reduction in the symptom clusters of psychosis in both treatment groups. Forty-seven percent of the patients in the remoxipride group and 34 percent of the patients in the haloperidol group showed clinically relevant improvement (reduction of total BPRS score by 50% or more). Similar results were obtained with the CGI. All EPS except "glabella tap" occurred significantly less frequently in the remoxipride group compared to the haloperidol group. Substantially lower incidence of EPS was found by active questioning in the remoxipride group compared to the haloperidol group. Also, considerably lower incidences of drowsiness/somnolence, tiredness/fatigue, and concentrating difficulty were observed in the remoxipride group. At the end of treatment, 66 percent of the patients in the haloperidol group and 22 percent in the remoxipride group were using anticholinergics. This study indicates that the newly developed neuroleptic remoxlpride is an effective, clinically safe, and well tolerated antipsychotic compound. In particular, few EPS were induced by remoxipride, as compared to haloperidol.