Chlorpromazine versus placebo for schizophrenia
Clive E Adams1, George A Awad, John Rathbone
1Cochrane Schizophrenia Group, The University of Nottingham, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road,, Nottingham, UK, NG7 2TU.
The Cochrane Database of Systematic Reviews
|January 8, 2014
Summary
This review of chlorpromazine for schizophrenia found it reduces relapses and improves symptoms, but causes significant side effects like sedation and movement disorders. It remains a benchmark treatment despite its imperfections.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Trials
Background:
- Chlorpromazine, developed in the 1950s, is a foundational treatment for schizophrenia.
- Its long-standing use necessitates a review of its efficacy and safety profile.
Purpose of the Study:
- To systematically review the effects of chlorpromazine compared to placebo in schizophrenia treatment.
- To quantify the benefits and risks associated with chlorpromazine therapy.
Main Methods:
- Conducted a comprehensive search of the Cochrane Schizophrenia Group's Trials Register and other sources.
- Included randomized controlled trials (RCTs) comparing chlorpromazine with placebo for schizophrenia.
- Analyzed dichotomous data using risk ratios and continuous data using mean differences with a fixed-effect model.
Main Results:
- Chlorpromazine significantly reduced relapse rates within six months to two years (RR 0.65) and improved overall symptoms and functioning (RR 0.71).
- Fewer participants receiving chlorpromazine withdrew from trials early (RR 0.64).
- Significant adverse effects included sedation (RR 2.79), acute movement disorders (RR 3.47), parkinsonism (RR 2.11), hypotension with dizziness (RR 2.38), and substantial weight gain (RR 4.92).
Conclusions:
- The review quantifies known clinical observations about chlorpromazine's effectiveness and side effect profile.
- Chlorpromazine's status as a benchmark treatment for psychosis is supported, though it is an imperfect medication.
- Evidence-based decision-making for clinicians, carers, and patients can be improved by judicious use of these findings.
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