Relapse prevention with antipsychotic drugs compared with placebo in patients with schizophrenia has not been sufficiently addressed by previous systematic reviews. We aimed to assess the association between such drugs and various outcomes in patients with schizophrenia to resolve controversial issues.
We searched the Cochrane Schizophrenia Group's specialised register for reports published before Nov 11, 2008; and PubMed, Embase, and ClinicalTrials.gov for those before June 8, 2011. We also contacted pharmaceutical companies and searched the reference lists of included studies and previous reviews. Randomised trials of patients with schizophrenia continued on or withdrawn from any antipsychotic drug regimen after stabilisation were eligible. Our primary outcome was relapse between 7 and 12 months. We also examined safety and various functional outcomes. We used the random effects model and verified results for the primary outcome with a fixed effects model. Heterogeneity was investigated with subgroup and meta-regression analyses.
We identified 116 suitable reports from 65 trials, with data for 6493 patients. Antipsychotic drugs significantly reduced relapse rates at 1 year (drugs 27%vs placebo 64%; risk ratio [RR] 0·40, 95% CI 0·33-0·49; number needed to treat to benefit [NNTB] 3, 95% CI 2-3). Fewer patients given antipsychotic drugs than placebo were readmitted (10%vs 26%; RR 0·38, 95% CI 0·27-0·55; NNTB 5, 4-9), but less than a third of relapsed patients had to be admitted. Limited evidence suggested better quality of life (standardised mean difference -0·62, 95% CI -1·15 to -0·09) and fewer aggressive acts (2%vs 12%; RR 0·27, 95% CI 0·15-0·52; NNTB 11, 6-100) with antipsychotic drugs than with placebo. Employment data were scarce and too few deaths were reported to allow significant differences to be identified. More patients given antipsychotic drugs than placebo gained weight (10%vs 6%; RR 2·07, 95% CI 2·31-3·25), had movement disorders (16%vs 9%; 1·55, 1·25-1·93), and experienced sedation (13%vs 9%; 1·50, 1·22-1·84). Substantial heterogeneity in size of effect was recorded. In subgroup analyses, number of episodes, whether patients were in remission, abrupt or gradual withdrawal of treatment, length of stability before trial entry, first-generation or second-generation drugs, and allocation concealment method did not significantly affect relapse risk. Depot preparations reduced relapse (RR 0·31, 95% CI 0·21-0·41) more than did oral drugs (0·46, 0·37-0·57; p=0·03); depot haloperidol (RR 0·14, 95% CI 0·04-0·55) and fluphenazine (0·23, 0·14-0·39) had the greatest effects. The effects of antipsychotic drugs were greater in two unblinded trials (0·26, 0·17-0·39) than in most blinded studies (0·42, 0·35-0·51; p= 0·03). In a meta-regression, the difference between drug and placebo decreased with study length.
Maintenance treatment with antipsychotic drugs benefits patients with schizophrenia. The advantages of these drugs must be weighed against their side-effects. Future studies should focus on outcomes of social participation and clarify the long-term morbidity and mortality of these drugs.
German Ministry of Education and Research.
"tive measures of outcome . Coombes et al . 2010 Despite the effectiveness of corticosteroid injections in the short term , non - corticosteroid injections might be of benefit for long - term treatment of lateral epicondylalgia . However , response to injection should not be generalised because of variation in effect between sites of tendinopathy . Leucht et al . 2012 Yes , P ! 0 . 01 Maintenance treatment with antipsychotic drugs benefits patients with schizophrenia . The advantages of these drugs must be weighed against their side - effects . Future studies should focus on outcomes of social participation and clarify the long - term morbidity and mortality of these drugs . Hempel et al . 2012 The p"
[Show abstract][Hide abstract] ABSTRACT: Background: There is evidence to suggest that component randomized controlled trials (RCTs) within systematic reviews may be biased. It is important that these reviews are identified to prevent erroneous conclusions influencing health care policies and decisions. Purpose: To assess the likelihood of bias in trials in 12 meta-analyses. Design: A review of 12 systematic reviews. Data Sources: Twelve recently published systematic reviews with 503 component randomized trials, published in the British Medical Journal, The Lancet, Journal of the American Medical Association, and The Annals of Internal Medicine before May 2012. Study Selection and Data Extraction: Systematic reviews were eligible for inclusion if they included only RCTs. We obtained the full text for the component RCTs of the 12 systematic reviews (in English only). We extracted summary data on age, number of participants in each treatment group, and the method of allocation concealment for each RCT. Data Synthesis: Five of the 12 meta-analyses exhibited heterogeneity in age differences (I-2 > 0.30), when there should have been none. In two meta-analyses, the age of the intervention group was significantly greater than that of the control group. Inadequate allocation concealment was a statistically significant predictor of heterogeneity in one trial as observed by a metaregression. Conclusions: Most of the sample of recent meta-analyses showed that there were signs of imbalance and/or heterogeneity in ages between treatment groups, when there should have been none. Systematic reviewers might consider using the techniques described here to assess the validity of their findings.
"Case management involves an iterative process of assessing each patient's strengths and weaknesses, providing regular and ongoing training (typically targeted on medication management, activities of daily living and social functioning), periodically re-assessing patients' functioning, and making mid-course corrections in the training package.- Given that discontinuation of medication is the main reason for relapse and rehospitalization,, training patients and their co-resident family members about adherence and providing them with psychological support for adherence (even in the presence of discomfort and side-effects) is the cornerstone of successful case management interventions. Many factors affect the adherence to medication, including the psychosocial characteristics of the patient and the patient's co-resident family members, fluctuations in disease symptomatology, the type and dosage of antipsychotic medication used, and the patient's tolerance of the medication., "
"Maintenance treatment with antipsychotic medication is effective at preventing relapse in schizophrenia (Leucht et al., 2012) but requires that patients are compliant. In common with other long-term conditions, around 50% of patients with schizophrenia are non-adherent with medication (Lacro, Dunn, Dolder, Leckband, & Jeste, 2002). "
[Show abstract][Hide abstract] ABSTRACT: Up to 50% of patients with schizophrenia are non-adherent with antipsychotic medication.
To establish the efficacy of adherence therapy (AT) compared to treatment as usual (TAU) in improving clinical outcomes in patients with schizophrenia following an acute exacerbation of illness.
A parallel-group, single-blind, randomised controlled trial. Fieldwork was conducted in Thailand. Patients received eight weekly sessions of AT in addition to TAU. The primary outcome was improvement in psychopathology (measured using the Positive and Negative Syndrome Scale (PANSS)) at 26-week follow-up. Secondary outcomes included patient attitudes towards medication, global functioning and side-effects.
In total, 70 inpatients with schizophrenia were recruited to the trial. At 26-week follow-up, PANSS total scores improved in the AT compared to the TAU group by a mean of -3.94 points (effect size = 0.24). The number needed to treat (NNT) was 5. There was no significant effect on patients' attitudes towards treatment, functioning or medication side-effects. No treatment-related adverse effects were reported.
AT improves psychopathology in Asian patients with schizophrenia following an acute exacerbation of illness.
International Journal of Social Psychiatry 04/2014; 61(1). DOI:10.1177/0020764014529099 · 1.15 Impact Factor
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