Flupenthixol versus placebo for schizophrenia
Shanghai Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 11/2012; 11(11):CD009777. DOI: 10.1002/14651858.CD009777.pub2
Flupenthixol is an antipsychotic drug, first made available in the UK in 1965. Available both as a tablet and long-acting injection, it has been used to treat schizophrenia for nearly 50 years and has been found to be effective and well tolerated by people with schizophrenia. The main side-effects are shaking, restlessness, a dry mouth and some weight gain. Although this drug has been available for many years, few systematic reviews of its effectiveness are available and the effects of this drug in helping people cope with the symptoms of schizophrenia are not currently well measured, quantified and known. This systematic review could include only one small study which was small and 30 years old. Flupenthixol was compared with a placebo (dummy drug). Fewer people taking flupenthixol required additional antipsychotic medication but there was no clear difference in people’s ability to cope and function socially. There was no clear information on: improving people’s mental state; helping their behaviour; increasing their use of services; people’s satisfaction with treatment; or costs and cost effectiveness. Flupenthixol is widely available and inexpensive so it is perhaps understandable that it remains a popular drug used for treating people with serious mental illnesses. However, the use of flupenthixol is based more on clinical experience and the decisions of psychiatrists rather than results from large-scale research studies and evidence-based information. The effectiveness and benefits of flupenthixol remain largely unknown and incomplete. Large randomised and placebo-controlled trials could be helpful in increasing knowledge about this drug. This summary has been written by Ben Gray from RETHINK.
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- "First introduced about 50 years ago, it continues to be widely prescribed by psychiatrists . A recent Cochrane review reported that there are few data from clinical trials investigating its absolute effects, and suggested that flupenthixol may well be worthy of careful investigation, partly to ensure that this inexpensive active drug is not forgotten (Shen et al. 2012). "
ABSTRACT: Several questions remain unanswered regarding the magnitude and time course of cognitive improvement in response to antipsychotic treatment. The purpose of this study was to assess changes in cognitive performance in antipsychotic-naive or minimally medicated patients with first-episode schizophrenia during the first 12 months of treatment, in a case-control design. Patients were treated with flupenthixol decanoate depot injection, according to a standard algorithm. The primary outcome measure was change in MATRICS Cognitive Consensus Battery (MCCB) composite score over 12 months. The sample comprised 92 patients and 100 healthy controls matched for age, sex, ethnicity and educational status. Cognitive function was assessed by means of the MCCB. A mixed-effects model identified a significant group × time effect (p ≤ 0.0001) for the MCCB composite score, with patients showing a greater degree of change than the controls. For the other MCCB domains there were significant group × time effects at adjusted significance level for attention and vigilance (p ≤ 0.0001), visual learning (p ≤ 0.0001), verbal learning (p = 0.005) and working memory (p ≤ 0.0001), but not for reasoning and problem solving (p = 0.04), speed of processing (p = 0.03) and social cognition (p = 0.06). There were moderate correlations between change in MCCB composite score and change in symptomatology as assessed by Positive and Negative Syndrome Scale factor analysis-derived domains. Substantial improvements in cognitive function were observed over and above a practice effect, and were significantly correlated with improvements in psychopathology and functionality.
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ABSTRACT: Myelination is a highly regulated developmental process whereby oligodendrocytes in the central nervous system and Schwann cells in the peripheral nervous system ensheathe axons with a multilayered concentric membrane. Axonal myelination increases the velocity of nerve impulse propagation. In this work, we present a novel in vitro system for coculturing primary dorsal root ganglia neurons along with myelinating cells on a highly restrictive and micropatterned substrate. In this new coculture system, neurons survive for several weeks, extending long axons on defined Matrigel tracks. On these axons, myelinating cells can achieve robust myelination, as demonstrated by the distribution of compact myelin and nodal markers. Under these conditions, neurites and associated myelinating cells are easily accessible for studies on the mechanisms of myelin formation and on the effects of axonal damage on the myelin sheath.
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