Valproate + antipsychotics compared to antipsychotics + placebo or antipsychotics alone for schizophrenia [1]
Summary
There is limited evidence, based on a number of trials, that the augmentation of antipsychotics with valproate may be effective for overall clinical response, and also for specific symptoms, especially in terms of excitement and aggression. However, this evidence was entirely based on open RCTs. Moreover, valproate was associated with a number of adverse events among which sedation and dizziness appeared significantly more frequently than in the control groups. Further randomised studies which are blinded are necessary before any clear recommendation can be made. Ideally these would focus on people with schizophrenia and aggression, on those with treatment-resistant forms of the illness and on those with schizoaffective disorders.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Clinically significant response
Important change - as defined by the studies
Valproate + antipsychotics probably improves the outcome. Data are based on moderate quality evidence.
Valproate + antipsychotics probably slightly reduces the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Use of additional medication for sedation at least once
Valproate + antipsychotics may improve the outcomes to do with how much hospital/community care is used, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Clinical response - mean change score PANSS total (high = poor)
In average, people recieving valproate + antipsychotics scored 5.85 lower than people treated with antipsychotics + placebo or antipsychotics alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear.
Abnormal liver function/increase in alanine transaminase/gamma-glutamyl transpeptidase
Valproate + antipsychotics probably makes little or no improvement to the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Valproate + antipsychotics probably makes little or no improvement to the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia [2]
Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved, endpoint - medium-term (various similar criteria)
Acupuncture added to standard dose antipsychotics may reduce the global state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may reduce the mental state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
In average, people recieving acupuncture added to standard dose antipsychotics scored 16 lower than people treated with standard dose antipsychotics. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear.
Trifluoperazine versus placebo for schizophrenia [3]
Summary
Our results agree with existing evidence that compared to placebo, trifluoperazine is an effective antipsychotic for people with schizophrenia. Furthermore, our review provides supportive evidence that trifluoperazine increases the risk of extrapyramidal adverse effects. Although the effect sizes against placebo are similar to those observed with other agents, they are based on data from many small, pre-CONSORT trials with generally either a low or very low GRADE evidence that has limited implication for clinical practice. Large, independent trials are needed that adhere to the CONSORT statement to compare trifluoperazine with placebo used in the treatment of schizophrenia and schizophrenia-like illnesses.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Clinical improvement - medium term. As defined by each study. Follow-up: mean 19 weeks
Trifluoperazine may slightly improve the global state outcome. Data are based on low quality evidence.
Any clinically significant response in psychotic symptoms (as defined by each study) - medium term. Numbers of participants experiencing 'intensified symptoms'Follow-up: mean 16 weeks
Trifluoperazine may improve the mental state outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Any reason - medium term. Number of participants leaving the studies early. Follow-up: mean 5 months
Trifluoperazine may reduce the finding treatment unacceptable or being withdrawn from treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Short term. Numbers of participants leaving the studies due to severe adverse effects. Follow-up: mean 2 months
Trifluoperazine may improve the outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Any clinically significant agitation or distress - medium term. As defined by each study. Follow-up: 4 months
Trifluoperazine may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Morita therapy for schizophrenia remains an experimental intervention. New trials are justified and specific plans for the design of future studies are outlined.
[Note: the 10 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
1a. Overall no clinically important improvement (BPRS) - short term - 25-30% change BPRS (follow-up: 10 weeks)
Morita therapy may reduce the mental state outcome but there is no clear difference between people given morita therapy and those recieving the control . These findings are based on data of low quality.
Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia [5]
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved, endpoint - medium-term (various similar criteria)
Acupuncture added to standard dose antipsychotics may reduce the global state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may reduce the mental state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
In average, people recieving acupuncture added to standard dose antipsychotics scored 16 lower than people treated with standard dose antipsychotics. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear.
The outcome was not measured/reported in the included studies.
Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia [6]
Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved, endpoint - medium-term (various similar criteria)
Acupuncture added to standard dose antipsychotics may reduce the global state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may reduce the mental state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
In average, people recieving acupuncture added to standard dose antipsychotics scored 16 lower than people treated with standard dose antipsychotics. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear.
The outcome was not measured/reported in the included studies.
Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia [7]
Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.[7]
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved, endpoint - medium-term (various similar criteria)
Acupuncture added to standard dose antipsychotics may reduce the global state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may reduce the mental state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
On average, people recieving acupuncture added to standard dose antipsychotics scored 16 lower than people treated with standard dose antipsychotics. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear.
The outcome was not measured/reported in the included studies.
Trifluoperazine versus placebo for schizophrenia [8]
Summary
Our results agree with existing evidence that compared to placebo, trifluoperazine is an effective antipsychotic for people with schizophrenia. Furthermore, our review provides supportive evidence that trifluoperazine increases the risk of extrapyramidal adverse effects. Although the effect sizes against placebo are similar to those observed with other agents, they are based on data from many small, pre-CONSORT trials with generally either a low or very low GRADE evidence that has limited implication for clinical practice. Large, independent trials are needed that adhere to the CONSORT statement to compare trifluoperazine with placebo used in the treatment of schizophrenia and schizophrenia-like illnesses.
[8]
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Clinical improvement - medium term. As defined by each study. Follow-up: mean 19 weeks
Trifluoperazine may slightly improve the global state outcome. Data are based on low quality evidence.
Any clinically significant response in psychotic symptoms (as defined by each study) - medium term. Numbers of participants experiencing 'intensified symptoms'Follow-up: mean 16 weeks
Trifluoperazine may improve the mental state outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Any reason - medium term. Number of participants leaving the studies early. Follow-up: mean 5 months
Trifluoperazine may reduce the finding treatment unacceptable or being withdrawn from treatment outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Short term. Numbers of participants leaving the studies due to severe adverse effects. Follow-up: mean 2 months
Trifluoperazine may improve the outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Any clinically significant agitation or distress - medium term. As defined by each study. Follow-up: 4 months
Trifluoperazine may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
The outcome was not measured/reported in the included studies.
^Wang, Y; Xia, J; Helfer, B (2016). "Valproate for schizophrenia". Cochrane Database of Systematic Reviews. 11: CD004028.pub4. doi:10.1002/14651858.CD004028.pub4.
^Shen, X; Xia, J; Adams, C (2014). "Acupuncture for schizophrenia". Cochrane Database of Systematic Reviews. 10: CD005475.pub2. doi:10.1002/14651858.CD005475.pub2.
^Koch, K; Mansi, K; Haynes, E (2014). "Trifluoperazine versus placebo for schizophrenia". Cochrane Database of Systematic Reviews. 1: CD010226.pub2. doi:10.1002/14651858.CD010226.pub2.
^He, Y; Li, C (2007). "Morita therapy for schizophrenia". Cochrane Database of Systematic Reviews. 1: CD006346. doi:10.1002/14651858.CD006346.
^Shen, X; Xia, J; Adams, C (2014). "Acupuncture for schizophrenia". Cochrane Database of Systematic Reviews. 10: CD005475.pub2. doi:10.1002/14651858.CD005475.pub2.
^Shen, X; Xia, J; Adams, C (2014). "Acupuncture for schizophrenia". Cochrane Database of Systematic Reviews. 10: CD005475.pub2. doi:10.1002/14651858.CD005475.pub2.
^ abShen, X; Xia, J; Adams, C (2014). "Acupuncture for schizophrenia". Cochrane Database of Systematic Reviews. 10: CD005475.pub2. doi:10.1002/14651858.CD005475.pub2.
^ abKoch, K; Mansi, K; Haynes, E (2014). "Trifluoperazine versus placebo for schizophrenia". Cochrane Database of Systematic Reviews. 1: CD010226.pub2. doi:10.1002/14651858.CD010226.pub2.
