Zuclopenthixol dihydrochloride for schizophrenia

Cochrane Database of Systematic Reviews, November 2017

This Cochrane Review finds evidence available suggest that zuclopenthixol dihydrochloride is not any worse than other antipsychotics in treating the symptoms of schizophrenia, however more trials providing good-quality data are needed before firm conclusions can be made.

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Prescribing of psychiatric drugs to people with a learning disability or autism

Public Health England, July 2015

This study finds that one in six adults with learning disabilities are being prescribed anti-psychotic drugs by their GP that are normally used to treat major mental illnesses. Over half of these adults do not have a recorded diagnosis of a condition these drugs are designed to treat.

Click here for further information and to download the report.

Second-generation antipsychotic effect on cognition in patients with schizophrenia—a meta-analysis of randomized clinical trials

Acta Psychiatrica Scandinavica, 16 January 2015

Objective:
To investigate the effect of second-generation antipsychotics on cognitive function in patients diagnosed with schizophrenia or schizoaffective disorder.

Method:
Multiple-treatments meta-analysis model.

Results:
On cognitive composite score, sertindole was superior to clozapine, effect size (ES) 0.87; 95% CI: 0.12–1.63, quetiapine, ES 0.75; 95% CI: 0.00–1.49, and first-generation antipsychotics (FGAs), ES 0.89; 95% CI: 0.14–1.64. Analyses on each cognitive domain showed clozapine, ES 0.37; 95% CI: 0.00–0.74, olanzapine, ES 0.31; 95%CI: 0.02–0.59, quetiapine, ES 0.34; 95% CI: 0.03–0.64, and FGAs, ES 0.51; 95% CI: 0.18–0.83 performing poorer on verbal working memory than ziprasidone, as well as FGAs performing poorer than risperidone, ES 0.31; 95% CI: 0.04–0.58. On executive function, sertindole performed better than clozapine, ES 0.82; 95% CI: 0.06–1.58, olanzapine, ES 0.81; 95% CI: 0.07–1.55, quetiapine, ES 0.76; 95% CI: 0.02–1.51, ziprasidone, ES 0.90; 95% CI: 0.14–1.67, and FGAs, ES 0.83; 95% CI: 0.08–1.58. On processing speed, FGAs performed poorer than sertindole, ES 0.97; 95% CI: 0.02–1.91, and quetiapine, ES 0.36; 95% CI: 0.01–0.72. On long-term verbal working memory, clozapine performed poorer than olanzapine, ES 0.41; 95% CI: 0.06–0.76. On verbal fluency, FGAs performed poorer than olanzapine, ES 0.26; 95% CI: 0.01–0.50, and clozapine, ES 0.44; 95% CI: 0.06–0.81. Lastly, FGAs, ES 0.41; 95% CI: 0.04–0.78, and clozapine, ES 0.44; 95% CI: 0.05–0.83, performed poorer on visuospatial skill compared to olanzapine.

Conclusion:
The meta-analysis was able to detect some trends in the data analyzed, but did not show any drug having a uniform positive cognitive profile.

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CR190. Consensus statement on high-dose antipsychotic medication

Royal College of Psychiatrists, November 2014

This report reflects the consensus views of a group of clinicians on the risks and benefits of high-dose antipsychotic medication for a range of clinical indications for which antipsychotic medication is commonly used in psychiatric practice. For each of these indications, the members of the Consensus Working Group took account of the evidence from the published literature and their clinical experience, and considered the clinical implications.

While there is little convincing evidence that off-label prescription of doses of antipsychotic medication above the licensed dosage range has any therapeutic advantage in any clinical setting, there is clear evidence for a greater side-effect burden and the need for appropriate safety monitoring. The key recommendation is that any prescription of high-dose antipsychotic medication should be seen as an explicit, time-limited individual trial with a distinct treatment target. There should be a clear plan for regular clinical review including safety monitoring. The high-dose regimen should only be continued if the trial shows evidence of benefit that is not outweighed by tolerability or safety problems.

Click here to download the report.