Comprehesiven clinical studies with thiothixene. A study of chlorpromazine: methodology and results with chronic semi-disturbed schizophrenics. The effect of chlorpromazine on serum cholesterol in chronic schizophrenic patients. Schizophrenia treated with and without chlorpromazine. Evaluation of trifluperidol in chronic schizaphrenia. Chlorpromazine in chronic schizophrenic women: I. Experimental design and effects at maximum point of treatment. Are there schizophrenics for whom drugs may be unnecessary or contraindicated? Prediction of relapse in schizophrenic outpatients treated by drug and sociotherapy. Psychological effects of single-dose antipsychotic medication. Chlorpromazine used with an intensive occupational therapy program; a controlled study. A controlled comparative investigation of the effects of promazine, chlorpromazine, and a placebo in chronic psychosis. A placebo-controlled comparison of zotepine versus chlorpromazine in patients with acute exacerbation of schizophrenia. Propranolol in schizophrenia. I. Comparison of propranolol, chlorpromazine and placebo. Family interaction patterns, drug treatment, and change in social aggression. A comparison of thioridazine, trifluoperazine, chlorpromazine, and placebo: a double-blind controlled study on the treatment of chronic, hospitalized, schizophrenic patients. Acute paranoid schizophrenia. (Treatment with chlorpromazine, trifluoperazine and placebo). Comparative study of TPS-23, chlorpromazine and placebo in chronic schizophrenic patients. Prophylactic effect of neuroleptics in symptom-free schizophrenics. Chlorpromazine in schizophrenic withdrawal and in the withdrawn schizophrenic. Does sigma receptor antagonism predict clinical antipsychotic efficacy? A controlled clinical study of chlorpromazine and reserpine in chronic schizophrenia. Premorbid asocial adjustment and response to phenothiazine treatment among schizophrenic inpatients. Parenteral haloperidol for rapid control of severe, disruptive symptoms of acute schizophrenia. LONG-TERM FOLLOW-UP STUDY OF SCHIZOPHRENIC PATIENTS. The immediate effects of chlorpromazine in newly admitted schizophrenic patients. Chlorpromazine and the untreated chronic schizophrenic: a long-term trial. Drug treatment in newly admitted schizophrenic patients. Evaluation of loxapine succinate in chronic schizophrenia. Phenothiazine effects on psychological and psychophysiological dysfunction in chronic schizophrenics. PHENOTHIAZINES IN PREVENTION OF PSYCHIATRIC HOSPITALIZATION. 3. DELAY OR PREVENTION OF HOSPITALIZATION. Effects of chlorpromazine on primary-process thought manifestations. The relative efficacy of vespral and chlorpromazine in the treatment of a group of chronic schizophrenic patients. Evaluation of butaclamol in chronic schizophrenic patients. The comparative effectiveness of six phenothiazine compounds, phenobarbital and inert placebo in the treatment of acutely ill patients: global measures of severity of illness.
nan nan nan nan nan nan This study reports that there are schizophrenics who do relatively well long term without the routine or continuous use of antipsychotic medication. Specially selected young males undergoing an acute schizophrenic episode were followed, after hospitalization, for up to three years. While hospitalized they were assigned randomly to either placebo or chlorpromazine treatment. Many unmedicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer rehospitalizations and better overall function in the community than patients who were given chlorpromazine while in the hospital. Factors related to post-hospital outcome were good premorbid history and short-lived paranoid characteristics. Considerations which may have an effect on the successful management of acute schizophrenic patients not on medication are mentioned. The findings underline the need for further study of how to utilize antipsychotic medication more selectively in the treatment of schizophrenia. Despite the established efficacy of neuroleptics for maintaining schizophrenics in the community, there are data suggesting that those with very good prognostic signs may do as well without drugs. In testing this, we find no evidence that patients with good signs are not in need of drugs; instead they profit most from drug treatment. Patients who benefit little (1) are men whose families were disrupted earlier in their lives, (2) live alone or with extended families whose attitudes toward the study are not positive, and (3) are irregular in taking their medication. The practical implication is that the drug nonresponder can be helped by some means to ensure regularity of medication taking, such as a visiting nurse or long-acting medication. A second research question is whether major role therapy (MRT, a combination of social casework and vocational rehabilitation) can lengthen the time until relapse. Major role therapy affected time to relapse in a disordinal manner; asymptomatic patients benefited from MRT, while in patients with greater symptom severity MRT- suprisingly--hastened relapse. It is hypothesized that symptomatic patients are suffering from an inability to manage an expanded and enriched cognitive field; MRT, a therapy that urges the patient to become more responsible and to expand his horizons, may actually induce a state with which the patient cannot cope. It is recommended that a therapy such as MRT be deferred until the patient is essentially asymptomatic. nan nan nan The aim of this study was to evaluate the efficacy of zotepine in the treatment of acute episodes of schizophrenia.
                Patients with acute exacerbation of schizophrenia (DSM-III-R criteria; n = 158) were allocated on a random, double-blind basis to receive zotepine (150 or 300 mg/day), chlorpromazine (300 or 600 mg/day) or placebo for 8 weeks. Symptoms were assessed on the BPRS, SANS and CGI scales at baseline and weeks 1, 2, 4, 6 and 8 and patients were assessed at these times for adverse effects. Analysis was by analysis of variance on the intent-to-treat population, with last observation carried forward.
                Mean BPRS scores improved statistically significantly more with zotepine than chlorpromazine (point estimate of difference -12.4, 95% CI -18.3 to -6.5) or placebo (point estimate of difference -12.7, 95% CI -18.6 to -6.8). Zotepine produced significantly fewer extrapyramidal symptoms (EPS) than chlorpromazine.
                Zotepine is an effective antipsychotic with low propensity for EPS. Fifty-three hospitalized chronic schizophrenic patients were treated with either propranolol, chlorpromazine or placebo in a double-blind randomized trials for up to three months. Propranolol in a usual dose of 640 mg/day, produced marked cardiovascular effects but no improvement in schizophrenic symptomatology relative to placebo. The effects of chlorpromazine were small and inconsistent. nan nan nan nan Prophylactic effects of psychotropic drugs on 55 schizophrenics in remission were evaluated for 3 years in a double-blind controlled study employing a cross-over design. Patients were randomly assigned to the following drugs orally administered twice a day: placebo; diazepam 15 mg; imipramine 50 mg; chlorpromazine 75 mg; and haloperidol 3 mg. The number of days of remission for each patient was recorded. Since only two patients received all five drug treatments, the data were analyzed using the number of days allocated to the "first assigned drugs" only and the cross-over aspect of the experimental design was disregarded. All patients treated with either the placebo, diazepam or imipramine relapsed within a year. On the other hand, four patients treated with chlorpromazine, or with haloperidol, were in remission for more than 1 year. Fifty percent of the patients relapsed within 16 days with placebo; 88 days with diazepam; 30 days with imipramine; 165 days with chlorpromazine; and 74 days with haloperidol. Within a year, only chlorpromazine significantly prolonged the remission state as compared to placebo and imipramine. At the end of the 3-year trial, both chlorpromazine and haloperidol significantly prolonged the remission state as compared to the other three drugs. These data suggest that neuroleptic treatment for a longer period is vitally important to prevent relapse even in schizophrenics in remission and that such a trial seems an efficient method for investigating the prophylactic effects of neuroleptics. nan The psychotogenic actions of sigma receptor agonists, such as pentazocine, have led to the hypothesis that sigma receptor antagonists may be putative antipsychotic agents. In this study, BW234U, a selective but relatively weak sigma receptor antagonist was compared at two different dosage ranges with chlorpromazine and placebo in a double-blind randomized treatment trial in schizophrenic patients undergoing acute exacerbation. During the 4-week blinded treatment period, there was a modest drop in Brief Psychiatric Rating Scale (BPRS) score in the chlorpromazine group, however, neither dosage range of BW234U, nor placebo produced a significant drop in the BPRS. Our results suggest that BW234U is an ineffective anti-psychotic agent in schizophrenics experiencing acute exacerbation of their illness. Due to BW234U's relatively weak antagonism at the sigma recognition site, this does not rule out the possibility that more potent and equally selective sigma antagonists may possess antipsychotic efficacy. nan nan Intramuscular haloperidol, at three dose levels, (5 mg, 2 mg, and 1 mg) chlorpromazine (25 mg), and placebo were compared for efficacy, rapidity of therapeutic onset, and safety in 50 acute psychotic patients requiring rapid control. The drugs were administered parenterally under double-blind conditions at half-hour intervals until successful control of moderate to very severe symptomatology was achieved or a maximum of four injections had been given. Global evaluation, BPRS, and target symptom ratings were performed. The overall results indicated that the 5 mg and 2 mg haloperidol doses were significantly superior to the 1 mg haloperidol and 25 mg chlorpromazine doses and to placebo. Transfer of patients to oral haloperidol was satisfactorily accomplished. Side effects for all medications were minimal and included slight to moderate EPS and drowsiness. The use of antiparkinson drugs completely controlled the extrapyramidal symptoms. nan To evaluate the clinical effectiveness of chlorpromazine in comparison with placebo over a brief period of hospitalization, the authors conducted a double-blind study of the drug in 44 acutely ill schizophrenic patients. These patients had been newly admitted to a brief treatment unit where the average length of stay was 7 to 10 days. The results of this study indicate that chlorpromazine had no more calming or antipsychotic effect than placebo during the first 5 days of treatment. The authors suggest that 5 days is too short a time for a clinical trial to gauge patient response to chlorpromazine. nan nan nan This study examined the effects of phenothiazine treatment on attentional-perceptual, cognitive, and psychophysiological dysfunction in chronic schizophrenics. Under double-blind conditions, 20 patients receiving chlorpromazine and 20 receiving placebo for eight weeks were tested by performance measures, clinically rated, and monitored for skin resistance and heart rate on four occasions. Phenothiazine effects on measures of attention-perception and on psychophysiological response were demonstrable, but not on tests and ratings of cognitive dysfunction. The direction of effects was toward normalization of function. Drug treatment tended to improve ability to sustain set, to increase efficiency of selective attention, and to increase rate of information processing. Autonomic reactivity was reduced and a deactivation effect suggested. Clinical improvement was correlated with reduction in attentional dysfunction. The results are discussed in terms of their implications for hypothesized behavioral mechanisms of drug action, primary "behavioral site" of drug action, therapeutic response measurement, and functional theories of schizophrenic psychopathology. nan nan nan In a double-blind, placebo-controlled study, an attempt was made to evaluate butaclamol in chronic schizophrenic patients using chlorpromazine (CPZ) as the standard comparative drug. With doses up to 50 mg/day, butaclamol was shown to have significant antipsychotic activity comparable to CPZ but with a much higher incidence of extrapyramidal signs. A more reasonable maintenance dose may be in the range of 5 to 20 mg/day. Rebound insomnia was noted again with butaclamol, which warrants further study. nan
The results of this review confirm much that clinicians and recipients of care already know but aim to provide quantification to support clinical impression. Chlorpromazine's global position as a 'benchmark' treatment for psychoses is not threatened by the findings of this review. Chlorpromazine, in common use for half a century, is a well established but imperfect treatment. Judicious use of this best available evidence should lead to improved evidence-based decision making by clinicians, carers and patients.
Please note the addition of 26 studies to awaiting classification section of the review may alter the conclusions of the review once assessed.