Chlorpromazine for schizophrenia: a Cochrane systematic review of 50 years of randomised controlled trials

BACKGROUND: Chlorpromazine (CPZ) remains one of the most common drugs used for people with schizophrenia worldwide, and a benchmark against which other treatments can be evaluated. Quantitative reviews are rare; this one evaluates the effects of chlorpromazine in the treatment of schizophrenia in comparison with placebo. METHODS: We sought all relevant randomised controlled trials (RCT) comparing chlorpromazine to placebo by electronic and reference searching, and by contacting trial authors and the pharmaceutical industry. Data were extracted from selected trials and, where possible, synthesised and random effects relative risk (RR), the number needed to treat (NNT) and their 95% confidence intervals (CI) calculated. RESULTS: Fifty RCTs from 1955–2000 were included with 5276 people randomised to CPZ or placebo. They constitute 2008 person-years spent in trials. Meta-analysis of these trials showed that chlorpromazine promotes a global improvement (n = 1121, 13 RCTs, RR 0.76 CI 0.7 to 0.9, NNT 7 CI 5 to 10), although a considerable placebo response is also seen. People allocated to chlorpromazine tended not to leave trials early in both the short (n = 945, 16 RCTs, RR 0.74 CI 0.5 to 1.1) and medium term (n = 1861, 25 RCTs, RR 0.79 CI 0.6 to 1.1). There were, however, many adverse effects. Chlorpromazine is sedating (n = 1242, 18 RCTs, RR 2.3 CI 1.7 to 3.1, NNH 6 CI 5 to 8), increases a person's chances of experiencing acute movement disorders, Parkinsonism and causes low blood pressure with dizziness and dry mouth. CONCLUSION: It is understandable why the World Health Organization (WHO) have endorsed and included chlorpromazine in their list of essential drugs for use in schizophrenia. Low- and middle-income countries may have more complete evidence upon which to base their practice compared with richer nations using recent innovations

Causal attribution of mental illness in south-eastern Nigeria

Background: Understanding of mental illness in sub-Saharan Africa has remained under-researched in spite of the high and increasing neuropsychiatric burden of disease in the region. Aims: This study investigated the causal beliefs that the Igbo people of south-eastern Nigeria hold about schizophrenia, with a view to establishing the extent to which the population makes psychosocial, biological and supernatural attributions. Method: Multi-stage sampling was used to select participants (N = 200) to which questionnaires were administered. Results: Mean comparison of the three causal models revealed a significant endorsement of supernatural causation. Logistic regressions revealed significant contributions of old age and female gender to supernatural attribution; old age, high education and Catholic religious denomination to psychosocial attributions; and high education to biological attributions. Conclusions: It is hoped that the findings would enlighten, augment literature and enhance mental health care service delivery

Use of mixed methods designs in substance research: a methodological necessity in Nigeria

The utility of mixed methods (qualitative and quantitative) is becoming increasingly accepted in health sciences, but substance studies are yet to substantially benefit from such utilities. While there is a growing number of mixed methods alcohol articles concerning developed countries, developing nations are yet to embrace this method. In the Nigerian context, the importance of mixed methods research is yet to be acknowledged. This article therefore, draws on alcohol studies to argue that mixed methods designs will better equip scholars to understand, explore, describe and explain why alcohol consumption and its related problems are increasing in Nigeria. It argues that as motives for consuming alcohol in contemporary Nigeria are multiple, complex and evolving, mixed method approaches that provide multiple pathways for proffering solutions to problems should be embraced

Family Planning Decisions, Perceptions and Gender Dynamics among Couples in Mwanza, Tanzania: A Qualitative Study.

Contraceptive use is low in developing countries which are still largely driven by male dominated culture and patriarchal values. This study explored family planning (FP) decisions, perceptions and gender dynamics among couples in Mwanza region of Tanzania. Twelve focus group discussions and six in-depth interviews were used to collect information from married or cohabiting males and females aged 18-49. The participants were purposively selected. Qualitative methods were used to explore family planning decisions, perceptions and gender dynamics among couples. A guide with questions related to family planning perceptions, decisions and gender dynamics was used. The discussions and interviews were tape-recorded, transcribed verbatim and analyzed manually and subjected to content analysis. Four themes emerged during the study. First, "risks and costs" which refer to the side effects of FP methods and the treatment of side -effects as well as the costs inherit in being labeled as an unfaithful spouse. Second, "male involvement" as men showed little interest in participating in family planning issues. However, the same men were mentioned as key decision-makers even on the number of children a couple should have and the child spacing of these children. Third, "gender relations and communication" as participants indicated that few women participated in decision-making on family planning and the number of children to have. Fourth, "urban-rural differences", life in rural favoring having more children than urban areas therefore, the value of children depended on the place of residence. Family Planning programs should adapt the promotion of communication as well as joint decision-making on FP among couples as a strategy aimed at enhancing FP use

Relationship Between Socioeconomic Status and Body Mass Index Among Adult Nigerians

There is a long tradition of observational studies from developed societies linking overweight and obesity to low socioeconomic status (SES). The aim of this study is to assess the relationship between SES and obesity and determine whether variations in the body mass index (BMI) of adult Nigerians is influenced by their SES. The height and body weight of 1067 adults, aged 30 - 60 years were measured and their BMI was calculated. A structured questionnaire which assessed socioeconomic (SE) variables such as income, education and occupation was used to objectively classify the participants into the different SE strata. A pictorial self-rating SES ladder of nine rungs was employed to assess the participants’ SES and to test the validity of the questionnaire. A high correlation ® = 0.951, P < 0.01) was found between the two SES assessment tools. SE scores were found to be inversely related to weight ® = - 0.113, P < 0.01) and BMI ® = - 0.172, P < 0.01), respectively. There was a significant relationship (X2 = 32.853; p = 0.000) between BMI categories and SES. Individuals in the lower SES had higher rates of overweight (24.8%) and obesity (12.9%). There were significant differences in the weight (F = 8.407; p = 0.000) and BMI (F = 20.66; p= 0.000) across the different SE strata. An inverse relationship was found between SES and BMI. Individuals in the lower SE strata had a greater BMI and a higher prevalence of overweight and obesity. KEY WORDS: socioeconomic status, body mass index, overweight, obesit

Navigating Obstacles, Nurturing Opportunities: A Multidimensional Approach to Poverty Reduction in Nigeria

This paper delves into the intricate web of factors perpetuating poverty in&nbsp;Africa\u27s largest economy – Nigeria. Nigeria grapples with a significant&nbsp;population living in extreme poverty. The paper underscores the multifaceted&nbsp;factors contributing to poverty, including historical, economic, social, and&nbsp;institutional elements, and the exacerbating role of gender inequality. This&nbsp;paper does not just diagnose problems; it prescribes actionable solutions. The&nbsp;conceptualization and recommendations for achieving the Sustainable&nbsp;Development Goals (SDGs) are very Western/European-centric. This paper&nbsp;takes an Africo-centric approach and perspective to the analysis and execution&nbsp;of SDG 1 (No Poverty). By synthesizing lessons from global best practices and&nbsp;homegrown innovations, the paper charts a path towards a more equitable&nbsp;Nigeria. Proposed strategies include gender-responsive initiatives, data-driven&nbsp;policies, and inclusive economic measures to address systemic inequalities and&nbsp;promote sustainable development. The paper also addresses the detrimental&nbsp;role of political patronage in poverty alleviation efforts and suggests&nbsp;countermeasures. It emphasizes the necessity for context-specific, data-driven&nbsp;approaches to poverty alleviation and robust institutional frameworks to ensure&nbsp;programme effectiveness and sustainability. The paper challenges policymakers, development practitioners, and citizens alike to reimagine&nbsp;poverty alleviation, advocating for a holistic approach that addresses root&nbsp;causes while embracing cutting-edge solutions. In conclusion, the paper&nbsp;recommends further research into unconditional cash transfers, climateresilient agriculture, and culturally sensitive poverty metrics to inform more&nbsp;effective poverty reduction strategies in Nigeria.&nbsp

Fluphenazine decanoate (depot) and enanthate for schizophrenia

Background: Intramuscular injections (depot preparations) offer an advantage over oral medication for treating schizophrenia by reducing poor compliance. The benefits gained by long-acting preparations, however, may be offset by a higher incidence of adverse effects. Objectives: To assess the effects of fluphenazine decanoate and enanthate versus oral anti-psychotics and other depot neuroleptic preparations for individuals with schizophrenia in terms of clinical, social and economic outcomes. Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (February 2011 and October 16, 2013), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. Selection criteria: We considered all relevant randomised controlled trials (RCTs) focusing on people with schizophrenia comparing fluphenazine decanoate or enanthate with placebo or oral anti-psychotics or other depot preparations. Data collection and analysis: We reliably selected, assessed the quality, and extracted data of the included studies. For dichotomous data, we estimated risk ratio (RR) with 95% confidence intervals (CI). Analysis was by intention-to-treat. We used the mean difference (MD) for normal continuous data. We excluded continuous data if loss to follow-up was greater than 50%. Tests of heterogeneity and for publication bias were undertaken. We used a fixed-effect model for all analyses unless there was high heterogeneity. For this update. we assessed risk of bias of included studies and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to create a 'Summary of findings' table. Main results: This review now includes 73 randomised studies, with 4870 participants. Overall, the quality of the evidence is low to very low.Compared with placebo, use of fluphenazine decanoate does not result in any significant differences in death, nor does it reduce relapse over six months to one year, but one longer-term study found that relapse was significantly reduced in the fluphenazine arm (n = 54, 1 RCT, RR 0.35, CI 0.19 to 0.64, very low quality evidence). A very similar number of people left the medium-term studies (six months to one year) early in the fluphenazine decanoate (24%) and placebo (19%) groups, however, a two-year study significantly favoured fluphenazine decanoate (n = 54, 1 RCT, RR 0.47, CI 0.23 to 0.96, very low quality evidence). No significant differences were found in mental state measured on the Brief Psychiatric Rating Scale (BPRS) or in extrapyramidal adverse effects, although these outcomes were only reported in one small study each. No study comparing fluphenazine decanoate with placebo reported clinically significant changes in global state or hospital admissions.Fluphenazine decanoate does not reduce relapse more than oral neuroleptics in the medium term (n = 419, 6 RCTs, RR 1.46 CI 0.75 to 2.83, very low quality evidence). A small study found no difference in clinically significant changes in global state. No difference in the number of participants leaving the study early was found between fluphenazine decanoate (17%) and oral neuroleptics (18%), and no significant differences were found in mental state measured on the BPRS. Extrapyramidal adverse effects were significantly less for people receiving fluphenazine decanoate compared with oral neuroleptics (n = 259, 3 RCTs, RR 0.47 CI 0.24 to 0.91, very low quality evidence). No study comparing fluphenazine decanoate with oral neuroleptics reported death or hospital admissions.No significant difference in relapse rates in the medium term between fluphenazine decanoate and fluphenazine enanthate was found (n = 49, 1 RCT, RR 2.43, CI 0.71 to 8.32, very low quality evidence), immediate- and short-term studies were also equivocal. One small study reported the number of participants leaving the study early (29% versus 12%) and mental state measured on the BPRS and found no significant difference for either outcome. No significant difference was found in extrapyramidal adverse effects between fluphenazine decanoate and fluphenazine enanthate. No study comparing fluphenazine decanoate with fluphenazine enanthate reported death, clinically significant changes in global state or hospital admissions. Authors' conclusions: There are more data for fluphenazine decanoate than for the enanthate ester. Both are effective antipsychotic preparations. Fluphenazine decanoate produced fewer movement disorder effects than other oral antipsychotics but data were of low quality, and overall, adverse effect data were equivocal. In the context of trials, there is little advantage of these depots over oral medications in terms of compliance but this is unlikely to be applicable to everyday clinical practice.Full Tex

Adaptation of vulcanized rubber as pessaries for the treatment of uterovaginal prolapse in a resource-poor setting

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The Supreme Being (God) and Man: Who Is to Blame for Bad Destiny?

In Yoruba traditional thought, human destiny has a mysterious power that controls human events. It is believed that every person has their life history before coming to the world. This implies that anything one does is not something done out of free will is done in fulfillment of a preordained or preordained sequence of events. However, Yoruba has such a controversial understanding of the meaning, nature, relevance and reality of the concept of destiny (ayanmo), which has long elicited philosophical interest. While various metaphysical interpretations have been given for this issue, it could be said that most of these interpretations may be seen in four forms: fatalism, predestination, soft-determinism and hard-determinism. However, less emphasis has been placed on man’s free will in determining destiny. Who is to be blamed for bad destiny between the Supreme Being (Olodumare) and man was not completely resolved. Therefore, this paper re-examines who is responsible for the bad destiny suffered by man, between God and Man. Having used critical analysis, this paper argues that in the light of human moral responsibility, character, afterlife, justice andjudgment, there is a shared responsibility between Supreme Being (God) and the man on the bad destiny suffered by man