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

IC‐P2‐074: Differentiating amnestic MCI converting to probable AD from stable amnestic MCI using FDG‐PET and an AD‐related hypometabolism overlap index

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152594/1/alzjjalz200805067.pd

P1‐338: The consistency of hypometabolic brain voxels in probable Alzheimer’s disease and amnestic mild cognitive impairment patients from the Alzheimer’s disease neuroimaging initiative

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152904/1/alzjjalz200805919.pd

O1–04–05: Six‐month cerebral metabolic declines in Alzheimer’s disease, amnestic mild cognitive impairment and elderly normal control groups: Preliminary findings from the Alzheimer’s disease neuroimaging initiative

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152688/1/alzjjalz200704081.pd

P1‐312: Differentiating amnestic mild cognitive impairment converting to probable Alzheimer’s disease from stable amnestic mild cognitive impairment using FDG‐PET and an Alzheimer’s disease‐related hypometabolism overlap index

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152471/1/alzjjalz200805903.pd

O1‐02–06: Twelve‐month cerebral metabolic declines in probable Alzheimer’s disease and amnestic mild cognitive impairment: Preliminary findings from the Alzheimer’s disease neuroimaging initiative (ADNI)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153255/1/alzjjalz200805225.pd

IC‐P2‐128: Twelve‐month cerebral metabolic declines in probable Alzheimer’s disease and amnestic mild cognitive impairment: Preliminary findings from the Alzheimer’s disease neuroimaging initiative

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152696/1/alzjjalz2008052583.pd

P‐024: The pattern and severity of FDG pet abnormalities in Alzheimer’s disease and amnestic mild cognitive impairment: Preliminary findings from the Alzheimer’s disease neuroimaging initiative

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152742/1/alzjjalz200704240.pd