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Alpha-1 proteinase inhibitor injection, also called alpha 1-PI, is used to treat a certain type of emphysema (a lung condition).

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How does the pituitary gland work?

The pituitary gland regulates important body functions and the hormonal system. For instance, it regulates body temperature, heart beat and urine production, as well as sleep, hunger and thirst. About the size of a pea, it is a protrusion at the base of the brain. The gland lies well protected in a small cavity of the cranial bones, level with the nose, and in the middle of the head.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 7, 2015

Antipsychotic Medicines for Children and Teens: A Review of the Research for Parents and Caregivers

This summary discusses using antipsychotic medicines to treat psychiatric conditions in children. It explains what medical research says about the benefits and possible side effects of these medicines when taken by children. This summary does not discuss other medicines to treat psychiatric conditions or non-medicine treatment options. It can help you talk with your child’s doctor to decide if an antipsychotic medicine is right for your child.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: September 4, 2012

Medicines for Treating Mental Health Conditions: A Review of the Research for Adults and Caregivers

This summary will tell you about research on how well some antipsychotic medicines work for conditions other than psychosis and bipolar disorder. It will also tell you about research on the risks of side effects for these medicines.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 1, 2012

Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder: A Review of the Research for Adults and Caregivers

This summary talks about one type of medicine—antipsychotics— used to treat schizophrenia and bipolar disorder. It will tell you what research says about how older and newer antipsychotics compare for treating schizophrenia and bipolar disorder in adults. Please note that the research on antipsychotics as treatment for bipolar disorder is limited, and more research is needed. This summary will also tell you about the possible side effects of antipsychotics. It can help you talk with your doctor about whether or not one of these antipsychotic medicines might be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: April 10, 2013

Aripiprazole versus placebo for schizophrenia

Schizophrenia is one of the major psychiatric disorders; it affects individuals' thinking, perception, affect and behaviour. It can occur in around 1% of the population. Aripiprazole is one of the newer antipsychotic medications introduced for the treatment of schizophrenia. When compared with placebo, people taking aripiprazole had fewer relapses, smaller numbers of participants left study early, and needed less additional antipsychotic medications. Insomnia and headache were the most commonly reported side effects, but were not much difference to placebo. Side effects such as akathisia, nausea and weight gain occurred more in the aripripazole group as compared to placebo. There has been a worry with newer antipsychotic medications and their effect on conductance problems in the heart, impaired glucose levels and excessive production of prolactin (which can cause unpleasant breast pain and secretion). On the limited evidence available (due to participants leaving early and fewer studies) aripiprazole appears to have a similar effect to that of placebo. The overall finding on its efficacy in treating schizophrenia is unchanged from those found in the original review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Second‐generation antipsychotic drugs for major depressive disorder 

This review found 28 studies on five second‐generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine and risperidone) comparing the effects of the drugs alone or adding them or placebo to antidepressants for major depressive disorder and dysthymia. There is evidence that amisulpride might lead to symptom reduction in dysthymia, while no important differences were seen for major depression. There is limited evidence that aripiprazole leads to symptom reduction when added to antidepressants. Olanzapine had no beneficial effects for treatment of depression when compared to antidepressants or compared to placebo but there was limited evidence for the benefits of olanzapine as additional treatment. Data on quetiapine indicated beneficial effects for quetiapine alone or as additional treatment when compared to placebo; data on quetiapine versus duloxetine did not show beneficial effects in terms of symptom reduction for either group, but quetiapine treatment was less well tolerated. The data, however, are very limited. Slight benefits of risperidone as additional treatment, in terms of symptom reduction, are also based on a rather small number of randomised participants. Generally, treatment with second‐generation antipsychotic drugs was associated with worse tolerability, mainly due to sedation, weight gain or laboratory values such as prolactin increase.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Risperidone alone or in combination for acute mania

This review included six trials and investigated the efficacy and tolerability of risperidone, an atypical antipsychotic, as treatment for mania compared to placebo or other medicines. High withdrawal rates from the trials limit the confidence that can be placed on the results. Risperidone, both as monotherapy and combined with lithium, or an anticonvulsant, was more effective at reducing manic symptoms than placebo but caused more weight gain, sedation and elevation of prolactin levels. The efficacy of risperidone was comparable to that of haloperidol both as monotherapy and as adjunctive treatments to lithium, or an anticonvulsant. Risperidone caused less movement disorders than haloperidol but there was some evidence for greater weight gain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Risperidone versus placebo for schizophrenia.

Schizophrenia is a serious, chronic and relapsing mental illness with a worldwide lifetime prevalence of about 1%. It is characterised by positive symptoms such as hallucinations and delusions, and negative symptoms such as emotional numbness and withdrawal. One third of those who have experienced an episode of schizophrenia recover and the illness does not recur. Another 30% experience an unremitting illness. Half of these people have a recurrent illness but with long episodes of considerable recovery from the positive symptoms. The overall cost of the illness to the individuals, their families and the community is considerable.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Aripiprazole for schizophrenia

Schizophrenia is a serious, chronic and relapsing mental illness with a worldwide lifetime prevalence of about one percent.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Risperidone versus other atypical antipsychotics for schizophrenia

This review examines the effects of risperidone compared to other second‐generation antipsychotic (SGA) drugs for schizophrenia. We identified 45 relevant studies with 7760 participants comparing risperidone with amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, sertindole and ziprasidone. Comparisons of risperidone with zotepine are currently not available. Risperidone was somewhat more successful than quetiapine and ziprasidone, but somewhat less successful than clozapine and olanzapine. The main disadvantage of risperidone were more frequent movement disorders and more prolactin increase compared to most other SGA drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Quetiapine versus typical antipsychotic drugs for schizophrenia

Antipsychotic drugs are the main treatment for schizophrenia, helping to treat both the positive symptoms (such as hearing voices, seeing things and having strange beliefs) and negative symptoms (including apathy, tiredness and loss of emotion) of this illness. Selecting the most effective antipsychotic drug that can be tolerated by people with schizophrenia is crucial to successful treatment. Older drugs (also known as typical or first generation antipsychotic drugs), such as chlorpromazine and haloperidol, have been used in treating schizophrenia for over 50 years. Although these older drugs are good at treating the positive symptoms of schizophrenia they tend to cause undesirable side effects. These side effects can mean that people do not tolerate or like taking these drugs, which may lead to relapse and admission to hospital. Since 1988, a newer generation of antipsychotic drugs has become available. These new drugs (known as atypical or second generation antipsychotic drugs) are effective in treating the symptoms of schizophrenia but thought to have less side effects than older drugs. However, although newer drugs may cause less side effects such as movement disorders, they have been linked to other side effects like heart problems or weight gain. Quetiapine is a new antipsychotic drug for schizophrenia that has been available for over a decade. However, it is not clear how the effects of quetiapine differ from older antipsychotic drugs. This review evaluated the effectiveness and tolerability of quetiapine versus older antipsychotic drugs. The review included 43 trials with a total of 7217 people. Most studies were from China. In the main, quetiapine did not differ from older drugs for the treatment of positive symptoms of mental illness. There were also no clear differences in terms of the treatment of negative symptoms. However, it is important to note that evidence from these trials suggests quetiapine causes fewer side effects (such as weight gain, dizziness, movement disorders, the inability to sit still, shaking, tremors and abnormal levels of the hormone prolactin, which can contribute to sexual and mental health problems). However, evidence from the trials is limited due to high numbers of people leaving early in almost all of the studies. More evidence through the completion of well designed studies comparing quetiapine with older antipsychotic drugs is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Ziprasidone versus other atypical antipsychotics for schizophrenia

Ziprasidone is one of a group of new 'atypical' antipsychotics used for treating schizophrenia. This review wanted to find out if there was evidence to support that there is any difference between ziprasidone and the other atypical medications. Because of the large number of people that dropped out of the studies it is difficult to draw any firm conclusions, however, people taking ziprasidone did not do as well regarding their symptoms, as those taking olanzapine and risperidone and perhaps amisulpride, but they were less likely to gain weight.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Quetiapine versus other atypical antipsychotic drugs for schizophrenia

Quetiapine is a second‐generation antipsychotic. Second‐generation or atypical antipsychotic drugs have become the mainstay of treatment in many countries for people with schizophrenia. They are called second‐generation drugs because they are newer than the older drugs, known as typical antipsychotics. Second‐generation drugs are thought to be better than the older drugs in reducing the symptoms of schizophrenia, such as hearing voices and seeing things, and are suggested to produce fewer side effects, such as sleepiness, weight gain, tremors and shaking. However, it is not clear how the various second‐ generation antipsychotic drugs differ from one other. The aim of this review therefore was to evaluate the effects of quetiapine compared with other second‐generation antipsychotic drugs for people with schizophrenia. The review included a total of 35 studies with 5971 people, which provided information on six comparisons (quetiapine vs the following: clozapine, olanzapine, risperidone, ziprasidone, paliperidone and aripiprazole). Comparisons with amisulpride, sertindole and zotepine do not exist, so more research is needed. A major limitation of all findings was the large number of people leaving studies and stopping quetiapine treatment (50.2% of people). The most important finding to note is that if a group is started on quetiapine, most will be off this drug within a few weeks (although the reasons for stopping quetiapine treatment are not covered by the review and so remain uncertain). Quetiapine may be slightly less effective than risperidone and olanzapine in reducing symptoms, and it may cause less weight gain and fewer side effects and associated problems (such as heart problems and diabetes) than olanzapine and paliperidone, but more than are seen with risperidone and ziprasidone. The limited information tends to suggest that people taking quetiapine may need to be hospitalised more frequently than those taking risperidone or olanzapine. This may lead to higher costs in some settings, but the information is not robust enough to guide managers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Clozapine versus other atypical antipsychotics for schizophrenia

This review compared the clinical effects of clozapine with the other atypical antipsychotics. Twenty‐seven studies fulfilled the review's criteria and provided data to compare clozapine with antipsychotics such as olanzapine, quetiapine, risperidone, ziprasidone and zotepine. Clozapine was somewhat more efficacious than zotepine. Also, inefficacy of treatment led more frequently to leaving the studies early in the risperidone group suggesting a certain higher efficacy of clozapine. The principal drawback of clozapine were its adverse effects which lead to significantly higher numbers of participants leaving the studies early compared to olanzapine and risperidone. Clozapine was associated with more sedation and hypersalivation than olanzapine, quetiapine and risperidone and with more seizures than olanzapine and risperidone. There was a higher incidence of white blood cell decrease in clozapine groups than olanzapine and more weight gain than in risperidone groups. On the other hand clozapine produced fewer movement disorder than risperidone and less prolactin increase than olanzapine, quetiapine and zotepine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Oral paliperidone for schizophrenia

Paliperidone, 9‐hydroxy‐risperidone, is an active metabolite of risperidone that is now commercially available in an oral formulation. We evaluated the efficacy, adverse effects, and safety of oral paliperidone in the treatment of people with schizophrenia and schizophrenia‐like illnesses. In short‐term studies, oral paliperidone is a more effective antipsychotic than placebo. The adverse effects of paliperidone are similar to those of risperidone. No data comparing the efficacy of paliperidone to risperidone over a meaningful period of time was available for this review; in a six‐day trial comparing paliperidone to risperidone we identified no difference in recurrence of psychotic symptoms or adverse effects. The manufacturer is also developing an intramuscular long‐acting formulation, but it is not yet commercially available; its use in the treatment of schizophrenia will be considered in a separate review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Paliperidone palmitate for schizophrenia

Paliperidone palmitate is a long‐acting intramuscular formulation of paliperidone, an active metabolite of risperidone that was previously available only in an oral formulation. We evaluated the efficacy, adverse effects, and safety of paliperidone palmitate in the treatment of people with schizophrenia and schizophrenia‐like illnesses. In short‐term studies, paliperidone palmitate is a more effective antipsychotic than placebo. The adverse effects of paliperidone palmitate are similar to those of oral paliperidone, oral risperidone, and risperidone long‐acting injection. In two short‐term studies, flexibly‐dosed paliperidone palmitate is roughly equivalent in efficacy and tolerability to flexibly‐dosed risperidone long‐acting injection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Molindone for schizophrenia and severe mental illness

Molindone is an older antipsychotic drug with a receptor binding profile similar to that of quetiapine, a novel atypical antipsychotic. We sought to determine the effects of molindone compared with placebo, typical and atypical antipsychotics for treating schizophrenia and related psychoses. We included fourteen randomised controlled trials. When compared to other typical antipsychotics molindone shows no difference in effectiveness and is no more or less likely than typical drugs to cause movement disorders, it does however cause significantly more weight loss. At present there is no evidence to suggest that it may have an atypical profile.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Ziprasidone for schizophrenia and severe mental illness

Pending

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

The efficacy of sulpiride augmentation for schizophrenia

Schizophrenia is a serious and chronic illness in which psychotic symptoms are prominent. The psychotic symptoms are often managed with drugs. Not all people with schizophrenia respond well to treatment with antipsychotic drugs and sulpiride is often used as an add‐on drug for promoting the efficacy of another medication. Several clinical trials reported effects of sulpiride augmentation for management of schizophrenia. We included four small trials which compared sulpiride plus clozapine with clozapine alone for very ill people. Evidence from the present review suggested that short‐term sulpiride plus clozapine probably is more effective than clozapine alone in producing clinical improvement in some people. The evidence is, however, weak and prone to considerable bias. This is a good area for more research.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Olanzapine compared to placebo or other medicine as treatment for mania

High withdrawal rates from the trials limit the confidence that can be placed on the results. Olanzapine was superior to placebo in reduction of manic symptoms both as monotherapy and combined with mood stabilizers, though caused weight gain. Olanzapine was more efficacious than divalproex and caused less nausea but more weight gain, somnolence and movement disorders. Olanzapine was comparable to haloperidol in efficacy, caused less movement disorders but greater weight gain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Systematic Reviews in PubMed

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