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

Version: April 24, 2000

Clozapine is an antipsychotic medication used in the treatment of schizophrenia. Clozapine is the only treatment proven to be effective for those people who do not respond to other antipsychotic medications. A fast pulse rate (tachycardia) is one of the more common side effects associated with clozapine use. It is reported to occur in 25 out of every 100 people treated with clozapine. The occurrence of a fast pulse rate may lead to palpitations in the person treated with clozapine, which can be unpleasant and worrying. A fast pulse rate by itself is not necessarily dangerous to the person and can be treated. There are medications available to treat a fast pulse rate and slow it down to a normal rate. Examples of such medications include beta‐blockers and calcium channel blockers. However, a fast pulse rate can lead to clozapine being stopped by doctors.

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

Version: June 9, 2016

Clozapine is an antipsychotic medication used in the treatment of schizophrenia, a mental health problem that can cause symptoms such as hallucinations and delusions and social withdrawal. Clozapine may be useful in those for whom other medications have not worked very well. One of the common side‐effects of clozapine is having too much saliva in the mouth (hypersalivation). This can be embarrassing in public and problematic, especially at night. This review is about ways of reducing this problem and includes 15 trials containing 964 people, most of which were done in hospitals in China. Treatments included medications that had previously been useful for this problem or were thought to work in theory. The medications used were from a group of drugs called antimuscarinics, traditional Chinese medicines or others. The trials were short (all four weeks or less). From these trials the antimuscarinics; astemizole, diphenhydramine and propantheline, were shown to be better than placebo at reducing hypersalivation. Another medication called oryzanol and a Chinese traditional medicine called Suo quo wan were found to have benefit over doxepin, an antimuscarinic. However, because of the shortness of the trials, poor reporting and the limitations of design, it is difficult to draw any firm conclusions from these results. 

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

Version: 2012

The first line of treatment of schizophrenia is usually antipsychotic drugs. These drugs help in the treatment of the ‘positive symptoms’ of schizophrenia, such as hearing voices, seeing things and having strange beliefs. However, these drugs often have serious side effects, such as weight gain, muscle stiffness, tiredness, apathy and lack of drive. Dribbling or drooling (hypersalivation) is another common side effect, which frequently occurs at night when asleep. This can be an embarrassing and stigmatising problem that can affect quality of life and cause people to stop their medication, which may result in relapse and going back into hospital. Dribbling and drooling can be difficult to treat; however, anticholinergic drugs can decrease production of saliva and dribbling. This review assessed the evidence for the benefit or harm of anticholinergic drugs used in treating hypersalivation caused by antipsychotic or neuroleptic medication. The review excluded the antipsychotic clozapine, as its role in causing hypersalivation has been the subject of another Cochrane review.

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

Version: December 19, 2013

People with intellectual disability have a low score on intelligence tests. They have problems in areas like self‐care, social relationships, work, education and dealing with the challenges of daily life. To make a diagnosis of intellectual disability, we use tests in which we compare the performance of an individual person on certain tasks with other people of his or her age. People with intellectual disabilities are unable to process information as efficiently as people without intellectual disability. Depending on the severity of their condition, they need varying degrees of support to cope with the demands and expectations of life. Those who have a mild intellectual disability are able to manage their affairs with some additional support. Those who have a severe intellectual disability, most of the time are unable to live independently and require support on a daily basis.

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

Version: September 23, 2015

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: November 10, 2010

Schizophrenia is a serious, chronic and relapsing mental illness with a worldwide lifetime prevalence of about one per cent. Schizophrenia is characterised by 'positive' symptoms such as hallucinations and delusions and 'negative' symptoms such as emotional numbness and withdrawal. One quarter of those who have experienced an episode of schizophrenia recover and the illness does not recur. Another 25% experience an unremitting illness. Half do have a recurrent illness but with long episodes of considerable recovery from the positive symptoms. The overall cost of the illness to the individual, their carers and the community is considerable.

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

Version: January 21, 2009

Schizophrenia is a severe mental illness that includes symptoms of hallucinations (sensations that appear real but are created by a person's mind), delusions (unrealistic beliefs) and apathy (lack of interest) which can significantly impact on people's lives. The main treatment is with antipsychotic medicines; however, some people with schizophrenia do not respond to antipsychotic medicines (called treatment resistance), which is a major challenge in the management of schizophrenia. The antipsychotic medicine, clozapine, is an effective medicine to use if treatment resistance occurs; however, it can cause unwanted side effects that include drowsiness, dizziness, headache, tremor (shaking), and excessive salivation (mouth watering). A more serious side effect is the reduction in the number of white blood cells, which can lead to an increased risk of infection. Clozapine is often used in combination with other antipsychotic medicines for treatment‐resistant schizophrenia, and this review investigated the clinical effects and safety of various clozapine combinations.

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

Version: March 23, 2017

Background: Schizophrenia is a severe mental illness that affects thinking and perception. People with schizophrenia often experience profound disruptions in their speech, emotional processes, behaviour and sense of self. Antipsychotic medication can be a helpful treatment for schizophrenia; however, taking antipsychotic medication can have unpleasant effects. Clozapine is an antipsychotic drug that can be useful in treating schizophrenia, particularly when other antipsychotic medications have not worked. It is unclear, however, what dose of clozapine is most effective with the least side effects. This review investigates the effects of receiving clozapine at four different dose levels (high dose, standard dose, low dose, very low dose).

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

Version: June 14, 2017

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: October 7, 2009

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: November 18, 2013

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: January 20, 2010

This review compares the effects of zotepine to other second generation antipsychotic drugs. Three trials suggest that the efficacy of zotepine may be comparable to risperidone and remoxipride. The evidence base is insufficient to provide firm conclusions as to whether zotepine is as effective or less effective than clozapine. The movement disorders and the cognitive changes appear to be similar to clozapine, risperidone and remoxipride. The need for antiparkinson medication is similar to risperidone and remoxipride, but may be associated with increased need than necessary with clozapine.

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

Version: October 6, 2010

People experiencing distressing delusions and hallucinations can often become agitated and aggressive. The antipsychotic drug haloperidol is widely used for the treatment of schizophrenia and psychosis‐induced agitation despite the possibility it can cause a number of serious side effects such as nausea, vomiting, dizziness, restlessness and muscle spasms.

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

Version: November 27, 2016

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: January 19, 2011

This review examined the effects of olanzapine compared to other second generation antipsychotic drugs for schizophrenia. We identified 50 relevant studies with 9476 participants, comparing olanzapine with amisulpride, aripiprazole, clozapine, quetiapine, risperidone and ziprasidone. Comparisons of olanzapine with the second generation antipsychotic drugs sertindole or zotepine are currently not available. Olanzapine was somewhat more efficacious than aripiprazole, quetiapine, risperidone and ziprasidone, whereas there was no efficacy difference compared to amisulpride and clozapine. The main disadvantage of olanzapine was its higher weight gain and associated metabolic problems compared to all other second generation antipsychotic drugs, except for clozapine.

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

Version: March 17, 2010

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

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

Antipsychotic medication was introduced in the 1950s to reduce or alleviate the symptoms of schizophrenia, such as the psychotic states of hearing voices, visual hallucinations and strange thoughts such as paranoia (feeling singled‐out or put upon by others). Medication for mental illness also helped to establish care in the community, because people could take medication in their homes or by regularly visiting the hospital. But this also led to new issues such as the effectiveness of different medication (taken alone or in combination) and compliance (the willingness of service users to take their medication without being supervised).

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

Version: June 28, 2017

Dual diagnosis is a term used to describe people who have both a psychiatric disorder and an alcohol or drug use disorder. Up to 75% of people with a serious mental illness (SMI) are dual diagnosis. It has been suggested that one of the reasons behind the high levels of substance use in people with SMI is due to 'self‐medication', with patients taking additional drugs in order to counter their distressing symptoms. People with a dual diagnosis have been shown to have more complications in their treatment, including higher rates of relapse and re‐hospitalisation, more contact with legal and forensic services, higher levels of psychotic symptoms, more risk‐taking behaviour, greater levels of side‐effects to antipsychotics and lower medication adherence. Antipsychotics are the main treatment for SMI. It has been suggested that second‐generation antipsychotics (SGAs) such as risperidone may be superior to older, first‐generation antipsychotics (FGAs) in improving negative affective states, reducing drug craving, improving subjective well‐being, and may lead to fewer side‐effects and hence greater medication adherence. Such improvements in symptoms may lead to less self‐medication with alcohol and drugs, and improved overall mental states. However it remains unclear to what extent risperidone, one of the first atypical antipsychotics to be manufactured, is superior to other antipsychotics for dual diagnosis.

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

Version: 2018

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