Abstract
Background
Schizophrenia is often a severe and disabling psychiatric disorder. Antipsychotics remain the mainstay of psychotropic treatment for people with psychosis. In limited resource and humanitarian contexts, it is key to have several options for beneficial, low‐cost antipsychotics, which require minimal monitoring. We wanted to compare oral haloperidol, as one of the most available antipsychotics in these settings, with a second‐generation antipsychotic, olanzapine.
Objectives
To assess the clinical benefits and harms of haloperidol compared to olanzapine for people with schizophrenia and schizophrenia‐spectrum disorders.
Search methods
We searched the Cochrane Schizophrenia study‐based register of trials, which is based on monthly searches of CENTRAL, CINAHL, ClinicalTrials.gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed and WHO ICTRP. We screened the references of all included studies. We contacted relevant authors of trials for additional information where clarification was required or where data were incomplete. The register was last searched on 14 January 2023.
Selection criteria
Randomised clinical trials comparing haloperidol with olanzapine for people with schizophrenia and schizophrenia‐spectrum disorders. Our main outcomes of interest were clinically important change in global state, relapse, clinically important change in mental state, extrapyramidal side effects, weight increase, clinically important change in quality of life and leaving the study early due to adverse effects.
Data collection and analysis
We independently evaluated and extracted data. For dichotomous outcomes, we calculated risk ratios (RR) and their 95% confidence intervals (CI) and the number needed to treat for an additional beneficial or harmful outcome (NNTB or NNTH) with 95% CI. For continuous data, we estimated mean differences (MD) or standardised mean differences (SMD) with 95% CIs. For all included studies, we assessed risk of bias (RoB 1) and we used the GRADE approach to create a summary of findings table.
Main results
We included 68 studies randomising 9132 participants.
We are very uncertain whether there is a difference between haloperidol and olanzapine in clinically important change in global state (RR 0.84, 95% CI 0.69 to 1.02; 6 studies, 3078 participants; very low‐certainty evidence).
We are very uncertain whether there is a difference between haloperidol and olanzapine in relapse (RR 1.42, 95% CI 1.00 to 2.02; 7 studies, 1499 participants; very low‐certainty evidence).
Haloperidol may reduce the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.70, 95% CI 0.60 to 0.81; 13 studies, 1210 participants; low‐certainty evidence). For every eight people treated with haloperidol instead of olanzapine, one fewer person would experience this improvement.
The evidence suggests that haloperidol may result in a large increase in extrapyramidal side effects compared to olanzapine (RR 3.38, 95% CI 2.28 to 5.02; 14 studies, 3290 participants; low‐certainty evidence). For every three people treated with haloperidol instead of olanzapine, one additional person would experience extrapyramidal side effects. For weight gain, the evidence suggests that there may be a large reduction in the risk with haloperidol compared to olanzapine (RR 0.47, 95% CI 0.35 to 0.61; 18 studies, 4302 participants; low‐certainty evidence). For every 10 people treated with haloperidol instead of olanzapine, one fewer person would experience weight increase.
A single study suggests that haloperidol may reduce the incidence of clinically important change in quality of life compared to olanzapine (RR 0.72, 95% CI 0.57 to 0.91; 828 participants; low‐certainty evidence). For every nine people treated with haloperidol instead of olanzapine, one fewer person would experience clinically important improvement in quality of life.
Haloperidol may result in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47; 21 studies, 5047 participants; low‐certainty evidence). For every 22 people treated with haloperidol instead of olanzapine, one fewer person would experience this outcome.
Thirty otherwise relevant studies and several endpoints from 14 included studies could not be evaluated due to inconsistencies and poor transparency of several parameters. Furthermore, even within studies that were included, it was often not possible to use data for the same reasons. Risk of bias differed substantially for different outcomes and the certainty of the evidence ranged from very low to low. The most common risks of bias leading to downgrading of the evidence were blinding (performance bias) and selective reporting (reporting bias).
Authors' conclusions
Overall, the certainty of the evidence was low to very low for the main outcomes in this review, making it difficult to draw reliable conclusions. We are very uncertain whether there is a difference between haloperidol and olanzapine in terms of clinically important global state and relapse. Olanzapine may result in a slightly greater overall clinically important change in mental state and in a clinically important change in quality of life. Different side effect profiles were noted: haloperidol may result in a large increase in extrapyramidal side effects and olanzapine in a large increase in weight gain. The drug of choice needs to take into account side effect profiles and the preferences of the individual. These findings and the recent inclusion of olanzapine alongside haloperidol in the WHO Model List of Essential Medicines should increase the likelihood of it becoming more easily available in low‐ and middle‐ income countries, thereby improving choice and providing a greater ability to respond to side effects for people with lived experience of schizophrenia.
There is a need for additional research using appropriate and equivalent dosages of these drugs. Some of this research needs to be done in low‐ and middle‐income settings and should actively seek to account for factors relevant to these. Research on antipsychotics needs to be person‐centred and prioritise factors that are of interest to people with lived experience of schizophrenia.
Keywords: Adult; Humans; Administration, Oral; Antipsychotic Agents; Antipsychotic Agents/adverse effects; Antipsychotic Agents/therapeutic use; Bias; Haloperidol; Haloperidol/adverse effects; Haloperidol/therapeutic use; Olanzapine; Olanzapine/adverse effects; Olanzapine/therapeutic use; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Schizophrenia; Schizophrenia/drug therapy; Weight Gain; Weight Gain/drug effects
Plain language summary
Haloperidol compared to olanzapine for people with schizophrenia
Key messages
We are very uncertain whether there is a difference between the two medications in terms of benefits.
Olanzapine may have slight advantages in terms of improving general state of mind (behaviour, mood, thoughts, perceptions, etc.) and may have some advantages in terms of quality of life.
People are more likely to gain weight with olanzapine and more likely to develop movement problems with haloperidol. People on haloperidol are more likely to stop taking their medication.
When choosing between haloperidol and olanzapine, factors to take into account are the person's preferences, characteristics such as their tendency to gain or lose weight and their experience with medications.
What is schizophrenia?
People with schizophrenia often hear voices, see things and have beliefs that others don't share. They may also feel very tired, have a lack of interest and may have trouble feeling emotions. This review is important because schizophrenia is a severe mental health condition, with an approximately 1% chance of being diagnosed over a person's lifetime.
What are haloperidol and olanzapine?
Haloperidol (pronounced HAL‐oh‐PER‐i‐dol) has been used in the treatment of schizophrenia for decades. It remains one of the most commonly prescribed treatments and has well‐defined benefits. It also has some side effects such as restlessness, uncontrollable shaking, tremors and stiffness, especially at high doses. Olanzapine (pronounced oh‐LAN‐za‐peen) is a newer medication. It has also been found to be useful in the treatment of schizophrenia, although it has its own side effects, weight gain being the most common. We wanted to better understand the differences in the clinical benefits of these medications and also to see which may be more suitable for use in lower‐income countries as well as during humanitarian emergencies.
What did we want to find out?
Is haloperidol better than olanzapine in treating schizophrenia or schizophrenia‐spectrum disorders?
What did we do?
We searched for randomised clinical trials that were carried out up to 14 January 2023. We looked for studies that randomly assigned people with schizophrenia and schizophrenia‐spectrum disorders to receive haloperidol or olanzapine in tablet form. The review includes 68 studies with 9132 participants.
What did we find?
According to our findings, we are very uncertain whether there is a difference between the two medications in general clinically important change and relapse. However, olanzapine may result in a slightly greater improvement in mental state (general state of mind such as behaviour, mood, thoughts, perceptions, etc.) and may result in some improvement in quality of life. On other measures, haloperidol and olanzapine were similar in terms of benefits. Additionally, both medications showed side effects: participants taking haloperidol were more likely than those on olanzapine to experience problems with movement, and those on olanzapine were more likely to gain weight. However, it should be noted that there was considerable discrepancy between some of the studies. In addition, an increased number of people on haloperidol left the studies early due to side effects. While there is insufficient information to understand the reason for this finding, we hypothesise that this may be linked to the use of higher equivalent doses of haloperidol compared to olanzapine in some studies.
What are the limitations of the evidence?
Studies need to focus on and include outcomes that are relevant for people with schizophrenia and their families. Most studies focused on benefits within the first year of use, and have not taken into account other factors that could be of interest to people with lived experience of schizophrenia, such as ability to work, family impact, social function and acceptability to the user. While some studies measured relapse as an outcome, the definition of relapse did not always make clear whether it resulted in a person's hospitalisation. This is important for people with schizophrenia and their families because relapse and hospitalisation are dramatic and significant setbacks.
It is important to understand that many studies did not use equivalent doses of the two medications when they were compared. Most studies used comparatively higher doses of haloperidol compared to olanzapine, which could be associated with more side effects and related clinical outcomes for people on haloperidol in these studies.
It is important to keep in mind that on careful review we have low or very low confidence in the priority findings because the studies had some weaknesses.
How up‐to‐date is the evidence?
The evidence is up‐to‐date as of 14 January 2023.
Summary of findings
Summary of findings 1. Haloperidol compared to olanzapine for people with schizophrenia and schizophrenia‐spectrum disorders.
| Haloperidol compared to olanzapine for people with schizophrenia and schizophrenia‐spectrum disorders | ||||||
| Patient or population: people with schizophrenia Setting: inpatient and outpatient Intervention: haloperidol Comparison: olanzapine | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with olanzapine | Risk with haloperidol | |||||
|
Global state: clinically important change (short‐ and medium‐term measured by CGI scale) |
473 per 1000 | 397 per 1000 (326 to 482) | RR 0.84
(0.69 to 1.02) NNTB not calculated |
3078 (6 RCTs) | ⊕⊝⊝⊝ VERY LOWa | Of the 6 studies reporting clinically important change in global state, 5 reported results in the short (< 7 months) and 1 in the medium term (7 to 12 months). Overall, we are very uncertain whether there is a difference between haloperidol and olanzapine in clinically important change in global state and there is a substantial level of heterogeneity across studies. |
|
Global state: relapse (short‐, medium‐, long‐term; definition of outcome applied by each study) |
326 per 1000 | 463 per 1000 (326 to 659) | RR 1.42
(1.00 to 2.02) NNTH not calculated |
1499 (7 RCTs) | ⊕⊝⊝⊝ VERY LOWb | Of the 7 studies reporting data on the incidence of relapse, 1 study reported results in the short term (< 7 months), 4 in the medium term (7 to 12 months) and 2 in the long term (> 12 months). Overall, we are very uncertain whether there is a difference between haloperidol and olanzapine in relapse and there is a substantial level of heterogeneity across studies. |
|
Mental state: clinically important change in overall mental state (short‐ and medium‐term data; defined as ≥ 50% reduction in endpoint PANSS score) |
396 per 1000 | 277 per 1000 (238 to 321) | RR 0.70
(0.60 to 0.81) NNTB ‐8.42 (‐13.2 to ‐6.31) |
1210 (13 RCTs) | ⊕⊕⊝⊝ LOWc | Of the 13 studies reporting on the incidence of clinically important change in overall mental state using a 50% reduction in PANSS score, 12 studies reported results in the short term (< 7 months) and 1 study in the medium term (7 to 12 months). Overall, the evidence suggests that haloperidol may reduce the incidence of clinically important change in overall mental state slightly compared to olanzapine. For every 8 people treated with haloperidol instead of olanzapine, 1 fewer person would experience clinically important change in overall mental state. The certainty of evidence for this outcome is low; however, the variation of results across studies was not important. |
|
Adverse effects/events: specific ‐ extrapyramidal ‐ any effect (short‐ and medium‐term data; measured by AIMS, BAS, DIEPSS, ESRS, SAS, TESS, UKU‐SERS, AMDP) |
132 per 1000 | 446 per 1000 (301 to 663) | RR 3.38
(2.28 to 5.02) NNTH 3.18 (1.89 to 5.91) |
3920 (14 RCTs) | ⊕⊕⊝⊝ LOWd | Of the 14 studies reporting on specific extrapyramidal adverse events, 11 were in the short term (< 7 months) and 3 in the medium term (7 to 12 months). Overall, haloperidol may result in a large increase in this side effect. For every 3 people treated with haloperidol instead of olanzapine, 1 additional person would experience extrapyramidal side effects. The certainty of the evidence is low and there is a substantial level of heterogeneity across studies. |
|
Adverse effects/events: specific ‐ metabolic ‐ weight increase (short‐, medium‐, long‐term data; defined as 7% increase in weight from baseline or definition applied by each study) |
185 per 1000 | 87 per 1000 (65 to 113) | RR 0.47
(0.35 to 0.61) NNTH ‐10.22 (‐13.89 to ‐ 8.33) |
4302 (18 RCTs) | ⊕⊕⊕⊝ LOWe | Of the 18 studies reporting weight increase, 14 were in the short term (< 7 months), 2 in the medium term (7 to 12 months) and 2 in the long term (> 12 months). Overall, the evidence suggests that there is a large reduction in the risk of weight gain with haloperidol compared to olanzapine. For every 10 people treated with haloperidol instead of olanzapine, 1 fewer person would experience weight increase. The certainty of the evidence is low and heterogeneity is moderate across studies. |
|
Quality of life: clinically important change in quality of life (short‐term data only; defined as ≥ 20% increase in QLS endpoint score) |
380 per 1000 | 274 per 1000 (217 to 346) | RR 0.72
(0.57 to 0.91) NNTB ‐9.40 (‐29.23 to ‐6.11) |
828 (1 RCT) | ⊕⊕⊝⊝ LOWf | The evidence from a single trial suggests that in the short term (< 7 months), haloperidol may reduce the incidence of clinically important change in quality of life compared to olanzapine. For every 9 people treated with haloperidol instead of olanzapine, 1 fewer person would experience clinically important change in quality of life. The certainty of the evidence for this outcome is low. |
|
Leaving the study early: adverse effects (short‐, medium‐, long‐term data; definition applied by each study) |
45 per 1000 | 90 per 1000 (72 to 111) | RR 1.99
(1.60 to 2.47) NNTH 22.40 (15.08 to 36.95) |
5047 (21 RCTs) | ⊕⊕⊝⊝ LOWg | Of the 21 studies reporting leaving the study early due to adverse effects, 12 were in the short term (< 7 months), 6 in the medium term (7 to 12 months) and 3 in the long term (> 12 months). The evidence suggests that haloperidol results in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine. For every 22 people treated with haloperidol instead of olanzapine, 1 fewer person would experience this outcome. The certainty of the evidence is low and variation of results across studies was not important. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Abbreviations: AIMS: Abnormal Involuntary Movement Scale; AMDP: Association for Methodology and Documentation in Psychiatry; BAS: Barnes Akathisia Scale; CGI: Clinical Global Impression; CI: confidence interval; DIEPSS: Drug‐Induced Extrapyramidal Symptom Scale; ESRS: Extrapyramidal Symptom Rating Scale; NNTB/NNTH: number needed to treat for an additional beneficial/harmful outcome; PANSS: Positive and Negative Syndrome Scale; QLS: Quality of Life Scale; RCT: randomised controlled trial; RR: risk ratio; SAS: Simpson Angus Scale; TESS: Treatment Emergent Symptom Scale; UKU‐SERS: UKU Side Effects Rating Scale Definition of time frames: short‐term < 7 months, medium‐term 7 to 12 months, long‐term > 12 months. | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aGlobal state ‐ clinically important change. We downgraded the outcome one level for (a) serious risk of bias, one additional level for (b) serious inconsistency (I2 = 73%), one additional level for (c) serious indirectness (considerable differences in study population and interventions) and one additional level for (d) serious imprecision (95% CI includes both an important effect and no effect).
bGlobal state ‐ relapse. We downgraded the outcome one level for (a) serious risk of bias, one additional level for (b) serious inconsistency (I2 = 75%), one additional level for (c) serious indirectness (considerable differences in study populations, interventions and outcome measures) and one additional level for (d) serious imprecision (95% CI includes both an important effect and no effect).
cMental state ‐ clinically important change in mental state. We downgraded the outcome one level for (a) serious risk of bias, and one additional level for (b) serious indirectness (considerable differences in study populations and interventions).
dAdverse effects/events: specific ‐ extrapyramidal ‐ any effect. We downgraded the outcome one level for (a) serious risk of bias, and one additional level for (b) serious indirectness (considerable differences in study population, interventions and outcome measures). Heterogeneity (I2 = 72%) was explained through sensitivity analysis by inadequate randomisation and high attrition rate data.
eAdverse effects/events: specific ‐ metabolic ‐ weight increase. We downgraded the outcome one level for (a) serious risk of bias, and one additional level for (b) serious indirectness (considerable differences in study population and interventions). Heterogeneity (I2 = 57%) was explained through sensitivity analysis by exclusion of two studies with inadequate interventions (i.e. high doses).
fQuality of life: clinically important change in quality of life. We downgraded the outcome one level for (a) serious risk of bias, and one additional level for (b) serious imprecision (95% CI includes both an important effect and little effect).
gLeaving the study early: adverse effects. We downgraded the outcome one level for (a) serious risk of bias, and one additional level for (b) serious indirectness (considerable differences in study populations and interventions).
Background
Description of the condition
Schizophrenia is often a severe and disabling psychiatric disorder, with about 1% global lifetime prevalence (Zare 2017). The manifestations of schizophrenia are typically grouped into positive, negative and cognitive sets of symptoms. Due to the symptoms of schizophrenia, individuals often experience difficulty in relationships, and maintaining work and daily activities, and may require hospitalisation to stabilise crisis situations. Positive symptoms include delusions (false beliefs) and hallucinations, while negative symptoms are characterised by impaired emotional response, lack of motivation and interest, poverty of speech, social withdrawal and an inability to feel pleasure in normally pleasurable activities (Carpenter 1994; Elis 2013). Cognitive impairment is a central component of the disorder. This includes deficits of attention, vigilance, visual and verbal memory, learning, reasoning and problem‐solving, and speed of processing (Green 2004).
The global incidence of schizophrenia is 15.2 per 100,000 population. People with schizophrenia have a two‐ to three‐fold increased risk of early death compared to the general population. Male sex is associated with earlier onset and severe cognitive and negative symptoms (Abel 2010). Many of the stressors faced by people in the settings where Médecins Sans Frontières (MSF) work are the same as those that are known to be associated with increased prevalence of psychotic presentations, including schizophrenia. Migrant status and living in urban settings, for example, are associated with a higher risk of developing the disease (McGrath 2004; McGrath 2008). Psychosis has also been shown to be more prevalent in refugees than host populations (Blackmore 2020). Poverty and income inequality are also associated with a higher prevalence of schizophrenia (Lund 2018).
People with schizophrenia generally have a poor prognosis, with one individual out of seven achieving complete remission (Jaaskelainen 2013). According to the findings from the global burden of disease study 2016, schizophrenia contributed 13.4 million years lost due to disability (YLDs), equivalent to 1.7% of the total global YLDs. Lower‐ and upper middle‐income countries (LMIC) experience four times the burden of schizophrenia as in high‐income countries (Charlson 2018). Only 12% of people with psychosis receive mental health care in low‐income countries (WHO 2022). Despite complete remission being uncommon in schizophrenia, there are many interventions that support recovery, including medication choices that can help reduce symptoms.
Antipsychotics remain the mainstay of treatment for schizophrenia (WHO 2016). Despite the broad range of oral and long‐acting injectable antipsychotics on the market, there are costs, availability and adverse effects to consider in selecting the most appropriate ones. In humanitarian and low‐income contexts, it is key to have several options for beneficial, low‐cost treatments that require minimal monitoring. It is also important to note the continued limited availability of essential psychotropics, including antipsychotics, in LMICs, resulting in people being unable to obtain treatment or having to pay out of pocket (WHO 2021).
Description of the intervention
Haloperidol is a first‐generation antipsychotic, developed by Paul Janssen in 1958. There is much evidence supporting the clinical benefits of haloperidol in the alleviation of positive symptoms, such as delusions and hallucinations (Lopez‐Munoz 2009). However, haloperidol also has significant adverse effects; the most frequently reported are extrapyramidal, which include movement disorders (dystonia, parkinsonism, tardive dyskinesia) and anticholinergic side effects (constipation, dry mouth, blurred vision) (Settle 1983). It should be noted that while recognised data on QTc is scarce (Ostuzzi 2022b), there is a recognised risk of QTc prolongation with most first‐generation antipsychotics, including haloperidol, meaning that the use of these medications in individuals suffering from arrhythmias or with major cardiologic risk factors must be considered. Recommendations for adult dosage of oral haloperidol vary between guidelines. Drugs.com recommends 0.5 mg to 2 mg for moderate, and 3 mg to 5 mg for severe psychosis, taken two to three times per day (Drugs 2020). The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide suggests a starting dose of 1.5 mg to 3 mg, up to a maximum of 20 mg a day (WHO 2016). The United Nations High Commissioner for Refugees (UNHCR), on the other hand, recommends a dose range of 2 mg to 12 mg, with a usual maintenance dose of 4 mg to 6 mg a day (Ostuzzi 2017). Haloperidol is one of now eight essential antipsychotic medications recommended by the WHO for the treatment of mental and behavioural disorders, with the addition of olanzapine and other antipsychotics in the most recent version (WHO 2023b). The other six medications are the oral formulations of chlorpromazine, risperidone, paliperidone, aripiprazole, quetiapine and clozapine (complementary). In addition to the long‐acting injectable formulations of fluphenazine and haloperidol, the long‐acting injectable formulations of paliperidone and risperidone have also been included (WHO 2023b).
Olanzapine is a second‐generation antipsychotic agent, introduced in the 1990s. Some evidence suggests high efficacy against both positive and negative symptoms (anergia, apathy), as well as fewer extrapyramidal adverse effects (Leucht 1999). However, adverse metabolic effects have been noted, including weight gain (Drugs 2020; Shirzadi 2006). The usual adult doses of oral olanzapine for schizophrenia are 5 mg to 10 mg per day for the initial dose, 10 mg per day for the first several days, with further dose adjustment to reach the target dose; the maximum dose should not exceed 20 mg per day (Drugs 2020). UNHCR clinical guidance provides a similar recommendation, with a dose range of 5 mg to 20 mg and a usual maintenance dose of 10 mg a day (Ostuzzi 2017). After taking into consideration the preferences of people requiring treatment, internationally recognised guidelines sometimes continue to recommend second‐generation antipsychotics such as olanzapine as a first choice in preference to first‐generation antipsychotics (Taylor 2018). Médecins Sans Frontières (MSF) experience in middle‐ and high‐income countries is that second‐generation antipsychotic medications remain strongly preferred for first‐line pharmacological management of psychotic disorders by local practitioners. Studies on dose equivalence between antipsychotics demonstrate that approximately 0.42 mg of haloperidol is equivalent to 1 mg of olanzapine (Leucht 2020).
MSF works in mental health in many global regions in low‐resource and humanitarian settings. In these settings, we have increasingly observed a notable movement away from first‐generation medications such as haloperidol and chlorpromazine, towards second‐generation antipsychotics, where these medications are available. We began to question whether the evidence clearly justified this shift and decided to contribute to the evidence by comparing a commonly used antipsychotic from each of the first and second generations. Olanzapine was selected based on a list of second‐generation medications that had strong evidence in terms of benefits (Huhn 2019), and that appeared to be increasingly available in the settings where we work. It was also chosen based on the length of time since it had been reviewed by Cochrane compared to other commonly used first‐generation antipsychotic medications.
While long‐acting injectable medications are increasingly considered relevant treatment options in low‐resource and humanitarian settings (Ostuzzi 2022a), and are advocated by MSF, they were excluded from this review partly due to the impracticality of their use in these settings because of the significant monitoring requirements at administration.
How the intervention might work
The exact mechanism of action of antipsychotics is not entirely understood. Due to its high potency to block dopamine (D2) and adrenergic (alpha 1) receptors, comparatively lower doses of haloperidol are needed to alleviate the positive symptoms of schizophrenia, such as delusions and hallucinations, compared to most other antipsychotics (Schotte 1993). The noted extrapyramidal adverse effects of typical antipsychotics, including haloperidol, may be related to higher antidopaminergic activity, which implicates the dorsolateral striatum of the brain (Xiberas 2001). Haloperidol achieves peak serum concentration between two and six hours after dosing; the mean half‐time elimination ranges from 15 to 37 hours (Kudo 1999).
Olanzapine is a comparatively newer antipsychotic, with a strong affinity for dopaminergic (D1 to D5), serotonergic (5‐HT2A, 5‐HT2B, 5‐HT2C), adrenergic (alpha 1) and histamine (H1) receptors. Olanzapine has a relatively weaker antagonism to dopaminergic and muscarinic receptors, compared with other groups of receptors (Bymaster 1999). Studies suggest that high binding affinity of olanzapine to the central and peripheral muscarinic M3, 5‐HT2C, and dopamine‐D2 receptors dysregulates lipid, glucose and insulin metabolism, causing antipsychotic‐induced weight gain and diabetes (Reynolds 2010; Weston‐Green 2013). After oral administration, olanzapine reaches peak plasma concentrations within five to eight hours. The mean half life elimination ranges from 21 to 54 hours, depending on smoking status, gender and age (Drugs 2020).
Why it is important to do this review
According to the WHO mhGAP Intervention Guide for mental, neurological and substance use disorders in non‐specialised health settings, version 2.0, haloperidol is one of three antipsychotics proposed for oral treatment of non‐affective psychosis, such as schizophrenia (WHO 2016), although we are aware that an update is due to be published soon. In addition, UNHCR clinical guidance recommends haloperidol as a first‐line treatment (Ostuzzi 2017). However, some patients do not tolerate it well, due to the extrapyramidal side effects (Fleischhacker 1994). Evidence suggests that olanzapine is also a clinically beneficial antipsychotic, although it has a different adverse effect profile (i.e. fewer extrapyramidal effects, but can cause weight gain) (Duggan 2005). The price of olanzapine has dropped since it became available in generic form. Olanzapine has recently been included in the WHO Essential Medicines List (WHO 2023b).
In humanitarian contexts, access to medication, especially for individuals with chronic mental health disorders, is often challenging (Jones 2009). Daily stressors in these contexts can prompt or exacerbate mental disorder (Miller 2010). First‐generation antipsychotics have strong advantages because of a combination of high efficacy, relatively easy access and low cost, but some side effects can present a major issue. An available, affordable and well‐tolerated option is important. Given its benefits, harms and cost profile, olanzapine may prove to be a good alternative to haloperidol, but a thorough, up‐to‐date, neutral review of the evidence from randomised trials is needed. In some communities where MSF works, olanzapine is used rather than first‐generation antipsychotics. However, the adverse metabolic effects of olanzapine present their own challenges.
This review aims to present and analyse available high‐quality evidence on the effects of haloperidol and olanzapine on people with schizophrenia. This review updates the evidence on haloperidol versus olanzapine from the 2005 Cochrane review on olanzapine, focusing on the relative benefits, harms and tolerability (Duggan 2005). The results from this review may help doctors who are working in humanitarian and LMIC contexts, such as those with MSF interventions, to prescribe the most appropriate antipsychotic, or to offer information on a viable alternative in cases of poor tolerability. This analysis of the literature could also contribute to considerations around future updates of the WHO mhGAP Intervention Guide.
This review will make an important addition to the family of related Cochrane reviews (Table 2).
1. Family of haloperidol and olanzapine reviews.
| Category | Link | Title | Status |
| Original parent review | Duggan 2005 | Olanzapine for schizophrenia | Review |
| Absolute effects | Adams 2013 | Haloperidol versus placebo for schizophrenia | Review |
| Li 2019 | Olanzapine versus placebo for people with schizophrenia | Protocol | |
| Comparative effects | Bhattacharjee 2016 | Aripiprazole versus haloperidol for people with schizophrenia and schizophrenia‐like psychoses | Protocol |
| Asenjo‐Lobos 2018 | Clozapine versus olanzapine for people with schizophrenia | Protocol | |
| Leucht 2018 | Haloperidol versus chlorpromazine for schizophrenia | Review | |
| Dold 2015 | Haloperidol versus first‐generation antipsychotics for the treatment of schizophrenia and other psychotic disorders | Review | |
| Tardy 2014 | Haloperidol versus low‐potency first‐generation antipsychotic drugs for schizophrenia | Review | |
| Ray 2017 | Haloperidol versus risperidone for schizophrenia | Protocol | |
| Komossa 2010 | Olanzapine versus other atypical antipsychotics for schizophrenia | Review | |
| Jayaram 2006 | Risperidone versus olanzapine for schizophrenia | Review | |
| Discontinuation | Essali 2019 | Haloperidol discontinuation for people with schizophrenia | Review |
| Alahdab 2012 | Olanzapine discontinuation for schizophrenia | Protocol | |
| Dose comparison | Donnelly 2013 | Haloperidol dose for the acute phase of schizophrenia | Review |
| Latifeh 2019 | Olanzapine dose for people with schizophrenia | Protocol | |
| Techniques of administration | Quraishi 1999 | Depot haloperidol decanoate for schizophrenia | Review |
| Hanafi 2017 | Haloperidol (route of administration) for people with schizophrenia | Protocol | |
| Herath Mudiyanselage 2009 | Olanzapine depot for schizophrenia | Protocol |
Objectives
To assess the clinical benefits and harms of haloperidol compared to olanzapine for people with schizophrenia and schizophrenia‐spectrum disorders.
Methods
Criteria for considering studies for this review
Types of studies
We considered all relevant randomised controlled trials (RCTs). For the analyses, we included RCTs meeting our inclusion criteria and reporting useable data. As per our protocol, studies not reporting the selected outcomes were excluded partly due to the very large number of studies identified, with the outcomes selected being the ones most relevant to patients, carers and clinicians.
If a trial was described as 'double‐blind' but implied randomisation, we carried out a sensitivity analysis to evaluate the effects of including such trials (see Sensitivity analysis).
We excluded quasi‐randomised studies, such as those that allocated intervention by alternate days of the week.
Where people were given treatments in addition to haloperidol versus olanzapine, we only included data if the adjunct treatment was evenly distributed between groups, and only where allocation of haloperidol and olanzapine was randomised.
Types of participants
The studies selected for consideration included adult participants, however defined (not younger than 15 years old), who had schizophrenia or schizophrenia‐spectrum disorders, including schizophreniform disorder, schizoaffective disorder and delusional disorder, by any means of diagnosis. This represents an array of clinical states, including those acutely ill, stabilised or a mix of the two. Where there were a range of diagnoses, we included only trials where the majority of participants (over 50%) were adults with a diagnosis of schizophrenia or schizophrenia‐spectrum disorders (non‐affective psychoses).
We were interested in making sure that the information was as relevant as possible to the current care of people with schizophrenia, so we aimed to highlight the current clinical state (acute, early post‐acute, partial remission, remission) and the stage (prodromal, first episode, early illness, persistent), and whether the studies primarily focused on people with particular problems (for example, negative symptoms, treatment‐resistant illnesses). See Subgroup analysis and investigation of heterogeneity.
Types of interventions
1. Haloperidol (oral)
Any dose.
2. Olanzapine (oral)
Any dose.
Types of outcome measures
Where studies reported results by time frame, we prioritised reporting of the overall time period, followed by individual ones ‐ first short‐term (less than 7 months), then medium‐term (7 to 12 months), then long‐term (over 12 months).
We then prioritised binary outcomes that recorded clear and clinically meaningful degrees of change (e.g. global impression of much improved, or more than 50% improvement on a rating scale, as defined in the trials) before continuous ones, and general outcomes over specific ones. Thus, for prioritised outcomes such as 'clinically important change', 'any change' and 'relapse', we used the definition applied by each trial. Most of the trials used the clinical global impression (CGI) and Positive and Negative Syndrome Scale (PANSS) for measuring clinically important changes in global and mental states, respectively. We therefore prioritised trial‐defined binary cut‐offs in CGI for global state, and a 50% reduction in endpoint PANSS score as the minimum clinically important difference (MCID) for clinically important change in mental state, as recommended (Leucht 2005). As a second tier, we reported outcomes using other cut‐off values for clinically important change (i.e. 20%, 25%, 75% reduction in endpoint PANSS score, and 40% reduction in endpoint BPRS score), and for a more inclusive summary measure, standardised mean difference (SMD) for comparable continuous outcomes.
Extrapyramidal side effects were evaluated using a variety of scales (i.e. Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Scale (BAS), Drug‐Induced Extrapyramidal Symptom Scale (DIEPSS), Extrapyramidal Symptom Rating Scale (ESRS), Simpson Angus Scale (SAS), Treatment Emergent Symptom Scale (TESS), UKU Side Effects Rating Scale (UKU‐SERS), Association for Methodology and Documentation in Psychiatry (AMDP)) and we prioritised reporting of combined binary outcomes as defined by each trial.
For weight gain, the majority of studies considered a 7% increase in body weight; we prioritised the trial‐defined binary outcome in weight gain for reporting purposes, over other measures.
For quality of life, as only one included study reported clinically important change, we prioritised this outcome, using a 20% increase in Quality of Life Scale (QLS) endpoint score. As a second tier, we reported the SMD of a variety of quality of life scales using average endpoint scores (i.e. Comprehensive Quality of Life Scale (GQOL T), Quality of Life Enjoyment and Satisfaction Questionnaire(Q‐LES‐Q), QLS, Short Form (36) Health Survey (SF‐36), Manchester Short Assessment of Quality of Life (MANSA), QoL, Subjective Quality of Life (S‐QoL).
For leaving the study early due to adverse effects, we prioritised the binary outcome as defined in each study. As a second tier, we reported outcomes by specific reason and time frame.
For additional information about scales, please see Data extraction and management and Included studies.
Primary outcomes
Global state
Clinically important change
Relapse
Adverse effects or events
Specific ‐ extrapyramidal ‐ any effect
Specific ‐ metabolic ‐ weight increase
Secondary outcomes
Global state
Average endpoint score (CGI, high = poor)
Any change in global state
Average change score in global state
Mental state
Overall
Clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score)
Clinically important change in overall mental state (≥ 20% reduction in PANSS endpoint score)
Clinically important change in overall mental state (≥ 25% reduction in PANSS endpoint score)
Clinically important change in overall mental state (≥ 75% reduction in PANSS endpoint score)
Clinically important change in overall mental state (≥ 40% reduction in Brief Psychiatric Rating Scale (BPRS) endpoint score)
Clinically important change in overall mental state ‐ remission (PANSS score ≤ 3 per symptom, for at least six months)
Average endpoint score (PANSS total, high = poor)
Average endpoint score (BPRS total, high = poor)
Average endpoint score (PANSS, BPRS total scores, SMD, high = poor)
Average change score (PANSS total, high = poor)
Specific
Negative symptoms ‐ clinically important change (≥ 20% reduction in PANSS‐N)
Negative symptoms ‐ clinically important change ‐ short‐term (≥ 40% reduction in PANSS‐N)
Negative symptoms ‐ average endpoint score (PANSS‐N, high = poor)
Negative symptoms ‐ average endpoint score (PANSS‐N, Simpson Angus Scale (SANS), SMD, high = poor)
Average endpoint score ‐ depression (Montgomery Asberg Depression Rating Scale (MADRS), high = poor)
Positive symptoms ‐ clinically important change ‐ medium‐term (≥ 20% reduction in PANSS‐P)
Positive symptoms ‐ average endpoint score (PANSS‐P, high = poor)
Positive symptoms ‐ average endpoint score (PANSS‐P, BPRS‐P, SMD, high = poor)
Psychopathology, general ‐ average endpoint score (PANSS psychopathology, high = poor)
Time to onset of effect
Needing additional benzodiazepines
General functioning
General
Clinically important change in general aspects of functioning
Average endpoint score (Global Assessment of Functioning (GAF), high = good)
Average endpoint score ‐ cognition (Subjective Cognitive Decline questionnaire (SCD), high = poor)
Average endpoint scores ‐ cognition (various domains, high = good)
Specific
Clinically important change in specific aspects of functioning
Any change in specific aspects of functioning
Cognition ‐ average endpoint scores ‐ medium‐term (various domains, high = good)
Adverse effects/events
General
Adverse drug reaction, requiring dose reduction or additional medication
Severe enough to cause withdrawal from study
Needing additional medication
Specific
Extrapyramidal ‐ various specific effects
Extrapyramidal ‐ average endpoint score (total score, high = poor)
Metabolic ‐ weight decrease
Metabolic ‐ weight ‐ high body mass index (BMI) (≥ 25 kg/m2) ‐ medium‐term
Metabolic ‐ weight ‐ average endpoint (kg)
Metabolic ‐ weight ‐ average increase
Metabolic ‐ weight ‐ waist circumference at endpoint (high = poor)
Metabolic ‐ weight ‐ waist circumference change data (high = poor)
Metabolic ‐ weight ‐ average change (various measures)
Metabolic ‐ metabolism‐related final serum levels (various measures)
Metabolic ‐ metabolism‐related serum levels (high = poor)
Metabolic ‐ metabolism related HDL serum levels ‐ endpoint (high = poor)
Metabolic ‐ metabolism‐related serum levels ‐ average change (high = poor)
Metabolic ‐ various binary
Anticholinergic ‐ various
Arousal ‐ various (non‐sleep) measures
Arousal ‐ sleep/sleepiness ‐ various binary outcomes
Cardiovascular ‐ various binary measures
Cardiovascular ‐ blood pressure endpoint (high = poor)
Gastrointestinal
Hepatic/haematological dysfunction
Hormonal ‐ high prolactin levels
Hormonal ‐ serum levels
Renal ‐ average creatinine change
Death ‐ during study or within 30 days of study discontinuation
Others
Quality of life
Clinically important change in quality of life (≥ 20% increase in QLS endpoint score, high = good)
Average endpoint total score (various scales, SMD, high = good)
Average endpoint score (QLS ‐ Heinrich & Carpenter, high = good)
Average endpoint score (WHO‐QOL‐BREF, high = good)
Various subscales ‐ average endpoint score (SF‐36, high = good)
Average endpoint score ‐ short‐term (QLS total, high = good)
Average change score in quality of life
Leaving the study early
Leaving the study early: adverse effects
Leaving the study early: any reason
Leaving the study early: various reasons
Leaving the study early: average time until discontinuation (months)
Service use
Admission to hospital after randomisation
Hospitalisation
Days in hospital
Economic
Direct costs
Indirect costs
Search methods for identification of studies
Electronic searches
Cochrane Schizophrenia study‐based register of trials
During the course of conducting this review, the Information Specialist searched the register on four occasions (11 June 2019, 10 July 2020, 10 February 2021 and 14 January 2023) using the following search strategy:
(*Haloperidol* AND *Olanzapine*) in Intervention Field of STUDY
In such study‐based registers, searching the major concept retrieves all the synonyms and relevant studies because all the studies have already been organised based on their interventions and linked to the relevant topics (Roberts 2021; Shokraneh 2017; Shokraneh 2021). This allows rapid and accurate searches that reduce waste in the next steps of systematic reviewing (Shokraneh 2019).
Following the methods from Cochrane (Lefebvre 2019), this register is compiled by systematic searches of major resources (CENTRAL, CINAHL, ClinicalTrials.gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed, WHO ICTRP) and their monthly updates, ProQuest Dissertations and Theses A&I and its quarterly update, handsearches, grey literature and conference proceedings (Shokraneh 2020). There are no language, date, document type or publication status limitations for inclusion of records into the register.
Searching other resources
1. Reference searching
We inspected the references of all included studies for further relevant studies.
2. Personal contact
We attempted contact with the first author of each included study for information regarding unpublished trials. We noted the outcome of this contact in the 'Characteristics of included studies' or 'Characteristics of studies awaiting classification' tables.
3. Previous Cochrane review
The large Cochrane review covering this area is now considerably out of date both in content and form (Duggan 2005). Nevertheless, it does contain useful information, including the clustering of the great number of reports into relevant studies. We used this work as a source document for this update of the haloperidol versus olanzapine comparison.
Data collection and analysis
Methods used in data collection and analysis for this update are set out below. For previous review methods, please see Appendix 1.
Selection of studies
Review authors KI, JC and AL independently inspected citations from the searches and identified relevant abstracts; CC and GK independently re‐inspected a random 20% sample of these abstracts to ensure reliability of selection. Any disagreements were resolved by consensus; where doubt remained, we acquired the full article. KI and JC obtained and inspected full reports of the abstracts or reports that met the review criteria. AL, CC and GK re‐inspected a random 20% of these full reports and decided whether these studies met the eligibility criteria. Where it was not possible to resolve disagreements by discussion, we sought further information by contacting the authors of the studies concerned for clarification.
The original review already contains collated clusters of reports relating to trials that are relevant to this new review. KI and JC inspected Duggan 2005, all the included trials relevant to the olanzapine versus haloperidol comparison and their references. JC (who is a native Mandarin speaker and writer) inspected studies in the Chinese language. Jun Xia (see Acknowledgements) supervised JC.
Data extraction and management
1. Extraction
Review authors KI and JC extracted data from all new included studies. To ensure reliability, AL, CC and GK independently extracted data from a random 10% sample of the total number of included studies. Data presented only in graphs and figures were extracted whenever possible, but included only if two review authors independently obtained the same result. If studies were multi‐centre, where possible, we extracted data relevant to each centre. We attempted to contact authors through an open‐ended request in order to obtain missing information or for clarification whenever necessary. GK and CC helped to clarify issues regarding any remaining problems, and these final decisions were documented.
KI inspected data extraction from relevant studies included in the previous review (Duggan 2005). AL, CC and GK independently extracted data from a random 10% of the relevant trials in Duggan 2005 to ensure the reliability of previous data extraction. If the previous data extraction was not reliable, KI and JC independently extracted the data from the previously included studies.
KI and JC used the previous risk of bias tables from Duggan 2005, and updated them where necessary. Again, AL, CC and GK cross‐checked a random 10% sample of the previous risk of bias tables for reliability. If the previous tables were not reliable, all review authors completed new risk of bias tables for all previously included studies.
JC extracted data and completed a new risk of bias table for the studies in the Chinese language under the supervision of Jun Xia.
2. Management
2.1 Forms
We extracted data onto Cochrane standard, pre‐designed, simple forms.
2.2 Scale‐derived data
We included continuous data from rating scales only if:
the psychometric properties of the measuring instrument were described in a peer‐reviewed journal (Marshall 2000);
the measuring instrument had not been written or modified by one of the trialists for that particular trial; and
the instrument was a global assessment of an area of functioning, and not a subscore that had not been validated or shown to be reliable as a stand‐alone instrument. However, there were exceptions; we included subscores from mental state scales that measured positive and negative symptoms of schizophrenia.
Ideally, the measurement instrument should either be a self‐report, or be completed by an independent rater or relative (not the therapist). We observed that the way measurement instruments were used was often not reported clearly in publications and so could not be included in the 'Description of studies' section.
2.3 Endpoint versus change data
There are advantages of both endpoint and change data: change data can remove a component of between‐person variability from the analysis; however, calculation of change needs two assessments (baseline and endpoint), which can be difficult to obtain in unstable and difficult‐to‐measure conditions, such as schizophrenia. We decided to use endpoint data first, and only use change data if the former were not available. We combined endpoint data in the analysis using mean differences (MDs) if the same scales were used and standardised mean differences (SMDs) if different but combinable scales were used (Deeks 2011).
2.4 Skewed data
Continuous data on clinical and social outcomes are often not normally distributed. To avoid the pitfall of applying parametric tests to non‐parametric data, we aimed to apply the following standards to relevant continuous data before including them.
For endpoint data from studies including fewer than 200 participants:
When a scale started from zero, we subtracted the lowest possible value from the mean, and divided this by the standard deviation (SD). If this value was less than one, it strongly suggested that the data were skewed, and we excluded these data. If this ratio was higher than one but less than two, it suggested that the data were skewed: we entered these data and tested whether their inclusion would change the results substantially. If such data changed the results, we entered them as 'other data'. Finally, if the ratio was larger than two, we included these data, because it was less likely that they were skewed (Altman 1996).
If a scale started from a positive value (such as the Positive and Negative Syndrome Scale (PANSS), which can have values from 30 to 210) (Kay 1986), we modified the calculation described above to take the scale starting point into account. In these cases, skewed data were present if 2 SD > (S − S min), where 'S' is the mean score and 'S min' is the minimum score.
Please note: we entered all relevant data from studies of more than 200 participants in the analysis, regardless of the above rules, because skewed data pose less of a problem in large studies. We also entered all relevant change data, as when continuous data are presented on a scale that includes a possibility of negative values (such as change data), it is difficult to tell whether or not data are skewed.
2.5 Common measurement
We aimed to convert variables that can be reported in different metrics, such as days in hospital (mean days per year, per week or per month) to a common metric (e.g. mean days per month). However, we did not identify such data.
2.6 Conversion of continuous to binary
Where possible, we made efforts to convert outcome measures to dichotomous data. This was done by identifying cut‐off points on rating scales, and dividing participants accordingly into 'clinically improved' or 'not clinically improved'. It is generally assumed that if there is a 50% reduction in a scale‐derived score, such as the Brief Psychiatric Rating Scale (BPRS; Overall 1962), or the PANSS (Kay 1986), this could be considered a clinically significant response (Leucht 2005a; Leucht 2005b). If data based on these thresholds were not available, we used the primary cut‐off presented by the original authors.
2.7 Direction of graphs
Where possible, for continuous variables we entered data in such a way that haloperidol is on the right and olanzapine is on the left of the no effect line. MD or SMD values > 1 represent a higher mean for the haloperidol group, and values < 1 for olanzapine, regardless of the nature of the effect (i.e. favourable or deleterious outcome). For binary outcomes, risk ratios > 1 (to the right of the graph) indicate a higher risk for the group on haloperidol, regardless of risk type, i.e. for something favourable like efficacy or deleterious like relapse.
Assessment of risk of bias in included studies
Review authors KI, JC and AL worked independently to assess risk of bias by using the criteria described in the revised guidance for rating risk of bias (Higgins 2008). This set of criteria is based on evidence of associations between potential overestimation of effect, and the level of risk of bias of the article, which may be due to aspects of sequence generation, allocation concealment, blinding of participants and outcomes assessors, incomplete outcome data and selective reporting, or the way in which these domains are reported.
If the raters disagreed, we made the final rating by consensus. Where inadequate details of randomisation and other characteristics of trials were provided, we attempted to contact the authors of the studies in order to obtain further information. We reported any lack of concurrence in quality assessment, but if disputes arose regarding the category to which a trial was to be allocated, we resolved this by discussion.
Measures of treatment effect
1. Binary data
For binary outcomes, we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI), as it has been shown that RR is more intuitive than odds ratio (Boissel 1999), and that odds ratios tend to be interpreted as RR by clinicians (Deeks 2000).
For binary outcomes presented in the summary of findings tables, we calculated the risks for the haloperidol and olanzapine groups respectively, using the RR for comparison (i.e. the risk in the haloperidol group divided by the risk in the olanzapine group). Where appropriate (i.e. binary outcomes with confidence intervals not crossing the null), we also calculated the number needed to treat for an additional beneficial outcome (NNTB) and the number needed to treat for an additional harmful outcome (NNTH), with their respective 95% CIs, as they are practical and useful for clinicians (Hutton 2009).
2. Continuous data
For continuous outcomes, we estimated the mean difference (MD) between groups where the same scale was used across studies. Where different continuous scales measured the same outcome, we used the standardised mean difference (SMD).
Unit of analysis issues
1. Cluster trials
Studies increasingly employ 'cluster randomisation' (such as randomisation by clinician or practice), but analysis and pooling of clustered data poses problems. Authors often fail to account for intra‐class correlation in clustered studies, leading to a unit of analysis error whereby P values are spuriously low, CIs unduly narrow and statistical significance overestimated (Divine 1992). This causes type I errors (Bland 1997; Gulliford 1999).
Where clustering had been incorporated into the analysis of primary studies, we presented these data as if from a non‐cluster randomised study, but adjusted for the clustering effect.
Where clustering was not accounted for in primary studies, we presented data in a table, with a (*) symbol to indicate the presence of a probable unit of analysis error. We sought to contact the first authors of studies to obtain intra‐class correlation coefficients for their clustered data and to adjust for this by using accepted methods (Gulliford 1999).
We sought statistical advice and were advised that the binary data from cluster trials presented in a report should be divided by a 'design effect'. This is calculated using the mean number of participants per cluster (m) and the intra‐class correlation coefficient (ICC): thus design effect = 1 + (m − 1) * ICC (Donner 2002). If the ICC was not reported, we assumed it to be 0.1 (Ukoumunne 1999).
If cluster studies were appropriately analysed and took intra‐class correlation coefficients and relevant data documented in the report into account, synthesis with other studies was possible using the generic inverse variance technique.
2. Cross‐over trials
A major concern with cross‐over trials is the carry‐over effect. This occurs if an effect (e.g. pharmacological, physiological or psychological) of the treatment in the first phase is carried over to the second phase. As a consequence, participants can differ significantly from their initial state at entry to the second phase, despite a washout phase. For the same reason, cross‐over trials are not appropriate if the condition of interest is unstable (Elbourne 2002). As both carry‐over and unstable conditions are very likely in severe mental illness, we aimed to use data only from the first phase of cross‐over studies.
3. Studies with multiple treatment groups
Where a study involved more than two treatment arms, if relevant we presented the additional treatment arms in comparisons. If data were binary, we simply added these and combined within the two‐by‐two table. If data were continuous, they were combined following the formula in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011a). Where additional treatment arms were not relevant, we did not use data from these arms.
Dealing with missing data
1. Overall loss of credibility
At some degree of loss of follow‐up, data must lose credibility (Xia 2009). If more than 50% of data was missing for any outcome, we did not use the data in the meta‐analyses. If more than 50% was lost to follow‐up in one treatment arm, but the total loss was less than 50%, we addressed this by downgrading the certainty of the evidence for the outcome involved (by two points). We also downgraded the certainty of the evidence (by one point) if the total loss was between 25% and 50%.
2. Binary
If attrition for a binary outcome was between 0% and 50%, and these data were not clearly described, we presented the data on an intention‐to‐treat analysis (ITT) basis. We assumed that those who left the study early had the same rates of negative outcome as those who completed it. We used the rate of those who stayed in the study ‐ in that particular arm of the trial ‐ and applied it to those who did not. We undertook a sensitivity analysis to test how prone the primary outcomes were to change, when we compared data from people who completed the study to that point to the intention‐to‐treat analysis using the above assumptions.
3. Continuous
3.1 Attrition
In the case where attrition for a continuous outcome was between 0% and 50%, and data only from people who completed the study to that point were reported, we presented and used these data.
3.2 Standard deviations
If standard deviations (SDs) were not reported, we tried to obtain the missing values from the trial authors. If they were not available, but we had an exact standard error (SE) and CIs available for group means, and either a P value or t value for differences in mean, we calculated SDs according to the rules described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011a). When only the SE was reported, we calculated SDs with the formula SD = SE * √(n). The Cochrane Handbook for Systematic Reviews of Interventions presents detailed formulae for estimating SDs from P, t or F values, CIs, ranges or other statistics (Higgins 2011a). If these formulae did not apply, we calculated the SDs according to a validated imputation method, based on the SDs of the other included studies (Furukawa 2006). Although some of these imputation strategies can introduce error, the alternative was to exclude a given study’s outcome, and thus lose information. We nevertheless examined the validity of the imputations in a sensitivity analysis that excluded imputed values.
3.3 Assumptions about participants who left the trials early or were lost to follow‐up
Various methods are available to account for participants who left the trials early or were lost to follow‐up. Some trials just present the results of those who completed the study; others use the method of last observation carried forward (LOCF). More recently, methods such as multiple imputation or mixed‐effects models for repeated measurements (MMRM) have become more of a standard. While the latter methods seem to be somewhat better than LOCF, we feel that the high percentage of participants leaving the studies early and differences between groups in their reasons for doing so is often the core problem in randomised schizophrenia trials (Leon 2006). Therefore, we did not exclude studies based on the statistical approach used. However, we used the more sophisticated approaches first, i.e. we used MMRM or multiple‐imputation rather than LOCF, and we only presented completer analyses if ITT data were not available. We addressed this issue when we assessed the incomplete outcome data risk of bias domain.
Assessment of heterogeneity
1. Clinical heterogeneity
We considered all included studies initially, without seeing comparison data, to judge clinical heterogeneity. We simply inspected all studies for participants or situations that were clearly different to the participants or situations in the other included studies and discussed such situations or participant groups.
2. Methodological heterogeneity
We considered all included studies initially, without seeing comparison data, to judge methodological heterogeneity. We simply inspected all studies for clearly outlying methods that we had not predicted would arise and discussed any such methodological outliers.
3. Statistical heterogeneity
3.1 Visual inspection
We visually inspected results to investigate the possibility of statistical heterogeneity.
3.2 Using the I² statistic
We investigated heterogeneity between studies by considering the I² statistic alongside the Chi² P value. The I² statistic provides an estimate of the percentage of inconsistency thought to be due to chance (Higgins 2003). The importance of the observed value of I² depends on the magnitude and direction of effects, as well as the strength of evidence for heterogeneity (e.g. P value from Chi² test, or a confidence interval for I²). We interpreted an I² estimate of 60% or higher, and accompanied by a statistically significant Chi² statistic, as evidence of substantial heterogeneity (Deeks 2011). When substantial levels of heterogeneity were found for the primary outcomes, we explored the reasons for heterogeneity (Subgroup analysis and investigation of heterogeneity).
Assessment of reporting biases
Reporting biases arise when the dissemination of research findings is influenced by the nature and direction of results (Egger 1997). These are described in section 10.1 of the Cochrane Handbook for Systematic Reviews of Interventions (Sterne 2011).
1. Protocol versus full study
We tried to locate protocols for the included randomised trials. If a protocol was available, we compared the outcomes in the protocol and in the published report. If the protocol was not available, we compared the outcomes listed in the methods section of the trial report with the results actually reported.
2. Funnel plot
We are aware that funnel plots may be useful in investigating reporting biases, but are of limited power to detect small‐study effects. We did not use funnel plots for outcomes where there were 10 or fewer studies, or where all studies were of similar size. In other cases, where funnel plots were possible, we sought statistical advice on their interpretation.
Data synthesis
We understand that there is no closed argument for preferential use of fixed‐effect or random‐effects models. The random‐effects method incorporates an assumption that the different studies are estimating different, yet related, intervention effects. This often seems to be true to us and the random‐effects model takes into account differences between studies, even if there is no statistically significant heterogeneity. However, there is a disadvantage to the random‐effects model: it puts added weight onto small studies, which often are the most biased ones. Depending on the direction of effect, these studies can either inflate or deflate the effect size. We chose to use the random‐effects model for our analyses.
Subgroup analysis and investigation of heterogeneity
1. Investigation of heterogeneity
We reported if heterogeneity was high. Firstly, we investigated whether data had been entered correctly. Secondly, if the data were correct, we visually inspected the forest plots, and successively removed outlying studies to see if homogeneity was restored. If we found obvious reasons for heterogeneity (e.g. different methods, study population, intervention or outcomes measures), we removed these trials from the pooled data analysis. If we did not find any obvious reason, we pooled the data from these studies and in these cases we reported on the heterogeneity.
When unanticipated clinical or methodological heterogeneity was obvious, we simply stated hypotheses regarding this for future reviews or versions of this review. We did not anticipate undertaking analyses relating to these.
Sensitivity analysis
We carried out sensitivity analyses, for primary outcomes only, to explore the influence of the factors listed below. If there were substantial differences in the direction or precision of effect estimates in any of the sensitivity analyses listed below, we removed data from the lower‐quality trials from the analyses, presented these data separately and discussed the issues. Where there were no substantial differences in the direction or precision of effect estimates, we kept data from the lower‐quality trials in the relevant analyses.
1. Implication of randomisation
We analysed the effects of including data from lower‐quality trials where randomisation was implied rather than clearly described.
2. Assumptions for lost data
We analysed the effects of including data where we had made assumptions regarding lost data (see Dealing with missing data).
3. Risk of bias
We analysed the effects of including data from trials that were at high risk of bias across one or more of the domains (see Assessment of risk of bias in included studies).
4. Imputed values
We aimed to analyse the effects of including data from trials where we used imputed values for the ICC to calculate the design effect in cluster‐randomised trials (see Unit of analysis issues).
5. Fixed‐ and random‐effects
We synthesised data using a random‐effects model; however, we also examined data using a fixed‐effect model to evaluate whether this altered the size or direction of effect estimates.
Summary of findings and assessment of the certainty of the evidence
Summary of findings table
We used the GRADE approach to interpret findings, and GRADEpro GDT to export data from our review in Review Manager to create a summary of findings table (GRADEpro GDT; Review Manager 2014; Schünemann 2011). Summary of findings tables provide outcome‐specific information about the overall certainty of the evidence from the included studies in the comparison, the magnitude of the effect of the interventions examined, and the sum of available data on all outcomes rated as important to patient care and decision‐making. We selected the following outcomes in the summary of findings table:
Global state: clinically important change (any time point, measured by CGI scale)
Global state: relapse (any time point, measured by the definition applied by each of the trials).
Adverse effects or events: specific ‐ extrapyramidal ‐ any effect (any time point, measured by the definition applied by each of the trials)
Adverse effects or events: specific ‐ metabolic effects ‐ weight increase (any time point, measured by the definition applied by each of the trials)
Mental state: clinically important change in overall mental state (any time point, ≥ 50% decrease in overall PANSS score from baseline)
Quality of life: clinically important change in quality of life (any time point, measured by the definition applied by each of the trials)
Leaving the study early: adverse effects (any time point, measured by the definition applied by each of the trials)
Results
Description of studies
For a substantive description of studies, please see the Characteristics of included studies and Characteristics of excluded studies tables.
Results of the search
The original search yielded 1791 potentially relevant reports (1425 records from the Duggan 2005 review and 366 records from the current review). We found 10 reports through additional searches. After screening, we excluded a total of 1097 duplicates and clearly irrelevant materials. Overall, we selected 644 full texts and assessed them for eligibility. We then grouped these into studies where several of the reports referred to the same trial. Of these, we excluded 143 studies (258 reports) because they were not randomised or quasi‐randomised, did not primarily involve people with schizophrenia, were comparing antipsychotic drugs but not oral haloperidol with olanzapine, were duplicate reports of the same trial or reported no useable data. Finally, after careful scrutiny, we were left with 386 publications reporting 68 studies. AL, CC and GK independently assessed a 10% random sample of the original 386 citations for inclusion and exclusion criteria. KI and JC agreed on inclusion and exclusion for this 10% sample. We contacted the corresponding authors of 32 trials for additional data and clarification; the authors of the remaining 36 included studies did not have appropriate contact information. Of the contacted authors, 12 replied with additional information or clarification.
Details of the search results are illustrated in the PRISMA flow chart (Figure 1).
1.
Combined flow diagram of current and previous (Duggan 2005) reviews.
Included studies
Sixty‐eight studies published between 1998 and 2022 were included in this systematic review. Forty‐one studies were in English and 27 in Chinese; one was reported in Spanish (Lilly 2006a). For additional information please see Table 3.
2. Haloperidol versus olanzapine: study size and number of reports.
1. Study design
All studies were either stated or described as being randomised and had a parallel‐group design. Twenty‐six studies applied double‐blind methodology and one study was rater blinded (Walther 2014). Twelve trials were reported to be open‐label (Avasthi 2001; Barak 2002; Crespo‐Facorro 2006; Dhar 2010; HGFH (Korea) 1998; Kahn (EUFEST) 2005; Lilly 2006a; Nag 2013; Parabiaghi (GiSAS) 2010; San 2012; Vedam 2022; Zhu 2014f), while 30 studies did not report blinding.
2. Length of trials
Fifty‐seven trials investigated a short‐term study duration (less than seven months) whereas eight studies evaluated a medium‐term period (from 9 to 12 months) (Kahn (EUFEST) 2005; Lilly (S029) 2007; Lilly 2006a; Malyarov 1999; Namjoshi 2002; Parabiaghi (GiSAS) 2010; Raposo 2011; Rosenheck (HGFI) 2003; San 2012). Only four trials were carried out over a long‐term period (more than 12 months) (Crespo‐Facorro 2006; Jones 1998 (P022); Lilly (HGGN) 2000; Tollefson (HGAJ) 1997).
3. Participants
The 68 included studies comprised a total of 9132 participants allocated to haloperidol and olanzapine. In the majority of studies, the study population was characterised as people with schizophrenia. Ten studies specifically enrolled people with their first episode of psychosis (Crespo‐Facorro 2006; Kahn (EUFEST) 2005; Lieberman (HGDH) 2003; Lin 2008; Liu 2011i; Luo 2012d; Ma 2005d; Saddichha 2007; San 2012; Zhang 2010ae). Two studies included severely agitated people (Kinon 2004; Walther 2014) and only one included people with an aggressive event (Krakowski 2006).
In most trials, the diagnoses of the participants were based on the international classification system Diagnostic and Statistical Manual of Mental Disorders IV (DSM‐IV). Four studies applied the DSM‐III‐R (Beasley (HGAD) 1996a; Beasley (E003) 1997; Tollefson (HGAJ) 1997; Walther 2014), two trials the DSM‐IV‐TR (Lindenmayer 2007; San 2012) and eight the International Classification of Diseases ‐ 10th Revision (ICD‐10) (Dhar 2010; Gründer (NeSSy) 2012; Ishigooka 2001; Malyarov 1999; Taraskina 2017; Zhang 2005g; Zhu 2014f, Zubair 2020). The diagnoses of the participants in trials conducted in China were based on the Chinese Classification of Mental Disorders (CCMD)‐III and CCMD‐II‐R classification systems (Ding 2013; Hu 2014i; Jiang 2009b; Li 2005f; Liu 2010l; Liu 2011i; Liu 2012ao; Luo 2012d; Ma 2005d; Pan 2005; Qin 2006a; Song 2009c; Xianzhen 2004; Xu 2014n; Zhang 2005g; Zhang 2010ad; Zhang 2016al; Zheng 2003b). Eight studies included people with schizophrenia but did not describe the means of diagnosis.
Most of the trials included people aged 18 to 65 years old. Nine studies included people under 18 years old (de Hann 2003; Lieberman (HGDH) 2003; Lin 2008; Mousavi 2013; Nag 2013; Qin 2006a; Song 2009c; Vedam 2022; Zhang 2013m) and three studies included people who were over 65 years of age (Barak 2002; Hu 2014i; Liu 2012ao). Most trial participants were of mixed sex. Song 2009c included only female participants, while Beasley (HGAD) 1996a, Raposo 2011 and Taraskina 2017 included only male participants. Four studies did not describe the age and sex of participants (Altamura (HGBQ) 1999; HGCJ (Hong Kong) 1998; HGCU (Taiwan) 1998; HGFH (Korea) 1998).
3. Size
The included studies involved 9132 participants. The largest trial randomised 1996 people (Tollefson (HGAJ) 1997), while the smallest study included only 20 participants (Barak 2002). Eighteen of the 68 studies randomised fewer than 50 people and in 20 trials the sample size was greater than 100. Ten of these randomised over 300 participants (Beasley (E003) 1997; Beasley (HGAD) 1996a; Kahn (EUFEST) 2005; Lilly (HGGN) 2000; Namjoshi 2002; Parabiaghi (GiSAS) 2010; Rosenheck (HGFI) 2003; Tollefson (HGAJ) 1997; Wang 2012k; Zubair 2020). For additional information please see Table 3.
4. Setting
Trials mainly took place in a mix of inpatient and outpatient settings. Twenty‐eight trials were conducted in an inpatient setting, while five trials were in outpatient settings (Buchanan 2003; Jones 1998 (P022); Nag 2013; Namjoshi 2002; Sergi 2007). There was no information regarding the setting for seven trials examined in this systematic review (Altamura (HGBQ) 1999; Lieberman (HGDH) 2003; Qin 2006a; Raposo 2011; Taraskina 2017; Zhang 2010ae).
5. Interventions
5.1 Haloperidol
A wide range of doses of haloperidol were used in the trials. The smallest doses were given in Kahn (EUFEST) 2005, which used a range of 1 to 4 mg/day for people with first episode psychosis; the largest doses were in Zhang 2010ae (up to 60 mg/day). Most studies used doses in the range of 4 to 20 mg/day. The majority of trials adjusted the dose of haloperidol according to participants' needs, with only six studies assigning a fixed dose (Bernardo (HGDD) 2001; de Hann 2003; Lindenmayer 2007; Mousavi 2013; Sergi 2007; Walther 2014). Forty‐one studies had a single comparison of haloperidol with olanzapine, while in 16 studies participants were also randomised to other antipsychotics such as amisulpride, aripiprazole, clozapine, flupentixol, quetiapine, risperidone, thiothixine and ziprasidone. Two studies did not clearly report the assigned dose range (Zhang 2005g; Zubair 2020).
5.2 Olanzapine
In the olanzapine arm, most studies used a dose range of 5 to 20 mg per day. Four trials appeared to give a low‐end dose in the range of 2.5 to 7.5 mg/day (Beasley (HGAD) 1996a; Beasley (E003) 1997; Boulay 2002; Vedam 2022), while one study assigned a dose range of 7.5 to 40 mg/day (the highest in this review) (San 2012). Two trials used low (2.5 to 7.5 mg/day), medium (7.5 to 12.5 mg/day) and high (12.5 to 17.5 mg/day) dose arms of olanzapine compared to haloperidol and placebo (Beasley (HGAD) 1996a; Beasley (E003) 1997). Fixed doses of olanzapine were used in only six trials (Bernardo (HGDD) 2001; de Hann 2003; Li 2005f; Lindenmayer 2007; Mousavi 2013; Vedam 2022). Only one study did not describe the means of doses used (Zubair 2020).
6. Outcomes
6.1 General
Our primary outcome measures were global state, relapse, mental state, adverse effects, quality of life and leaving the study early.
6.1.1 Global state
Six of the included studies (five short‐term, one medium‐term) reported clinically important change in global state using the Clinical Global Impression (CGI) scale (Beasley (HGAD) 1996a; Beasley (E003) 1997; Lilly 2006a; Lieberman (HGDH) 2003; Liu 2011i; Tollefson (HGAJ) 1997). The CGI is a commonly used measure of symptom severity, treatment response and the efficacy of treatments in studies of patients with mental disorders and compares the conditions of the person standardised against other people with the same diagnosis (Guy 1976).
6.1.2 Relapse
We found seven trials reporting data on relapse at medium‐ and long‐term follow‐up (Beasley (HGAD) 1996a; Crespo‐Facorro 2006; Lilly (HGGN) 2000; Lilly (S029) 2007; Lilly 2006a; Namjoshi 2002; Zubair 2020). Relapse was defined as deterioration after a period of improvement, although measured differently in each study. Crespo‐Facorro 2006, Lilly (HGGN) 2000 and Lilly (S029) 2007 used criteria such as increase either in BPRS, PANSS and CGI scores, and hospitalisation or suicide attempt, while Lilly 2006a identified relapsed using only the CGI‐S score. Two studies defined relapse as any hospitalisation for psychopathology (Beasley (HGAD) 1996a; Namjoshi 2002). One study did not clearly report the definition of relapse used (Zubair 2020).
6.1.3 Mental state
We pre‐specified at least a 50% reduction from baseline in PANSS/BPRS score as a clinically relevant cut‐off and identified 13 studies reporting data using this cut‐off. In addition, we observed many studies using alternative cut‐offs. Lilly (HGGN) 2000 and Lilly (S029) 2007 used cut‐offs of 20% while 12 trials, mainly from China, reported data separately for cut‐offs of at least 25%, 50% and 75% reduction from baseline in PANSS score. Only three studies reported data on mental state using the BPRS scale with a cut‐off of at least 40% reduction from baseline (Chaudhry 2003; Liu 2012ao; Tollefson (HGAJ) 1997).
6.1.4 Quality of life
We identified 13 studies reporting data on quality of life using nine different outcome scales (Avasthi 2001; Buchanan 2003; Chaudhry 2003; Kahn (EUFEST) 2005; Lilly (S029) 2007; Lilly 2006a; Ma 2005d; Song 2009c; Tollefson (HGAJ) 1997; Xianzhen 2004; Xu 2014n; Zhang 2016al; Zhu 2014f). Of these, only a single trial provided data on clinically important response in terms of quality of life using a cut‐off of 20% improvement from baseline on the QLS scale (Tollefson (HGAJ) 1997).
6.2 Outcome scales providing useable data
Details of the scales that provided usable data are shown below. Reasons for exclusion of data are given under 'Outcomes' in the Characteristics of included studies table.
6.2.1 Global state scales
6.2.1.1 Clinical Global Impression Scale ‐ CGI Scale (Guy 1976)
This is used to assess both the severity of illness and clinical improvement, comparing the overall symptoms as well as social and occupational functioning of the person, standardised against other people with the same diagnosis. A seven‐point scoring system is usually used with low scores showing decreased severity and/or overall improvement.
6.2.2 Mental state scales
6.2.2.1 Brief Psychiatric Rating Scale ‐ BPRS (Overall 1962)
This is used to assess the severity of abnormal mental state. The original scale has 16 items, but a revised 18‐item scale is commonly used. Each item is defined on a seven‐point scale varying from 'not present' to 'extremely severe', scoring from 0 to 6 or 1 to 7. Scores can range from 0 to 126, with high scores indicating more severe symptoms.
6.2.2.2 Hamilton Rating Scale for Depression ‐ HDRS (Hamilton 1960)
This instrument is designed to be used only on people already diagnosed as suffering from an affective disorder of depressive type. It is used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The scale contains 17 variables measured on either a five‐ or a three‐point rating scale, the latter being used where quantification of the variable is either difficult or impossible. Among the variables are: depressed mood, suicide, work and loss of interest, retardation, agitation, gastro‐intestinal symptoms, general somatic symptoms, hypochondriasis, loss of insight and loss of weight. It is useful to have two raters independently scoring the person at the same interview. The scores of the person are obtained by summing the scores of the two physicians. High scores indicate greater severity of depressive symptoms.
6.2.2.3 Hamilton Anxiety Rating Scale ‐ HAMA (Hamilton 1969)
The Hamilton Anxiety Scale is a rating scale developed to quantify the severity of anxiety symptomatology, often used in psychotropic drug evaluation. It consists of 14 items, each defined by a series of symptoms. Each item is rated on a five‐point scale, ranging from 0 (not present) to 4 (severe). The 14 items consist of: anxious mood, tension, fears, insomnia, intellectual, depressed mood, somatic complaints (muscular), somatic complaints (sensory), cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, genitourinary symptoms, autonomic symptoms and behaviour at interview.
6.2.2.4 Mini Mental State Examination ‐ MMSE (Folstein 1975)
This clinician‐administered clinical evaluation assesses cognition in five areas: orientation, immediate recall, attention and calculation, delayed recall and language. The test takes 15 minutes to administer and the score ranges from 0 (severe impairment) to 30 (normal).
6.2.2.5 Positive and Negative Syndrome Scale ‐ PANSS (Kay 1986)
This schizophrenia scale has 30 items, each of which can be defined on a seven‐point scoring system varying from 1 ‐ absent to 7 ‐ extreme. It can be divided into three sub‐scales for measuring the severity of general psychopathology, positive symptoms (PANSS‐P) and negative symptoms (PANSS‐N). A low score indicates lesser severity.
6.2.2.6 Scale for the Assessment of Negative Symptoms ‐ SANS (Andreasen 1983)
This six‐point scale gives a global rating of the following negative symptoms: alogia, affective blunting, avolition‐apathy, anhedonia‐asociality and attention impairment. Higher scores indicate more symptoms.
6.2.2.7 Montgomery Asberg Depression Rating Scale ‐ MADRS (Montgomery 1979)
A 65‐item comprehensive psychopathology scale was used to identify the 17 most commonly occurring symptoms in primary depressive illness. Ratings are based on 10 items, with higher scores indicating more symptoms.
6.2.2.8 Subjective Well‐being on Neuroleptics Scale ‐ SWN (de Haan 2002a)
The SWN is an instrument to measure the subtle subjective changes, such as restrictions in emotionality, the clarity of thinking and spontaneity that are often referred to as 'pharmacogenic depression' or the 'neuroleptic induced deficit syndrome'.
6.2.2.9 Calgary Depression Scale for Schizophrenia ‐ CDSS (Addington 1993)
Developed at the University of Calgary, the CDSS specifically assesses the level of depression in schizophrenia. It has been extensively evaluated in both relapsed and remitted patients and appears sensitive to change.
6.2.3 Adverse effects scales
6.2.3.1 Abnormal Involuntary Movement Scale ‐ AIMS (Guy 1976)
This has been used to assess tardive dyskinesia, a long‐term, drug‐induced movement disorder and short‐term movement disorders such as tremor.
6.2.3.2 Association for Methodology and Documentation in Psychiatry (AMDP‐5 1981)
This is a 40‐item adverse event questionnaire.
6.2.3.3 Barnes Akathisia Scale ‐ BAS (Barnes 1989)
The scale comprises items rating the observable, restless movements that characterise akathisia, a subjective awareness of restlessness, and any distress associated with the condition. These items are rated from 0 ‐ normal to 3 ‐ severe. In addition, there is an item for rating global severity (from 0 ‐ absent to 5 ‐ severe). A low score indicates low levels of akathisia.
6.2.3.4 COSTART Terms (COSTART 1990)
This is a list drawn up by the US Food and Drug Administration in order to help with a consistent description of adverse reactions. It is not a scoring system. Eighteen studies reported usable data.
6.2.3.5 Drug‐Induced Extrapyramidal Symptom Scale ‐ DIEPSS (Inada 1996)
This is a nine‐item scale used to assess the extrapyramidal syndromes, parkinsonism, akathisia, dystonia and dyskinsia.
6.2.3.6 Extrapyramidal Symptom Rating Scale ‐ ESRS (Chouinard 1980)
This consists of a questionnaire relating to parkinsonian symptoms (nine items), a physician's examination for parkinsonism and dyskinetic movements (eight items), and a clinical global impression of tardive dyskinesia. High scores indicate severe levels of movement disorder.
6.2.3.7 Hillside Akathisia Scale ‐ HAS (Fleischhacker 1989)
The Hillside Akathisia Scale (HAS) has two subjective and three objective items for which anchored rating points are provided.
6.2.3.8 Simpson Angus Scale ‐ SAS (Simpson 1970)
This 10‐item scale, with a scoring system of 0 to 4 for each item, measures drug‐induced parkinsonism, a short‐term drug‐induced movement disorder. A low score indicates low levels of parkinsonism.
6.2.3.9 UKU Side Effects Rating Scale ‐ UKU‐SERS (Lingjaerde 1987)
The UKU rates four major topics: psychological side effects (10 items), neurological side effects (eight items), autonomic side effects (11 items) and other side effects (19 items). Each item is defined by means of a four‐point scale where zero means not/doubtfully present. The score range is 0 to 144.
6.2.3.10 Leeds Sleep Evaluation Questionnaire ‐ LSEQ (Parrott 1980)
The SEQ is a simple 10‐item bipolar visual analogue scale (VAS) type questionnaire that can be used to evaluate sedative effects in psychotropic drugs. Four areas are tapped: 1) sleep onset, 2) quality of sleep, 3) ease of awakening and 4) integrity of morning behaviour. The SEQ has been factor analysed and four factors were identified: 1) getting asleep, 2) perceived sleep quality, 3) awakening and 4) early morning behaviour. A high score indicates improvement.
6.2.4 Quality of life scales
6.2.4.1 Quality of Life Scale (Lehman 1983)
This standardised assessment includes areas such as living situation, leisure activities, relationships and finances. This is rated on a seven‐point scale, with higher scores indicating a better quality of life.
6.2.4.2 Quality of Life Scale ‐ QLS (Carpenter 1984)
This semi‐structured interview is administered and rated by trained clinicians. It contains 21 items rated on a seven‐point scale based on the interviewer's judgement of patient functioning. A total QLS and four sub‐scale scores are calculated, with higher scores indicating less impairment.
6.2.4.3 Quality of life assessment ‐ WHOQOL‐BREF (WHO 1996)
The WHOQOL‐BREF instrument comprises 26 items, each scored from 1 to 5, which measure the following broad domains: physical health, psychological health, social relationships and environment. It assesses the individual's perceptions in the context of their culture and value systems, and their personal goals, standards and concerns.
6.2.4.4 The Short Form (36) Health Survey ‐ SF‐36 (Ware 1992)
This self‐reporting measure consists of eight scaled scores. Each scale is directly transformed into a zero to 100 scale on the assumption that each question carries equal weight.
6.2.4.5 Manchester Short Assessment of Quality of Life ‐ MANSA (Priebe 1999)
A rating scale to assess quality of life focusing on satisfaction with life as a whole and with life domains. Higher scores indicate less impairment.
6.2.5 Satisfaction
6.2.5.1 Drug Attitude Inventory ‐ DAI‐30 (Hogan 1983)
This is a self‐report 30‐item scale for assessing patient satisfaction with antipsychotic treatment in patients with schizophrenia. This inventory is designed to measure the person's subjective responses to medications as well as values and attitudes towards illness and health. Higher scores indicate a more favourable attitude towards antipsychotic drug treatment. A positive total final score means a positive subjective response (compliant). A negative total score means a negative subjective response (non‐compliant).
6.3 Missing outcomes
None of the studies evaluated patient satisfaction with care. Outcomes such as living status, employment status and community burden were not investigated in the included studies. Economic outcomes such as cost of care were also not mentioned in any study.
Excluded studies
We excluded 143 trials (see the Excluded studies table). Fifty‐nine studies were excluded because they were not appropriately randomised, while 26 trials did not allocate participants to both haloperidol and olanzapine treatment arms. Forty‐four studies were excluded due to having no outcomes of interest. In 10 trials, participants did not receive oral medication (Bayar 2005; Freeman 2009; Hsu 2010; Kong 2009; Lilly (HGHB) 2005; Lilly (HGHV) 2005; Lilly (TW‐S025) 2006; McCue 2006; Wright 2003 (HGAB); Yan 2022). In 14 studies, the characteristics of participants did not meet our inclusion criteria. We excluded three trials from the current review due to inappropriate study design. Two of these studies were randomised cross‐over trials with no data available before the first cross‐over (Dalheim 1997; Kinon (HGFW)) and another was a cohort study (Voruganti 2002). There were two studies that were terminated before the start of the trial (NCT00419653; Ortho‐McNeil 2010).
In order to consider these excluded studies for other reviews, we grouped them according to the characteristics of study population, interventions used and existing Cochrane reviews related to those comparisons (see Table 4).
3. Excluded studies' comparisons that should be considered for other reviews.
*Sorted by participant, then by interventions, then by study tag.
IM: intramuscular
Ongoing studies
There are currently no ongoing studies.
Studies awaiting assessment
There are currently no studies awaiting assessment.
Risk of bias in included studies
See also Figure 2 and Figure 3.
2.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Allocation
All 68 studies were stated to be randomised. We rated 43 included trials (63.2%) as having a low risk of bias from randomisation as they described adequate random sequence generation, while 25 studies (36.8%) did not clearly report the details of randomisation. The methods used for sequence generation were computer‐generated random numbers, block randomisation and random number tables.
Only 14 studies (20.6%) described adequate allocation concealment. We rated 54 trials (79.4%) as having an unclear risk of selection bias as they did not describe an adequate method of allocation concealment.
Blinding
Twenty‐five (37%) studies were reported as “double‐blind” and provided sufficient information to be rated as having a low risk of bias in the risk assessment tool. Another 29 (43%) trials did not report whether blinding had been performed at all, while only one study declared that outcome assessors alone were blinded (Walther 2014), and therefore we rated them as having an unclear risk of bias. We rated 14 trials (20.6%) as having a high risk of bias as they were open‐label studies. No study tested the success of blinding participants or evaluators.
Blinding of outcome assessment was adequately reported in 24 studies (35.3%) and therefore we rated it as having a low risk of bias. We rated 11 studies as having a high risk of bias (17%) as the outcome assessment in these trials was not blinded (Avasthi 2001; Barak 2002; Crespo‐Facorro 2006; Dhar 2010; HGFH (Korea) 1998; Kahn (EUFEST) 2005; Lilly 2006a; Nag 2013; Pan 2005; San 2012; Vedam 2022).
Incomplete outcome data
We rated nearly 88.2% (60/68) of the included trials as having a low risk of attrition bias, as they had no missing outcome data, a low proportion of participants left the trial early or an intention‐to‐treat (ITT) analysis was used to deal with the missing data. Eight trials had a relatively low proportion of missing data or did not report the number of withdrawals, but reported an intention‐to‐treat analysis and therefore we rated them as having either a low or unclear risk of attrition bias (Chaudhry 2003; Crespo‐Facorro 2006; de Hann 2003; HGFH (Korea) 1998; Kahn (EUFEST) 2005; Lahti 2007; Lilly 2006a; Sergi 2007). We rated five trials as having a high risk of attrition bias due to a high proportion of missing outcome data (Avasthi 2001; Ishigooka 2001; Krakowski 2006; Qin 2006a; Rosenheck (HGFI) 2003).
Selective reporting
We rated 16 included trials (23.5%) as having a low risk of selective reporting as the results were analysed in accordance with a pre‐specified analysis plan and reported data for all measured outcomes. We rated 47 trials as having an unclear risk of selective reporting as their pre‐specified research plans were not available in sufficient detail. We rated the remaining five trials as having a high risk of selective reporting for failure to report the results of several prespecified outcomes (Gründer (NeSSy) 2012; Kinon 2004; Krakowski 2006; Taraskina 2017; Wang 2012k).
Other potential sources of bias
Twenty‐two included studies were reported to be sponsored or conducted by pharmaceutical companies. Another 34 trials failed to report sources of funding. Clinical drug trials funded by pharmaceutical companies yield favourable results for the sponsor’s products more often than independent trials (Schott 2010).
We found one study that included only female and three other studies that included only male participants, therefore potential gender bias could not be excluded.
Effects of interventions
See: Table 1
See Table 1 for the main comparisons. Other comparisons can be found in Appendix 2 with corresponding data, tables and figures at https://github.com/aellosa2024/Haloperidol_Olanzapine.git. Dosing sub‐analysis can be found in Appendix 3.
Comparison 1: Haloperidol versus olanzapine: main outcomes
Global state
1.1. Global state: clinically important change (CGI, high = poor)
Priority outcome: Six studies report clinically important change in global state in the short (five trials) and medium term (one trial). Overall, we are very uncertain whether there is a difference between haloperidol and olanzapine in clinically important change in global state (RR 0.84, 95% CI 0.69 to 1.02; 3078 participants). There was a substantial level of heterogeneity amongst the results (Chi2 = 18.51; df = 5.0; P = 0.002; I² = 73%; Analysis 1.1; Table 1).
1.1. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 1: Global state: clinically important change
1.1.1 Short‐term
The evidence from five trials suggests that in the short term, haloperidol may result in little to no difference in this outcome, compared to olanzapine (RR 0.82, 95% CI 0.66 to 1.03; 3007 participants). There was a substantial level of heterogeneity amongst the results (Chi2 = 16.19; df = 4.0; P = 0.003; I2 = 75%).
1.1.2 Medium‐term
The evidence from a single trial suggests that haloperidol may result in little to no difference in this outcome in the medium term compared to olanzapine (RR 0.95, 95% CI 0.70 to 1.30; 71 participants).
1.1.3 Publication bias
We did not perform a funnel plot analysis because so few studies were identified.
1.2 Global state: relapse
Priority outcome: Seven studies reported short‐ (one trial), medium‐ (four trials) and long‐term (two trials) data on the incidence of relapse. Overall, we are very uncertain whether there is a difference between haloperidol and olanzapine in relapse (RR 1.42, 95% CI 1.00 to 2.02; 1499 participants). There was a substantial level of heterogeneity among the results (Chi² = 24.39, df = 6.0; P = 0.0004; I² = 75%; Analysis 1.2; Table 1).
1.2. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 2: Global state: relapse
1.2.1 Short‐term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of relapse compared to olanzapine (RR 2.17, 95% CI 1.48 to 3.20; 350 participants).
1.2.2 Medium‐term
Four trials reported data for this outcome. The evidence suggests that in the medium term, haloperidol may result in little to no difference in relapse compared to olanzapine (RR 1.06, 95% CI 1.00 to 1.12; 720 participants). Variation of results among studies was not important (Chi2 = 1.68; df = 3.0; P = 0.64; I2 = 0%).
1.2.3 Long‐term
Two trials reported data for this outcome. The evidence suggests that in the long term, haloperidol may result in a large increase in relapse compared to olanzapine (RR 2.04, 95% CI 1.37 to 3.03; 429 participants). Variation of results among studies was not important (Chi2 = 0.06; df = 1.0; P = 0.80; I2 = 0%).
1.2.4 Publication bias
We did not perform a funnel plot analysis because so few studies were identified.
Mental state
1.3. Mental state: overall clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score)
Priority outcome: Thirteen studies reported data on the incidence of clinically important change in overall mental state in the short term (12 trials) and the medium term (one trial). Overall, the evidence suggests that haloperidol may reduce the incidence of clinically important change in overall mental state slightly compared to olanzapine (RR 0.70, 95% CI 0.60 to 0.81; 13 studies, 1210 participants). The NNTB for this outcome was ‐8.42 (95% CI ‐13.2 to ‐6.31), which suggests that one fewer person will experience clinically important change in overall mental state for every eight treated with haloperidol instead of olanzapine. The certainty of the evidence for this outcome is low; however, variation of results across studies was not important (Chi² = 8.69; df = 12; P = 0.73; I² = 0%). (See Analysis 1.3; Table 1).
1.3. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 3: Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score)
1.3.1 Short‐term
The evidence from 12 trials suggests that in the short term, haloperidol may reduce the incidence of clinically important change in mental state slightly compared to olanzapine (RR 0.76, 95% CI 0.64 to 0.91; 1008 participants). Variation of results among studies was not important (Chi2 = 4.98; df = 11.0; P = 0.93; I2 = 0%).
1.3.2 Medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may reduce the incidence of clinically important change in mental state compared to olanzapine (RR 0.55, 95% CI 0.41 to 0.73; 202 participants).
1.3.3 Publication bias
The studies reporting data for this outcome are mainly of similar sample size, therefore we did not perform funnel plot analysis.
1.4 Mental state: Overall ‐ average endpoint score (PANSS, BPRS total scores, SMD, high = poor)
Forty studies reported average endpoint PANSS and BPRS total scores in the short (26 trials), medium (13 trials) and long term (one trial). Overall, in the short, medium and long term, haloperidol may result in slightly higher average endpoint PANSS and BPRS scores compared to olanzapine (SMD 0.41, 95% CI 0.29 to 0.53; 5459 participants). There was a substantial level of heterogeneity among studies (Chi² = 153.07; df = 41; P < 0.00001; I² = 73%; Analysis 1.4).
1.4. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 4: Mental state: overall ‐ average endpoint score (PANSS, BPRS total scores, SMD, high = poor)
1.4.1 Short‐term (PANSS, BPRS total scores, high = poor)
The evidence from 26 trials suggests that in the short term, haloperidol may result in slightly higher average endpoint PANSS and BPRS scores compared to olanzapine (SMD 0.34, 95% CI 0.21 to 0.47; 4144 participants). There was a substantial level of heterogeneity among studies (Chi2 = 77.06; df = 27; P < 0.00001; I2 = 65%).
1.4.2 Medium‐term (PANSS, BPRS total scores)
The evidence from 13 trials suggests that in the medium term, haloperidol may result in slightly higher average endpoint PANSS and BPRS scores compared to olanzapine (SMD 0.57, 95% CI 0.28 to 0.86; 1271 participants). There was a substantial level of heterogeneity among studies (Chi² = 71.61; df = 12; P < 0.00001; I² = 83%).
1.4.3 Long‐term (PANSS total scores only)
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (SMD 0.38, 95% CI ‐0.22 to 0.97; 44 participants).
Adverse effects/events
(See Analysis 1.5 and Analysis 1.6 for priority outcomes in adverse effects).
1.5. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 5: Adverse effects/events: specific ‐ extrapyramidal ‐ any effect
1.6. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 6: Adverse effects/events: specific ‐ metabolic ‐ weight increase
Specific adverse events/effects
1.5 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect
Priority outcome: Fourteen studies reported the incidence of extrapyramidal side effects, 11 in the short term and three in the medium term. Overall, haloperidol may result in a large increase in the incidence of extrapyramidal symptoms when compared to olanzapine (RR 3.38, 95% CI 2.28 to 5.02; 3920 participants). For this outcome, the NNTH was 3.18 (95% CI 1.89 to 5.91), which suggests that, on average, one additional person would experience extrapyramidal side effects for every three people treated with haloperidol instead of olanzapine. The certainty of the evidence for this outcome is low and there was a substantial level of heterogeneity amongst studies (Chi² = 47.25; df = 13; P < 0.00001; I² = 72%; Analysis 1.5; Table 1).
1.5.1 Short‐term
The evidence from 11 trials suggests that in the short term, haloperidol may result in large increase in the incidence of extrapyramidal side effects compared to olanzapine (RR 4.02, 95% CI 2.58 to 6.24; 3530 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 39.03; df = 10; P < 0.0001; I² = 74%).
1.5.2 Medium‐term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.75, 95% CI 0.54 to 5.73; 390 participants). There was a substantial level of heterogeneity amongst studies (Chi2 = 7.33; df = 2.0; P = 0.03; I2 = 73%).
1.5.3 Publication bias
A reasonable funnel plot analysis was possible for this outcome (more than 10 studies included). The funnel plot does not indicate possible publication bias.
1.6 Adverse effects/events: specific ‐ metabolic ‐ weight increase
Priority outcome: Eighteen studies reported data on the incidence of clinically important weight increase in the short (14 trials), medium (two trials) and long term (two trials). Overall, the evidence suggests that haloperidol likely results in a large reduction in the incidence of weight increase compared to olanzapine (RR 0.47, 95% CI 0.35 to 0.61; 4302 participants). The NNTH was ‐10.22 (95% CI ‐13.88 to ‐8.33), which suggests that, on average, for every 10 patients treated with haloperidol instead of olanzapine, one fewer patient would experience clinically important weight increase. There was a low certainty of evidence and moderate level of heterogeneity for this outcome (Chi2 = 39.92; df = 17.0; P = 0.001; I2 = 57%; Analysis 1.6; Table 1).
1.6.1 Short‐term
The evidence from 13 trials suggests that in the short term, haloperidol likely results in a reduction in the incidence of weight gain compared to olanzapine (RR 0.46, 95% CI 0.32 to 0.66; 3547 participants). For this outcome, heterogeneity was substantial (Chi2 = 33.41; df = 13.0; P = 0.001; I2 = 61%).
1.6.2 Medium‐term
The evidence from two trials suggests that in the medium term, haloperidol likely results in a reduction in the incidence of weight gain compared to olanzapine (RR 0.59, 95% CI 0.46 to 0.75; 388 participants). For this outcome, the variation of results among studies was not important (Chi² = 0.44, df = 1; P = 0.51; I² = 0%).
1.6.3 Long‐term
The evidence from two trials suggests that in the long term, haloperidol likely results in a reduction in the incidence of weight gain compared to olanzapine (RR 0.15, 95% CI 0.05 to 0.47; 367 participants). For this outcome, the variation of results among studies was not important (Chi² = 0.00; df = 1; P = 0.96; I² = 0%).
1.6.4 Publication bias
A reasonable funnel plot analysis was possible for this outcome (more than 10 included studies). The funnel plot indicates possible publication bias (Figure 4).
4.
Funnel plot of comparison: 1 Comparison haloperidol vs olanzapine, outcome: 1.6 Adverse effects/events: specific ‐ metabolic ‐ weight increase.
Quality of life
1.7 Quality of life: clinically important change in quality of life (≥ 20% increase in QLS endpoint score, high = good)
We identified a single trial reporting short‐ and long‐term data for this outcome (Analysis 1.7).
1.7. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 7: Quality of life: clinically important change in quality of life (≥ 20% increase in QLS endpoint score)
1.7.1 Short‐term ‐ six weeks
Priority outcome: The evidence from a single trial suggests that in the short term, haloperidol may reduce the incidence of clinically important change in quality of life compared to olanzapine (RR 0.72, 95% CI 0.57 to 0.91; 1 study, 828 participants). The NNTB for this outcome is ‐9.40 (95% CI ‐29.23 to ‐6.11), which suggests that, on average, for every nine people treated with haloperidol instead of olanzapine, one fewer person would experience clinically important change in quality of life. The certainty of the evidence for this outcome is low (Table 1).
1.7.2 Long‐term ‐ 12 months
The evidence from a single trial suggests that in the long term, haloperidol may result in a slight decrease in the incidence of clinically important change in quality of life compared to olanzapine (RR 0.79, 95% CI 0.63 to 1.00; 1 study, 539 participants).
1.7.3 Publication bias
We did not perform a funnel plot analysis because so few studies were identified.
Note: We did not find any usable data for the following outcomes related to quality of life:
Average change score in quality of life
1.8 Quality of life: overall ‐ average endpoint total score (various scales, SMD, high = good)
Eleven studies reported average endpoint total score for quality of life using various scales in the short (eight trials) and medium term (three trials). Overall, haloperidol may result in a slightly lower improvement in quality of life compared to olanzapine (SMD ‐0.38, 95% CI ‐0.66 to ‐0.09; 1213 participants; Analysis 1.8). There is a substantial level of heterogeneity amongst studies (Chi² = 55.81; df = 10; P < 0.00001; I² = 82%)
1.8. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 8: Quality of life: overall ‐ average endpoint total score (various scales, SMD, high = good)
1.8.1 Short‐term ‐ GQOL T, Q‐LES‐Q, QLS, SF‐36 scales
The evidence from eight trials suggests that in the short term, haloperidol may result in a lower improvement in quality of life compared to olanzapine (SMD ‐0.50, 95% CI ‐0.87 to ‐0.12; 746 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 39.77; df = 7; P < 0.00001; I² = 82%).
1.8.2 Medium‐term ‐ MANSA, QoL, S‐QoL scales (high = good)
The evidence from eight trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (SMD ‐0.07, 95% CI ‐0.40 to 0.25; 467 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 5.74; df = 2; P = 0.06; I² = 65%).
Leaving the study early
1.9 Leaving the study early: adverse effects
Priority outcome: Twenty‐one studies reported the incidence of leaving the study early due to adverse effects in the short (12 trials), medium (six trials) and long term (three trials). Overall, haloperidol may result in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47; 5047 participants). The NNTH for this outcome was 22.40 (15.08 to 36.95), which suggests that one additional person would leave the study early due to adverse effects for every 22 patients treated with haloperidol instead of olanzapine. The certainty of the evidence for this outcome is low and variation of results among studies was not important (Chi² = 12.11; df = 20; P = 0.91; I2 = 0%). (See Analysis 1.9; Table 1).
1.9. Analysis.
Comparison 1: Comparison haloperidol vs olanzapine: main outcomes, Outcome 9: Leaving the study early: adverse effects
1.9.1 Short‐term
The evidence from 12 trials suggests that in the short term, haloperidol results in a large increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 2.00, 95% CI 1.49 to 2.68; 3527 participants). Variation of results among studies was not important (Chi² = 8.85; df = 11; P = 0.64; I² = 0%).
1.9.2 Medium‐term
The evidence from six trials suggests that in the medium term, haloperidol may result in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.95, 95% CI 1.25 to 3.03; 1109 participants). Variation among studies was not important (Chi² = 1.92; df = 5; P = 0.86; I² = 0%).
1.9.3 Long‐term
The evidence from three trials suggests that in the long term, haloperidol results in a large increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 2.01, 95% CI 1.24 to 3.27; 411 participants). Variation among studies was not important (Chi² = 1.32; df = 2; P = 0.52; I² = 0%).
1.9.4 Publication bias
A reasonable funnel plot analysis was possible for this outcome (more than 10 studies included). The funnel plot suggests possible publication bias (Figure 5).
5.
Funnel plot of comparison: 1 Comparison haloperidol vs olanzapine, outcome: 1.9 Leaving the study early: adverse effects.
Comparison 2: Haloperidol versus olanzapine: sensitivity analyses
2.1 Global state: clinically important change: sensitivity analysis (inadequately randomised, high attrition rate data excluded)
2.1.1 Short‐term
We excluded Lilly 2006a from the evaluation of the clinically important change in global state due to high risk of bias and incomplete outcome data. Sensitivity analyses did not reveal markedly different results. The evidence suggests that haloperidol may result in little to no difference compared to olanzapine in this comparison (RR 0.82, 95% CI 0.66 to 1.03; 5 studies, 3007 participants; short‐term data). There was a substantial level of heterogeneity amongst studies (Chi2 = 16.19; df = 4.0; P = 0.003; I2 = 75%; Analysis 2.1).
2.1. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 1: Global state: clinically important change; sensitivity analysis (inadequate randomised, high attrition rate data excluded)
2.2 Global state: clinically important change: sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate clinically important change in global state. Sensitivity analysis did reveal markedly different results. The evidence suggests that haloperidol may reduce the incidence of clinically important change in global state slightly compared to olanzapine (RR 0.76, 95% CI 0.69 to 0.83; 6 studies, 3078 participants). There was a substantial level of heterogeneity amongst studies (Chi2 = 18.51; df = 5.0; P = 0.002; I2 = 73%; Analysis 2.2).
2.2. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 2: Global state: clinically important change; sensitivity analysis (fixed‐effect model applied)
2.2.1 Short‐term
The evidence from five trials suggests that in the short term, haloperidol may reduce the incidence of clinically important change in global state slightly compared to olanzapine (RR 0.74, 95% CI 0.67 to 0.81; 3007 participants). There was a substantial level of heterogeneity amongst studies (Chi2 = 16.19; df = 4.0; P = 0.003; I2 = 75%).
2.2.2 Medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.95, 95% CI 0.70 to 1.30; 71 participants).
2.3 Global state: relapse: sensitivity analysis (inadequately randomised, high attrition rate data excluded)
We excluded Lilly (HGGN) 2000 and Lilly 2006a from the evaluation of relapse due to high risk of bias and incomplete outcome data. Sensitivity analysis did not reveal markedly different results. Overall, haloperidol may result in a slight increase in relapse compared to olanzapine (RR 1.34, 95% CI 0.91 to 1.99; 5 studies, 1227 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 21.23; df = 4.0; P = 0.0003; I² = 81%; Analysis 2.3).
2.3. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 3: Global state: relapse: sensitivity analysis (inadequate randomised, high attrition rate data excluded)
2.3.1 Short‐term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase of relapse compared to olanzapine (RR 2.17, 95% CI 1.48 to 3.20; 350 participants).
2.3.2 Medium‐term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine (RR 1.06, 95% CI 1.00 to 1.12; 649 participants). Variation among studies was not important (Chi² = 1.44; df = 2; P = 0.49; I² = 0%).
2.3.3 Long‐term
The evidence from a single trial suggests that in the long term, haloperidol may result in a large increase in the incidence of relapse compared to olanzapine (RR 2.12, 95% CI 1.28 to 3.51; 228 participants).
2.4 Global state: relapse: sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate relapse. Sensitivity analysis did reveal markedly different results. Overall, the evidence suggests that haloperidol may increase the incidence of relapse compared to olanzapine (RR 1.09, 95% CI 1.03 to 1.16; 7 studies, 1499 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 24.39; df = 6; P = 0.0004; I² = 75%; Analysis 2.4).
2.4. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 4: Global state: relapse: sensitivity analysis (fixed‐effect model applied)
2.4.1 Short‐term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of relapse compared to olanzapine (RR 2.17, 95% CI 1.48 to 3.20; 350 participants).
2.4.2 Medium‐term
The evidence from four trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine (RR 1.06, 95% CI 1.00 to 1.12; 720 participants). Variation among studies was not important (Chi² = 1.68; df = 3; P = 0.64; I² = 0%).
2.4.3 Long‐term
The evidence from two trials suggests that in the long term, haloperidol may result in a large increase in the incidence of relapse compared to olanzapine (RR 2.04, 95% CI 1.37 to 3.03; 429 participants). Variation among studies was not important (Chi² = 0.06, df = 1; P = 0.80; I² = 0%).
2.5 Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (inadequately randomised, high attrition rate data excluded)
We excluded Ding 2013, Jiang 2009b, Luo 2012d and Qin 2006a from the evaluation of clinically important change in overall mental state due to high risk of bias and incomplete outcome data. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may result in a slight decrease in the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.71, 95% CI 0.60 to 0.84; 9 studies, 861 participants). Variation among studies was not important (Chi² = 6.35; df = 8; P = 0.61; I² = 0%; Analysis 2.5).
2.5. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 5: Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (inadequate randomised, high attrition rate data excluded)
2.5.1 Short‐term
The evidence from eight trials suggests that in the short term, haloperidol may result in a slight reduction in the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.80, 95% CI 0.66 to 0.98; 659 participants). Variation among studies was not important (Chi² = 1.81; df = 7; P = 0.97; I² = 0%).
2.5.2 Medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large reduction in the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.55, 95% CI 0.41 to 0.73; 202 participants).
2.6 Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate clinically important change in overall mental state. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may reduce the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.70, 95% CI 0.60 to 0.81; 13 studies, 1210 participants). Variation among studies was not important (Chi² = 8.69; df = 12; P = 0.73; I² = 0%; Analysis 2.6).
2.6. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 6: Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (fixed‐effect model applied)
2.6.1 Short‐term
The evidence from 12 trials suggests that in the short term, haloperidol may reduce the incidence of clinically important change in overall mental state when compared to olanzapine (RR 0.76, 95% CI 0.64 to 0.91; 1008 participants). Variation among studies was not important (Chi² = 4.98; df = 11; P = 0.93; I² = 0%).
2.6.2 Medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large reduction in the incidence of clinically important change in overall mental state when compared to olanzapine (RR 0.55, 95% CI 0.41 to 0.73; 202 participants).
2.7 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (inadequately randomised, high attrition rate data excluded)
We excluded Crespo‐Facorro 2006, Hu 2014i, Lilly 2006a, Pan 2005, Taraskina 2017 and Xianzhen 2004 from the evaluation of extrapyramidal side effects due to high risk of bias and incomplete outcome data. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may result in a large increase in the incidence of extrapyramidal side effects compared to olanzapine (RR 2.98, 95% CI 2.04 to 4.37; 3440 participants). Variation among studies was not important (Chi² = 10.41; df = 7; P = 0.17; I² = 33%; Analysis 2.7).
2.7. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 7: Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (inadequate randomised, high attrition rate data excluded)
2.7.1 Short‐term
The evidence from seven trials suggests that in the short term, haloperidol may result in large increase in the incidence of extrapyramidal side effects compared to olanzapine (RR 3.38, 95% CI 2.16 to 5.31; 3166 participants). Variation between studies was not important (Chi² = 9.73; df = 6; P = 0.14; I² = 38%).
2.7.2 Medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may increase the incidence of extrapyramidal side effects compared to olanzapine (RR 1.67, 95% CI 0.67 to 4.17; 274 participants).
2.8 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate extrapyramidal adverse effects. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may result in a large increase in the incidence of extrapyramidal side effects compared to olanzapine (RR 2.39, 95% CI 2.13 to 2.69; 14 studies, 3920 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 47.25; df = 13.0; P < 0.00001; I² = 72%; Analysis 2.8).
2.8. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 8: Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (fixed‐effect model applied)
2.8.1 Short‐term
The evidence from 11 trials suggests that in the short term, haloperidol may result in large increase in the incidence of extrapyramidal side effects compared to olanzapine (RR 2.42, 95% CI 2.15 to 2.73; 3530 participants). There was a substantial level of heterogeneity amongst studies (Chi² = 39.03; df = 10; P < 0.0001; I² = 74%).
2.8.2 Medium‐term
The evidence from three trials suggests that in the medium term, haloperidol may increase the incidence of extrapyramidal side effects compared to olanzapine (RR 1.79, 95% CI 0.98 to 3.30; 390 participants). There was a substantial level of heterogeneity amongst studies (Chi2 = 7.33; df = 2.0; P = 0.03; I2 = 73%).
2.9 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (inadequately randomised trials excluded)
We excluded Avasthi 2001, Ding 2013 and Lilly (HGGN) 2000 from the evaluation of weight increase as a metabolic adverse effect due to a high risk of inadequate randomisation. Sensitivity analysis did not reveal markedly different results. Overall, haloperidol may result in a large reduction in the incidence of weight increase compared to olanzapine (RR 0.46, 95% CI 0.35 to 0.60; 14 studies, 3863 participants). There was a moderate level of heterogeneity amongst studies (Chi2 = 25.98; df = 13.0; P = 0.02; I2 = 50%; Analysis 2.9).
2.9. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 9: Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (inadequate randomised trials excluded)
2.9.1 Increase ‐ short‐term
The evidence from 11 trials suggests that in the short term, haloperidol may result in a large reduction in the incidence of weight increase compared to olanzapine (RR 0.42, 95% CI 0.29 to 0.60; 11 studies, 3364 participants). There was a moderate level of heterogeneity amongst studies (Chi2 = 21.57; df = 10.0; P = 0.02; I2 = 54%).
2.9.2 Increase ‐ medium‐term
The evidence from two trials suggests that in the medium term, haloperidol may reduce the incidence of weight increase compared to olanzapine (RR 0.59, 95% CI 0.46 to 0.75; 2 studies, 388 participants). Variation between studies was not important (Chi² = 0.44; df = 1; P = 0.51; I² = 0%).
2.9.3 Increase ‐ long‐term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.14, 95% CI 0.02 to 1.10; 1 study, 111 participants).
2.10 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (high attrition rate data excluded)
We excluded Avasthi 2001, Chaudhry 2003 and Kahn (EUFEST) 2005 from the evaluation of weight increase as a metabolic adverse effect due to incomplete outcome data. Sensitivity analysis did not reveal markedly different results. Overall, haloperidol may result in a large reduction in the incidence of weight increase compared to olanzapine (RR 0.40, 95% CI 0.28 to 0.57; 15 studies, 3939 participants). There was a moderate level of heterogeneity amongst studies (Chi2 = 29.81; df = 14.0; P = 0.008; I2 = 53%; Analysis 2.10).
2.10. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 10: Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (high attrition rate data excluded)
2.10.1 Increase ‐ short‐term
The evidence from 12 trials suggests that in the short term, haloperidol may result in large reduction in the incidence of weight increase compared to olanzapine (RR 0.41, 95% CI 0.27 to 0.63; 3310 participants). There was a moderate level of heterogeneity amongst studies (Chi2 = 25.63; df = 11.0; P = 0.007; I2 = 57%).
2.10.2 Increase ‐ medium‐term
The evidence from a single trial suggests that in the medium term, haloperidol may reduce the incidence of weight increase compared to olanzapine (RR 0.52, 95% CI 0.34 to 0.81; 1 study, 262 participants).
2.10.3 Increase ‐ long‐term
The evidence from two trials suggests that in the long term, haloperidol may result in large reduction in the incidence of weight increase compared to olanzapine (RR 0.15, 95% CI 0.05 to 0.47; 367 participants). Variation between studies was not important (Chi² = 0.00; df = 1; P = 0.96; I² = 0%).
2.11 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate increase in weight as a metabolic adverse effect. Sensitivity analysis did not reveal markedly different results. Overall, haloperidol may reduce the incidence of weight increase compared to olanzapine (RR 0.51, 95% CI 0.44 to 0.59; 18 studies, 4302 participants). There was a moderate level of heterogeneity amongst studies (Chi2 = 39.92; df = 17.0; P = 0.001; I2 = 57%; Analysis 2.11).
2.11. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 11: Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (fixed‐effect model applied)
2.11.1 Increase ‐ short‐term
The evidence from 14 trials suggests that in the short term, haloperidol may result in large reduction in the incidence of weight increase compared to olanzapine (RR 0.49, 95% CI 0.40 to 0.58; 3547 participants). There was a substantial level of heterogeneity amongst studies (Chi2 = 33.41; df = 13.0; P = 0.001; I2 = 61%).
2.11.2 Increase ‐ medium‐term
The evidence from two trials suggests that in the medium term, haloperidol may reduce the incidence of weight increase compared to olanzapine (RR 0.59, 95% CI 0.46 to 0.75; 388 participants). Variation between studies was not important (Chi² = 0.44; df = 1; P = 0.51; I² = 0%).
2.11.3 Increase ‐ long‐term
The evidence from two trials suggests that in the long term, haloperidol may result in large reduction in the incidence of weight increase compared to olanzapine (RR 0.15, 95% CI 0.05 to 0.47; 367 participants). Variation between studies was not important (Chi² = 0.00; df = 1; P = 0.96; I² = 0%).
2.12 Leaving the study early: adverse effects: sensitivity analysis (inadequately randomised trials excluded)
We excluded Avasthi 2001, Lilly (HGGN) 2000, Lilly 2006a and Wang 2012k from the evaluation of study discontinuation due to adverse effects as they were rated as being at high risk of bias due to inadequate randomisation. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may increase the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.96, 95% CI 1.55 to 2.48; 16 studies, 4301 participants). Variation between studies was not important (Chi² = 7.96; df = 15; P = 0.93; I² = 0%; Analysis 2.12).
2.12. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 12: Leaving the study early: adverse effects: sensitivity analysis (inadequate randomised trials excluded)
2.12.1 Short‐term
The evidence from nine trials suggests that in the short term, haloperidol may increase the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.88, 95% CI 1.39 to 2.54; 3108 participants). Variation between studies was not important (Chi² = 5.60; df = 8; P = 0.69; I² = 0%).
2.12.2 Medium‐term
The evidence from five trials suggests that in the medium term, haloperidol may increase the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.90, 95% CI 1.21 to 2.97; 1038 participants). Variation between studies was not important (Chi² = 1.43; df = 4; P = 0.84; I² = 0%).
2.12.3 Long‐term
The evidence from two trials suggests that in the long term, haloperidol may result in a large increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 2.66, 95% CI 1.33 to 5.33; 155 participants). Variation between studies was not important (Chi² = 0.08; df = 1; P = 0.78; I² = 0%).
2.13 Leaving the study early: adverse effects: sensitivity analysis (fixed‐effect model applied)
We applied a fixed‐effect approach instead of a random‐effects model to evaluate study discontinuation due to adverse effects. Sensitivity analysis did not reveal markedly different results. Overall, the evidence suggests that haloperidol may increase the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47; 21 studies, 5047 participants). Variation between studies was not important (Chi² = 12.11; df = 20; P = 0.91; I² = 0%; Analysis 2.13).
2.13. Analysis.
Comparison 2: Comparison haloperidol vs olanzapine: sensitivity analyses, Outcome 13: Leaving the study early: adverse effects: sensitivity analysis (fixed‐effect model applied)
2.13.1 Short‐term
The evidence from 12 trials suggests that in the short term, haloperidol may result in a large increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 2.00, 95% CI 1.49 to 2.68; 3527 participants). Variation between studies was not important (Chi² = 8.85; df = 11; P = 0.64; I² = 0%).
2.13.2 Medium‐term
The evidence from six trials suggests that in the medium term, haloperidol may increase the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.95, 95% CI 1.25 to 3.03; 1109 participants). Variation between studies was not important (Chi² = 1.92; df = 5; P = 0.86; I² = 0%).
2.13.3 Long‐term
The evidence from three trials suggests that in the long term, haloperidol may result in a large increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 2.01, 95% CI 1.24 to 3.27; 411 participants). Variation between studies was not important (Chi² = 1.32; df = 2; P = 0.52; I² = 0%).
Discussion
Summary of main results
Global state: clinically important change
Six studies reported clinically important change in global state in the short (five trials) and medium term (one trial). Overall, nearly half of the participants benefited from either medication in terms of clinically important change in global state (i.e. 47.3% of those assigned to olanzapine versus 39.7% of those assigned to haloperidol). With these results we are very uncertain whether there is a difference between haloperidol and olanzapine in clinically important change in global state (RR 0.84, 95% CI 0.69 to 1.02; 3078 participants) and there is substantial variation amongst results (Chi2 = 18.51; df = 5.0; P = 0.002; I² = 73%; Analysis 1.1; Table 1).
Global state: relapse
Seven studies reported short‐ (one trial), medium‐ (four trials) and long‐term (two trials) data on the incidence of relapse. Overall, close to half (46.3%) of those assigned to haloperidol and a third (32.6%) of those assigned to olanzapine relapsed. With these results we are very uncertain whether there is a difference between haloperidol and olanzapine in relapse (RR 1.42, 95% CI 1.00 to 2.02; 1499 participants) and there is substantial variation amongst the results (Chi² = 24.39; df = 6.0; P = 0.0004; I² = 75%; Analysis 1.2; Table 1).
The results, however, are nuanced and influenced by time frame. A single trial with short‐term data (RR 2.17, 95% CI 1.48 to 3.20; 350 participants) and two trials with long‐term data (RR 2.04, 95% CI 1.37 to 3.03; 429 participants) suggest that haloperidol may lead to a higher incidence of relapse than olanzapine. On the other hand, according to medium‐term data, haloperidol may result in little to no difference in relapse compared to olanzapine (RR 1.06, 95% CI 1.00 to 1.12; 720 participants).
Mental state: clinically important change in overall mental state (> 50% reduction in PANSS score)
Thirteen studies reported data on the incidence of clinically important change in overall mental state using a criterion of greater than 50% reduction in PANSS score; 12 trials reported results at short‐term and one at medium‐term follow‐up. Overall, the evidence suggests that just over a quarter (27.7%) of participants assigned to haloperidol, and over one‐third (39.6%) of those assigned to olanzapine showed clinically important improvement in mental state. Overall results suggest that haloperidol may reduce the incidence of clinically important change in overall mental state slightly compared to olanzapine (RR 0.70, 95% CI 0.60 to 0.81; 1210 participants). In other words, those on olanzapine may see improvement in their mental state more often. For every eight people treated with haloperidol instead of olanzapine, one fewer person would experience this improvement (NNTB ‐8.42, 95% CI ‐13.2 to ‐6.31). The certainty of the evidence for this outcome is low; however, the variation in results across studies is not important (I² = 0%; Analysis 1.3; Table 1).
Consistent with these findings, when combining average PANSS and BPRS endpoint scores (40 trials, with 26 in the short, 13 in the medium and one in the long term), the evidence suggests that haloperidol may result in slightly higher average endpoint scores compared to olanzapine (SMD 0.41, 95% CI 0.29 to 0.53; 5459 participants; Analysis 1.4).
Adverse effects/events: specific ‐ extrapyramidal ‐ any effect
Of the 14 studies reporting on specific extrapyramidal adverse events, 11 were in the short term and three in the medium term. Extrapyramidal side effects were recorded in nearly half (44.6%) of those assigned to haloperidol and a small minority (13.2%) of those assigned to olanzapine. Overall, the evidence suggests that haloperidol may result in a large increase in this side effect compared to olanzapine (RR 3.38, 95% CI 2.28 to 5.02; 3920 participants). For every three people treated with haloperidol instead of olanzapine, one additional person would experience extrapyramidal side effects (NNTH 3.18, 95% CI 1.89 to 5.91). The certainty of the evidence is low and there is substantial variation amongst the results (Chi² = 47.25; df = 13.0; P < 0.00001; I² = 72%; Analysis 1.5; Table 1).
Adverse effects/events: specific ‐ metabolic ‐ weight increase
Eighteen studies report data for the incidence of clinically important weight increase in the short (14 trials), medium (two trials) and long term (two trials). Meaningful weight increase was reported for 8.7% of those assigned to haloperidol and 18.5% of those assigned to olanzapine. Overall, the evidence suggests that there may be a large reduction in the risk of weight gain with haloperidol compared to olanzapine (RR 0.47, 95% CI 0.35 to 0.61; 4302 participants). In other words, those on olanzapine were more likely to gain weight. For every 10 people treated with haloperidol instead of olanzapine, one fewer person would experience weight increase (NNTH ‐10.22, 95% CI ‐13.89 to ‐8.33). The certainty of the evidence was low and there is moderate variation amongst results (Chi² = 39.92; df = 17.0; P = 0.001; I² = 57%; Analysis 1.6; Table 1). A reasonable funnel plot analysis was possible for this outcome (more than 10 included studies). The funnel plot indicates possible publication bias (Figure 4).
Quality of life: clinically important change in quality of life (≥ 20% increase in endpoint QLS score)
The evidence from a single short‐term trial reporting clinically important change in quality of life suggests that haloperidol may reduce the incidence of improvement compared to olanzapine (RR 0.72, 95% CI 0.57 to 0.91). In other words, a greater proportion of people taking olanzapine (38%) had a clinically important improvement in quality of life compared to those taking haloperidol (27.4%). For every nine people treated with haloperidol instead of olanzapine, one fewer person would experience clinically important improvement in quality of life (NNTB ‐9.40, 95% CI ‐29.23 to ‐6.11). The certainty of the evidence for this outcome is low (Analysis 1.7; Table 1). Results similarly showed a small advantage for olanzapine when combining results from continuous outcomes for average endpoint total score of various scales (SMD ‐0.38, 95% CI ‐0.66 to ‐0.09; 11 studies, 1213 participants; Analysis 1.8).
Leaving the study early: adverse effects
Twenty‐one studies report leaving the study early due to adverse effects, 12 in the short term, six in the medium term and three in the long term. In general, leaving the study early due to adverse effects was uncommon, with 9% of those assigned to haloperidol and 4.5% of those assigned to olanzapine experiencing this outcome. Overall, the evidence suggests that haloperidol may result in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47; 5047 participants). For every 22 people treated with haloperidol instead of olanzapine, one fewer person would experience this outcome (NNTH 22.40, 95% CI 15.08 to 36.95). The certainty of the evidence for this outcome is low and variation of results across studies was not important (I² = 0%). Results were similar for short‐, medium‐ and long‐term studies (Analysis 1.9; Table 1).
1. Completeness
Somewhat surprisingly for such important studies, there was a lack of data in the included studies on global state, functioning, service use and satisfaction of participants. In addition, there was often chaos in how outcomes were reported. For example, 11 studies measured quality of life in the short and medium term using different scales and criteria. Then, there are notable omissions. We did not find any study with usable data on economic outcomes and, to our knowledge, only four studies looking at these medications over the long term have been carried out.
An explanation of scale‐derived outcomes was also lacking, limiting the ability of the reader to comprehend the practical impact of these outcomes on the study participant. For example, studies may have measured ‘≥ 20% reduction in PANSS endpoint score’ but then failed to explain to the reader how this would clinically impact the average person experiencing such a change.
2. Applicability
The review includes 68 studies carried out in various settings (e.g. in and outpatients), with different study populations (e.g. participants with an acute episode of schizophrenia, first‐episode schizophrenia, drug‐naive, stable schizophrenia) and duration (e.g. short, medium and long term). Stratification of results by duration was possible as this is typically clearly defined in studies, but this was not the case for clinical state of participants, as most studies either did not clearly define this or did not stratify their results by these categories. This conflation could mask some important distinctions in outcomes. The range of doses of haloperidol used in the included trials is typically higher than current international best practice guidelines and does not follow in line with studies on equivalence, whereas the mean doses of olanzapine are in line with recommendations. This may have led to a higher risk of extrapyramidal effects for study participants on haloperidol and an associated greater risk of leaving studies earlier.
Most studies were carried out in stable, higher‐income settings under controlled conditions and so may be less applicable to crisis‐affected and low‐income settings, where access to specialised clinical mental health care and stable supplies is very often less available. For example, best practice for assessing and following up the metabolic impact of atypical antipsychotics such as olanzapine includes monitoring with specialised blood testing (i.e. HbA1c), which is frequently unavailable in humanitarian and low‐income settings. The clinical and methodological diversity in existing trials does, however, improve applicability with the proviso that there is a lack of studies in low‐income and humanitarian contexts.
Quality of the evidence
We assessed the quality of the trials using the risk of bias guidance (Higgins 2011b) and tabulated the results as best we could within RevMan Web. Overall, the quality of the 68 included studies was very low to moderate.
All included studies were reported to be randomised, however only 43 (63%) reported adequate randomisation and allocation concealment. The studies were largely conducted decades after the original CONSORT statement of 1996 and there can be little reason not to provide a full description of this key part of methodology. Although most studies were reported to be double‐blind, related procedures were clearly described in only 25 trials (37%). The majority of included studies had low proportions of participants leaving the trial early. Trials from China had almost no attrition. This could reflect a different care/trial culture, but that should not mean that these findings are not applicable. Fifty‐two of the included studies were rated as unclear or high risk of bias for selective reporting. This was mainly due to failure to report the results of several pre‐specified outcomes.
There were innumerable other difficulties with outcome reporting, for example:
use of different scales for similar outcomes;
use of many ways of measuring weight;
poor or non‐reporting of variance of continuous outcomes; and/or
differing time points of reporting.
Had there been consistency of measurement and high‐quality reporting of outcomes, there would have been more data to report and the consent given by those entering the studies would have been better honoured.
Potential biases in the review process
The authors of this review made every effort to minimise bias in the review process by ensuring the protocol was peer‐reviewed and then published in its own right, collaborating with Cochrane Schizophrenia to obtain the most comprehensive list of studies possible and through strict adherence to the Cochrane Handbook.
Nonetheless, our search (as any search) could have been prone to bias, such as publication or reporting bias. We attempted to minimise this by contacting authors for whom we had limited results to request unpublished data and reports. This effort was successful in only two cases.
Twenty‐six of the included trials were in Chinese and their data were extracted and assessed for bias by a native Mandarin‐speaking review author. We view the inclusion of these studies as a strength. By the inclusion of these data, the diversity of contexts and populations is increased. It should be noted, however, that despite improvements in reporting (newer trials are more likely to follow CONSORT recommendations), several methodological studies have raised concerns about the quality of the vast number of studies on antipsychotic drugs emerging from mainland China (Tong 2018; Wu 2009). Inclusion of the data from China in this review serves to narrow confidence intervals of the effect estimates. There is no substantive difference between the findings emerging from China and the rest of the world.
Of the 68 studies included in this review, 22 were reported to have been sponsored or conducted by a pharmaceutical company, and 35 did not report a funding source. It is well known that industry‐sponsored studies tend to favour their second‐generation antipsychotics over the first‐generation comparator (Melander 2003; Montgomery 2004; Turner 2012). Despite this real threat, there is the clear impression from this review that both drugs are effective antipsychotics, and both have their problematic adverse effects. Olanzapine does not shine out over haloperidol despite the potential bias generated by pecuniary interest in the results of the original trialists. It is possible that the effects we have found for olanzapine are exaggerated by the biases of the original trials and that this second‐generation drug is not as valuable as is highlighted in this review. We think that unlikely. We are not naive to the potential biases of drug company‐supported work – but countering that are the reporting requirements contingent on industry, the many staff in drug companies who do wish to conduct and report fair trials, and the systematic methods of the reviewing process we have tried to apply.
Agreements and disagreements with other studies or reviews
This review updates an earlier Cochrane review (Duggan 2005), albeit one that was much broader in its scope. One key comparison within Duggan 2005 was the same as this review. In this current update of the haloperidol versus olanzapine comparison, we have used more sophisticated methods, checked and re‐checked data extraction, included many more studies, added a summary of findings table and undertaken risk of bias assessment much more carefully, as had not been envisioned in 2005. Generally, however, the findings of the current review are consistent with those of Duggan 2005.
Other reviews have examined haloperidol and olanzapine, along with comparisons of other antipsychotic drugs, and have broadly had the same findings. The most recent reviews at time of writing are Schneider‐Thoma 2022 and Ostuzzi 2022b. In both these reviews, olanzapine was found to perform better in relapse prevention than haloperidol. In comparison, in this review we are very uncertain whether there is a difference between the two drugs (Analysis 1.2; Table 1), however when trials were analysed by time frame, the short‐ and long‐term studies suggest that haloperidol may lead to a higher incidence of relapse than olanzapine (Analysis 1.2). Ostuzzi 2022b showed olanzapine to be more tolerable than haloperidol. Both found a higher risk of weight gain for olanzapine and a higher risk of extrapyramidal effects or use of antiparkinsonian medication with haloperidol. Each of these findings is in line with our review (Analysis 1.5; Analysis 1.6; Analysis 1.9; Table 1).
In addition, Huhn 2019 found an overall change in symptoms slightly favouring olanzapine, in keeping with this finding in this review ‐ a clinically important change in overall mental state (Analysis 1.3). In Huhn 2019, most of this effect appears to be due to the impact of olanzapine in reducing negative symptoms, which could be in keeping with our finding in Analysis 1.3. For this review, however, the effect ‐ or lack of it ‐ of olanzapine on negative symptoms was not a primary focus of the review; the findings of Analysis 1.3 are therefore not conclusive and should be viewed with great caution. The higher than recommended dose range of haloperidol used in the studies and the consequently greater risk of developing extrapyramidal side effects may have confounded these results, with side effects misinterpreted as negative symptoms.
Other reviews also agree that haloperidol and olanzapine differ more in their harms than they do in their benefits and findings regarding adverse effects are consistent between reviews. Haloperidol causes a higher risk of extrapyramidal side effects and olanzapine is associated with a higher risk of weight gain. Other reviews have also struggled with the limited data on the impact of these drugs on quality of life.
Overall, regarding the assessment of the quality of the evidence, whilst different approaches were used by different reviews (for example, GRADE in this review and CINeMA in Huhn 2019), the general quality of the data was considered low.
Authors' conclusions
Implications for practice.
1. For people with schizophrenia
According to our findings, about half of people taking either medication experience an overall improvement; however, it is difficult to reach strong conclusions about the differences between haloperidol and olanzapine other than their different side effects. Of note, however, there appears to be a somewhat greater improvement in quality of life for people under olanzapine. Both haloperidol and olanzapine do help symptoms and signs of psychosis and improve functioning in major areas of the person's life such as at home, work, school and in relationships. Both medications may lead to side effects. Most people, given either medication, do not develop movement problems (such as tremors and stiffness) but it does seem clear that more of those given haloperidol do so (one in three) when compared with olanzapine (one in six). Perhaps this difference is also reflected in studies demonstrating an increased risk of leaving the study early (one in 10 people under haloperidol versus one in 20 people under olanzapine) and the trend towards increased risk of relapse for people on haloperidol. As most of these problems should become apparent early in treatment, people given either drug should know if they are experiencing this type of difficulty quite quickly. This then gives the opportunity to seek treatment review, including dose reduction, potentially adding other medications to reduce the impact of side effects, or stopping and swapping if required. Also, both drugs do seem to be linked with a risk of gaining weight, however more so with olanzapine. Weight gain may be slightly slower to reveal itself and even though there are mitigation strategies, it takes considerable time and effort to correct. It is important to understand these adverse effects when making a decision about which antipsychotic is a better fit for the person. Either of these two drugs are effective options for people with lived experience of schizophrenia despite their side effects.
Many studies have not taken into account specific factors that could be of interest to people with lived experience of schizophrenia, such as ability to work, impact on the family and social function. Importantly, acceptability and accessibility for the user are also rarely considered. There is not much follow‐up data on the clinical effects and safety of these drugs in the long term (more than one year). People with lived experience of schizophrenia, therefore, might be justified in suggesting trying one or other of these drugs in the short or medium term to see how it affects them, with consideration thereafter about continuation on the current medication or changing to a new medication into the medium term.
2. For clinicians
Both of these drugs have an antipsychotic effect. They both have the effect of helping improve the core psychotic symptoms – to a considerable degree – and within a few weeks. There is insufficient evidence to find differences in clinically important change globally. However, olanzapine may result in slightly greater improvement in mental state and in greater improvement in quality of life. On other measures, haloperidol and olanzapine were similar in terms of benefits, or at least the evidence was not strong enough to discern them. The two drugs demonstrated different side effect profiles. Weight gain was more common with olanzapine (one in five with olanzapine versus one in 11 with haloperidol), whereas extrapyramidal side effects were more common with haloperidol (one in three with haloperidol versus one in six with olanzapine). The drug of choice – if a range of medications is available – usually includes the person's preference, their characteristics and the characteristics of their illness. Based on these findings, for example, people with obesity or concerns about weight gain (or both) would benefit more from haloperidol. Those with previous extrapyramidal side effects or cardiac arrhythmias would benefit more from olanzapine. Due to limited data, we were not able to observe conclusive differences when comparing some notable metabolic side effects such as prolactin levels, triglycerides, glucose, high‐/low‐density lipoprotein or total cholesterol. While there was a trend towards an increased risk of relapse with haloperidol, it should be noted that the evidence was very uncertain and there is considerable discrepancy between some of the studies. Haloperidol likely increases the rate of people leaving the study early due to adverse effects (one in 10 versus one in 20). While there is insufficient information to understand the reason for this outcome, we hypothesise that it is possible this may be linked to using higher equivalent doses of haloperidol compared to olanzapine in some trials. When prescribing, it is always important to keep in mind dose equivalence.
Based on Médecins Sans Frontières (MSF) experience, especially in middle‐ and high‐income settings, olanzapine and other latter‐generation antipsychotics have become preferred as first‐line treatment, whereas haloperidol is more frequently used as a second‐ or third‐line option for people with treatment resistance. Either medication is a valuable and effective treatment for people with lived experience of schizophrenia.
Where there is no choice, for example where supplies of one or the other treatment are unavailable, giving either is not a ‘second best’ treatment (Adams 2006).
Antipsychotic medication needs to be considered only one part of a person's treatment plan that ensures the person's personal goals are collaboratively taken into account and that includes and prioritises psychosocial support and care.
3. For policymakers
Due to its similar benefits and different side effect profiles, the availability of olanzapine alongside haloperidol would improve choice and provide a greater ability to respond to side effects for people with lived experience of schizophrenia. Although haloperidol and olanzapine are both off‐patent and available as generic medications (haloperidol off‐patent since 2001, olanzapine since 2011), based on MSF experience, haloperidol is more widely available and cheaper in many countries (Chisholm 2016). Given this, olanzapine could be a valuable additional option in low‐resource and humanitarian contexts and there is a strong argument for it to be included in national essential medicines lists alongside haloperidol and other second‐generation antipsychotics as argued by the 24th Expert Committee on Selection and Use of Essential Medicines (WHO 2023) and as included in the most recent edition of the WHO Model List of Essential Medicines (WHO 2023b).
Second‐generation antipsychotic medications were once promoted as an investment in community‐based services partially associated with an expected reduction in emergency care and hospitalisation due to relapse. In this review, however, the evidence is insufficient to draw conclusions in this regard, although there is a trend towards relapse being more common with haloperidol. Of note, the only non‐industry funded study indicated a non‐statistically significant finding in the opposite direction.
Implications for research.
1. General
There would have been a greater amount of relevant data to review if trials had reported their results in a more complete and consistent way, for example using COMET or CONSORT recommendations.
1.1 Redundancy
Currently, there are 30 studies that seem entirely relevant to this review, which we had to exclude as no data were usable. Furthermore, even within studies that we have included, it proved impossible to use much of the data. Better reporting and greater access to original data would certainly have improved this review. Such waste represents lost opportunities for understanding and suggests a potential breach of trust with those participants whose data are lost to future use.
1.2 Specificity
1.2.1 Multiple publications of the same trial
The original calls for registers of studies predate most of the trials included in this review (Schulz 1995) and, although the company producing olanzapine was mostly clear in its reporting of the data over and over again from the same study ‐ unlike others at the time (Huston 1996) ‐ the piecing together of the studies from the multiple publications and presentations was a formidable task. For example, we identified 142 presentations/publications of one study (Tollefson (HGAJ) 1997). Much time could have been saved by fewer publications and use of unique study identifiers.
1.2.2 Standardisation of outcome reporting
The studies reviewed approached certain outcomes using a wide variety of measurement approaches. To take weight gain as an example, it is clear that one of the compounds relevant to this review causes this problem (Analysis 1.6). Nonetheless, the outcome was measured in six different ways across the reviewed studies, making comparative analysis impossible. There is a great risk of loss of information with this multiplicity of reporting techniques. A standardisation of outcome reporting, such as is called for by COMET, may well have increased the confidence in some of the important findings of this review.
2. Specific
2.1 Reviews
2.1.1 Review titles from excluded studies
As is common with this type of work, we had to exclude many interesting studies that should at least be considered for use within other reviews. These are tabulated in Characteristics of excluded studies and, where a Cochrane review already exists, this is referenced.
2.1.2 Reviews relevant to the care of people with schizophrenia in humanitarian settings
People with lived experience of schizophrenia in humanitarian settings should have access to the best treatment. Hence, reviews should include all antipsychotics (oral and depot) in the WHO Model List of Essential Medicines (WHO 2023b) and other antipsychotics that have showed promising results, such as amisulpride and ziprasidone.
2.2 Trials
Although there were many randomised controlled trials carried out that compared haloperidol with olanzapine, there is a need for more consistent and well‐designed randomised clinical studies. They are necessary because the methodological quality of the individual trials included in this review was low in many cases. Studies also typically included an array of clinical states (e.g. acutely ill, stabilised or a mix of both) and either did not clearly define participants or did not provide stratified results by presentation, something future studies should address better. Therefore, high‐quality trials are required to appraise the benefits and harms of haloperidol in comparison to olanzapine. For a suggested design for these studies, please see Table 5.
2.2.1 Settings
The current evidence is based predominantly on studies carried out in high‐income settings. Future studies need to focus on more diverse settings, including humanitarian as well as low‐ and middle‐income (LMIC) settings, or actively work to take factors relevant to these settings into account during design. Pragmatic trials in LMICs also need to be considered.
2.2.2 Interventions
New trials would need to use doses that are within the universally recommended range, which in this case would often mean doses of haloperidol that are equivalent to olanzapine. Trials need to respect equivalence doses between the antipsychotics compared, based on the latest reviews and meta‐analyses. This would mean that 1 mg olanzapine is an equivalent dose to 0.42 mg of haloperidol (Leucht 2020).
Trials need to include more suitable choices for very vulnerable populations in emergencies. For example, trials in humanitarian settings should include three‐month, long‐acting injectable antipsychotics, such as paliperidone palmitate. It could be of great added value for people living with schizophrenia in remote areas, in places with very little access to mental health services, for nomadic populations, internally displaced persons, refugees, migrants, etc. Also, trials including olanzapine need to be considered in these settings.
2.2.3 Outcomes
Future studies need to include more detail on the impact of treatment on social and occupational functioning, family, healthy days and patient satisfaction. Understanding the impact of intervention treatments on quality of life is particularly relevant. Eleven studies measured quality of life as an outcome; however, there were no common scales or criteria used. Finally, we did not find any studies with usable data on economic outcomes.
Importantly, though nevertheless challenging, there are also a limited number of studies viewing outcomes in the long term, indicating a gap in knowledge regarding comparative efficacy and the impact of side effects after 12 months. In order to understand these long‐term effects, study methods alternative to RCTs, such as advanced statistics applied to large observational datasets, will be necessary.
4. Suggested design of study.
| Methods | Allocation: randomised; explicitly described methods of randomisation and allocation concealment
Blinding: double‐blinded and independent raters Setting: favouring community‐based care rather than hospital Duration: 52 |
| Participants | Diagnosis: schizophrenia (according to diagnostic criteria) N = 300* Age: adults Sex: both |
| Interventions |
|
| Outcomes | Global state: clinically important response to treatment General: time to all‐cause treatment failure marked by its discontinuation, relapse, general impression of clinician (CGI), improvement as defined by patient/carer, adherence with treatment, healthy days Mental state: clinically important response to treatment Leaving the study early: by cause Adverse events: any serious adverse event Service use: number of hospitalisations, days in hospitals, necessity for high‐intensity care (for example, need for home‐based care) Quality of life; clinically important response ‐ QLS/WHOQOL‐BREF/S‐QoL/context‐/culture‐adapted scales Social functioning: return to everyday living for 80% of time* Economic outcomes ‐ or proxy measures Pharmacological interactions |
| Notes | *Powered to be able to identify a difference of ~20% between groups for primary outcome with adequate degree of certainty |
| BPRS: Brief Psychiatric Rating Scale CGI: Clinical Global Impression PANSS: Positive and Negative Syndrome Scale QOL: Quality of Life Questionnaire S‐QoL: Schizophrenia Quality of Life Questionnaire WHOQOL‐BREF ‐ WHO Quality of Life‐BREF | |
History
Protocol first published: Issue 10, 2019
Acknowledgements
The authors would like to thank all the staff at Cochrane Schizophrenia for their support and assistance.
We particularly thank the following people for their contribution to this review:
Lorna Duggan ‐ performing previous work that was the foundation of the current review (Duggan 2005).
Clive Adams ‐ guidance through the review process, comments and recommendations, analysis, and editing the manuscript.
Claire Irving ‐ guidance through the review process, comments and recommendations, analysis, and editing the manuscript.
Farhad Shokraneh ‐ carrying out the study search and data collection from the Cochrane study‐based register, support in tables.
Ghazaleh Aali ‐ technical support with RevMan and advice on managing errors.
Jun Xia ‐ guidance on data collection.
Editorial and peer reviewer contributions
Cochrane Schizophrenia supported the authors in the development of this review.
The following people conducted the editorial process for this article:
Sign‐off Editor (final editorial decision): Karla Soares‐Weiser, Editor‐in‐Chief, Cochrane.
Managing Editor (selected peer reviewers, provided editorial guidance to authors, edited the article): Sam Hinsley, Cochrane Central Editorial Service.
Editorial Assistant (conducted editorial policy checks, collated peer reviewer comments and supported the editorial team): Lisa Wydrzynski, Cochrane Central Editorial Service.
Copy Editor (copy editing and production): Jenny Bellorini, Cochrane Central Production Service.
Peer reviewers (provided comments and recommended an editorial decision): Jose M Rubio, Institute of Behavioral Science, Feinstein Institutes for Medical Research, USA (clinical review); Joseph P McEvoy, Augusta University, Augusta, USA (clinical review); Brian Duncan (consumer review); Jennifer Hilgart, Cochrane (methods review); Steve McDonald, Cochrane Australia (search review). One additional peer reviewer provided clinical peer review but chose not to be publicly acknowledged.
Parts of this review were generated using RevMan HAL v 4.0, RevMan 5.3 and RevMan Web.
This has been an initiative supported by the five operational centres of Médecins Sans Frontières (MSF) and their respective Mental Health Advisors, as well as by Epicentre and MSF International.
Appendices
Appendix 1. Methods used in previous review
Data collection and analysis
1. Selection of studies
We (LD, MF) independently inspected all reports of identified studies. It was usually possible to resolve any disagreement by consensus; however, where doubt remained. we acquired the full article. We independently decided whether these met the review criteria. No blinding to the names of authors, institutions and journal of publication took place. Again, we resolved any disagreements by consensus. When this proved impossible, we sought further information and, in the interim, added these trials to the 'Awaiting assessment' list. LD, MF and JR independently inspected citations from the subsequent updated search (2004) and identified relevant abstracts. We obtained and inspected full reports of the abstracts meeting the review criteria.
2. Assessment of methodological quality
We allocated trials to three quality categories, as described in the Cochrane Collaboration guidelines (Alderson 2004). We only included trials in Category A or B in the review.
3. Data management
3.1 Data extraction
We independently extracted data and resolved disagreement by discussion. When this was not possible, we sought further information from trial authors.
3.2 Intention‐to‐treat analysis
Where possible, we analysed data on an intention‐to‐treat basis and assumed that those who had not been accounted for had the less positive outcome. This rule did not include the outcome of 'death'. We tested this assumption with a sensitivity analysis. For continuous data it is impossible to manage the data in this way, therefore we presented 'completer' data. Where feasible, we converted continuous scores to dichotomous data. If, for a given outcome, more than 50% of the total numbers randomised were not accounted for, we did not present results as such data are impossible to interpret with authority. If, however, more than 50% of those in one arm of a study were lost, but the total loss was less than 50%, we marked data with '*' to indicate the result may well be prone to bias.
4. Data analysis
4.1 Binary data
When summation was appropriate, with binary outcomes such as improved/not improved, we calculated the relative risk (RR) statistic with a 95% confidence interval (CI) and used a random‐effects model. In addition, as a measure of efficiency, we estimated the number needed to treat (NNT) or the number needed to harm (NNH) from the pooled totals.
4.2 Continuous data
4.2.1 Normally distributed data
Continuous data on clinical and social outcomes are often not normally distributed. To avoid the pitfall of applying parametric tests to non‐parametric data, we applied the following standards to all data before inclusion: (a) standard deviations and means were reported in the paper or were obtainable from the authors; (b) when a scale started from the finite number zero, the standard deviation, when multiplied by two, was less than the mean (as otherwise the mean is unlikely to be an appropriate measure of the centre of the distribution) (Altman 1996); (c) if a scale started from a positive value (such as PANSS which can have values from 30 to 210) the calculation described above was modified to take the scale starting point into account. In these cases, skew is present if 2 SD > (SSmin), where S is the mean score and Smin is the minimum score. Endpoint scores on scales often have a finite start and end point and these rules can be applied to them. When continuous data are presented on a scale which includes a possibility of negative values (such as change on a scale), it is difficult to tell whether data are non‐normally distributed (skewed) or not. Skewed data are presented in the 'Other data' tables rather than included in the analysis. For change data (endpoint minus baseline), the situation is even more problematic. In the absence of individual patient data it is impossible to know if data are skewed, though this is likely. After consulting the ALLSTAT electronic statistics mailing list, we presented change data in order to summarise available information. In doing this, it was assumed either that data were not skewed or that the analyses could cope with the unknown degree of skew. Again, without individual patient data it is impossible to test this assumption. Where both change and endpoint data were available for the same outcome category, we have presented only endpoint data. We acknowledge that by doing this, much of the published change data could have been excluded, but argue that endpoint data is more clinically relevant and that if change data were to be presented along with endpoint data, it would be given undeserved equal prominence. We contacted authors of studies that only reported change for endpoint figures.
4.2.2 Summary statistic
For continuous outcomes, we estimated a weighted mean difference (WMD) between groups.Again, this was based on the random‐effects model, as this takes into account any differences between studies even if there is no statistically significant heterogeneity. We did not consider continuous data presented without use of summary statistics (i.e. mean, SD, SE, median, interquartile range), although we noted the existence of these data in the text.
4.2.3 Valid scales
Many rating scales are available to measure outcomes in mental health trials (Marshall 2000). These scales vary in quality and many are poorly validated. It is generally accepted that measuring instruments should have the properties of reliability (the extent to which a test effectively measures anything at all) and validity (the extent to which a test measures that which it is supposed to measure). Before publication of an instrument, most scientific journals insist that its reliability and validity be demonstrated to the satisfaction of referees. As a minimum standard, we excluded data from unpublished rating scales. In addition, the rating scale should be either: (i) a self report; or (ii) completed by an independent rater or relative. More stringent standards for instruments may be set in future editions of this review. Continuous data may be presented from different scales, rating the same outcome. In this event, we presented all data without summation and inspected the general direction of effect.
4.2.4 Conversion to a common metric
To facilitate comparison between trials, we converted variables (such as days in hospital) that could be reported in different metrics (mean days per year, per week or per month) to a common metric (e.g. mean days per month).
4.3 Cluster trials
Studies increasingly employ 'cluster randomisation' (such as randomisation by clinician or practice) but analysis and pooling of clustered data poses problems. Firstly, authors often fail to account for intra‐class correlation in clustered studies, leading to a 'unit of analysis' error (Divine 1992) whereby P values are spuriously low, confidence intervals unduly narrow and statistical significance overestimated. This causes type I errors (Bland 1997; Gulliford 1999). Where clustering was not accounted for in primary studies, we presented the data in a table, with a (*) symbol to indicate the presence of a probable unit of analysis error. In subsequent versions of this review we will seek to contact first authors of studies to obtain intra‐class correlation coefficients of their clustered data and to adjust for this by using accepted methods (Gulliford 1999). Where clustering has been incorporated into the analysis of primary studies, we will also present these data as if from a non cluster‐randomised study, but adjusted for the clustering effect. We have sought statistical advice and have been advised that the binary data as presented in a report should be divided by a 'design effect'. This is calculated using the mean number of participants per cluster (m) and the intra‐class correlation co‐efficient (ICC) Design effect = 1+(m‐1)*ICC (Donner 2002). If the ICC was not reported it was assumed to be 0.1 (Ukoumunne 1999).
5. Investigation for heterogeneity
Firstly, we considered all the included studies within any comparison to judge clinical heterogeneity. We then visually inspected the graphs to investigate the possibility of statistical heterogeneity and supplemented this using, primarily, the I2 statistic. This provides an estimate of the percentage of variability due to heterogeneity rather than to chance alone. Where the I2 estimate was greater than or equal to 75%, we interpreted this as indicating the presence of high levels of heterogeneity (Higgins 2003). If inconsistency had been high, data would not have been summated, but we would have presented them separately and investigated reasons for heterogeneity.
6. Addressing publication bias
We entered all data from all identified and selected trials into a funnel graph (trial effect against trial size) in an attempt to investigate the likelihood of overt publication bias (Egger 1997).
7. General
Where possible, we entered data in such a way that the area to the left of the line of no effect indicated a favourable outcome for olanzapine.
Appendix 2. Comparison haloperidol versus olanzapine: secondary outcomes
See Summary of Findings Table for the main comparisons. Secondary outcomes findings are below, and corresponding data, tables and figures inhttps://github.com/aellosa2024/Haloperidol_Olanzapine.githttps://github.com/aellosa2024/Haloperidol_Olanzapine.git
COMPARISON 4: HALOPERIDOL vs OLANZAPINE: SECONDARY OUTCOMES
Global state
4.1 Global state: 1a. Average endpoint score (CGI, high=poor)
4.1.1 total ‐ short term
Twelve studies reported continuous data for global state using CGI scale and its components (Analysis 4.1). Eight trials reported short term average total CGI endpoint scores. Overall, the evidence suggests that in the short term, haloperidol may result in a slightly higher total CGI score compared to olanzapine (MD 0.25, 95% CI 0.05 to 0.45; participants=2639). There was a moderate level of heterogeneity amongst results in this subgroup (Chi2=13.18; df=7.0; P=0.07; I2=47%).
4.1.2 severity ‐ short term
The evidence from two short term trials suggests that haloperidol may result in a slightly higher CGI severity score compared to olanzapine (MD 0.25, 95% CI ‐0.27 to 0.78, participants=123). There was a moderate level of heterogeneity amongst results in this subgroup (Chi2=2.16; df=1.0; P=0.14; I2=53%).
4.1.3 severity ‐ medium term
The evidence from two medium term trials suggests that haloperidol may result in little to no difference in CGI severity score compared to olanzapine (MD 0.09, 95% CI ‐0.18 to 0.37; participants=315).
4.1.4 improvement ‐short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference in CGI improvement score compared to olanzapine (MD 0.00, 95% CI ‐0.51 to 0.51; participants=60).
4.1.5 improvement ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference in CGI improvement score compared to olanzapine (MD 0.10, 95% CI ‐0.24 to 0.44; participants=254).
4.2 Global state: 1b. Average endpoint score (CGI‐S, high=poor, skewed data)
These continuous data, from three trials, had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.2
Note: We did not find any usable data for following outcomes related to global state:
Any change in global state
Average change score in global state
Mental State
4.3 Mental state: 1a. Overall‐clinically important change in overall mental state (>/= 20% reduction in PANSS endpoint score)
Two studies reported clinically important change in mental state in the medium and long term, using a cut‐off of 20% decrease in endpoint PANSS score. Overall, haloperidol may result in little to no difference in mental state compared to olanzapine (RR 0.88, 95% CI 0.73 to 1.07, participants=517; Anaysis 4.3).
4.3.1 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference in mental state compared to olanzapine (RR 0.85, 95% CI 0.67 to 1.07; participants=261).
4.3.2 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference in mental state compared to olanzapine (RR 0.96, 95% CI 0.69 to 1.33, participants= 256).
4.4 Mental state: 1b. Overall‐clinically important change in overall mental state ‐ short term (>/= 25% reduction in PANSS endpoint score
Twelve studies reported short term incidence of clinically important change in mental state defined as 25% increase in endpoint PANSS scale. Overall, in the short term, haloperidol may result in little to no difference in mental state compared to olanzapine (RR 1.06, 95% CI 0.85 to 1.32, participants=1008, studies=12; Analysis 4.4).
4.5 Mental state: 1c. Overall ‐ clinically important change in overall mental state ‐ short term (>/= 75% reduction in PANSS endpoint score)
The evidence from eight studies suggests that in the short term, haloperidol may reduce the incidence of clinically important change in mental state slightly compared to olanzapine (RR 0.73, 95% CI 0.58 to 0.90; participants=668; ).
4.6 Mental state: 1d. Overall‐clinically important change in overall mental state ‐ short term (>/=40% reduction in BPRS endpoint score)
We identified three studies reporting data on clinically important change in overall mental state in the short term defined as a 40% or greater reduction in the BPRS endpoint score. The evidence suggests that in the short term, haloperidol may result in a slight reduction in the incidence of this outcome compared to olanzapine (RR 0.80, 95% CI 0.62 to 1.02; participants=2335). There was a substantial level of heterogeneity amongst results (Chi2=12.45; df=2.0; P=0.002; I2=84%; Analysis 4.6.
4.7 Mental state: 1e. Overall ‐ clinically important change in overall mental state‐ remission ‐ medium term (PANSS score </=3 per symptom, for at least six months)
Two studies reported medium term data for remission, defined as PANSS score of lower or equal to three per symptom for at least six months. The evidence suggests that in the medium term, haloperidol may result in a decrease in PANSS score compared to olanzapine (RR 0.56, 95% CI 0.31 to 1.01; participants=316). There was a moderate level of heterogeneity amongst results (Chi2=2.41; df=1.0; P=0.12; I2=59%; Analysis 4.7).
4.8 Mental state: 2a. Overall ‐ average endpoint score (PANSS total, high=poor)
Thirty‐five studies reported average endpoint PANSS total scores in the short (22 trials), the medium (11 trials) and the long term (one trial). Overall, haloperidol may result in a higher average endpoint PANSS total score compared to olanzapine (MD 5.82 95% CI 4.18 to 7.45, participants=4973). There was a substantial level of heterogeneity amongst results (Chi2=127.14; df=34.0; P<0.00001; I2=73%; Analysis 4.8).
4.8.1 short term
The evidence from 22 trials suggests that in the short term that haloperidol may result in a slightly higher average endpoint PANSS total score compared to olanzapine (MD 5.02, 95% CI 3.21 to 6.82, participants=3765). There was a substantial level of heterogeneity amongst results (Chi2=60.42; df=21.0; P<0.0001; I2=65%).
4.8.2 medium term
The evidence from 12 trials suggests that in the medium term, haloperidol may result in a higher average endpoint PANSS total score compared to olanzapine (MD 7.27 95% CI 3.86 to 10.67; participants=1210). There was a substantial level of heterogeneity amongst results (Chi2=62.22; df=11.0; P<0.00001; I2=82%).
4.8.3 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 7.32, 95% CI ‐3.99 to 18.63; participants=44).
4.9 Mental state: 2b. Overall ‐ average endpoint score (BPRS total, high=poor)
Six studies reported average endpoint BPRS total scores in the short (five trials) and medium term (one trial). Overall, in the short and medium term, haloperidol may result in little to no difference compared to olanzapine in average endpoint score BPRS score (MD 1.02, 95% CI ‐0.57 to 2.61; participants=417; Analysis 4.9.
4.9.1 short term
The evidence from five trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.91, 95% CI ‐0.85 to 2.67; participants=356).
4.9.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 1.50, 95% CI ‐2.21 to 5.21, participants=61).
4.10 Mental state: 2c. Overall ‐average endpoint score (BPRS total, high=poor, skewed data)
These continuous data from seven trials had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.10.
4.11 Mental state: 3a. Overall ‐ average change score ‐ short term (PANSS total, high=poor)
The evidence from two trials using PANSS change score (i.e. improvement) suggests that in the short term, haloperidol may result in a slightly lower score compared to olanzapine (MD 9.24, 95% CI 3.17 to 15.31; participants=302; Analysis 4.11).
4.12 Mental state: 3b. Overall ‐ average change score ‐ short term (PANSS total, high=poor, skewed data)
These continuous data (one RCT‐ short term) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.12.
4.13 Mental state: 4a. Specific ‐ average endpoint score ‐ depression ‐ short term (MADRS, high=poor)
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in average endpoint MADRS score compared to olanzapine (MD 7.0, 95% CI 4.76 to 9.24; participants=20; Analysis 4.13).
4.14 Mental state: 4b. Specific ‐ average endpoint score ‐ depression (MADRS, high=poor, skewed data)
These continuous data (seven RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.14.
4.15 Mental state: 4c. Specific ‐ average endpoint score ‐ aggression ‐ short term (MOAS, high=poor, skewed data)
These continuous data (one RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.15.
4.16 Mental state: 4d. Specific ‐ average endpoint score ‐ depression (various scales, high=poor, skewed data)
These continuous data (four RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.16.
4.17 Mental state: 5a. Specific ‐ negative symptoms ‐ clinically important change (>/=20% reduction in PANSS‐N)
Two studies reported data for clinically important change in negative symptoms defined as at least 20% reduction in endpoint PANSS‐N score. Overall, haloperidol may result in little to no difference compared to olanzapine in at least 20% reduction in endpoint PANSS‐N score (RR 0.88, 95% CI 0.71 to 1.09; participants=309; Analysis 4.17).
4.17.1 short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.72, 95% CI 0.30 to 1.71; participants=35).
4.17.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.89, 95% CI 0.72 to 1.11; participants=274).
4.18 Mental state: 5b. Specific ‐ negative symptoms ‐ clinically important change ‐ short term (>/=40% reduction in PANSS‐N)
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in the incidence of at least 40% reduction in endpoint PANSS‐N score (RR 0.51, 95% CI 0.14 to 1.79; participants=35; Analysis 4.18).
4.19 Mental state: 5c. Specific ‐ negative symptoms ‐ average endpoint score (PANSS‐N, high=poor)
Eighteen studies report average endpoint PANSS‐N scores at short (16 trials), medium (one trial) and long term (one trial). Overall, haloperidol may result in an increase in average endpoint PANSS‐N score slightly compared to olanzapine (MD 2.01, 95% CI 1.22 to 2.80; studies=18; participants=3474). There was a moderate level of heterogeneity amongst studies (Chi2=35.15; df=17; P=0.006; I2=52%; Analysis 4.19).
4.19.1 short term
The evidence from 16 trials suggests that in the short term, haloperidol may result in an increase in average endpoint PANSS‐N score slightly compared to olanzapine (MD 2.06, 95% CI 1.25 to 2.87; participants=3181). There was a moderate level of heterogeneity amongst studies (Tau²=1.00; Chi²=28.15, df=15; P=0.02; I²=47%).
4.19.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.30, 95% CI ‐1.20 to 1.80; participants=249).
4.19.3 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a large increase in average endpoint PANSS‐N score compared to olanzapine (MD 4.75, 95% CI 1.40 to 8.10; participants=44).
4.20 Mental state: 5d. Specific ‐ negative symptoms ‐ average endpoint score (PANSS‐N, SANS, SMD, high=poor)
There were 20 total trials reporting average endpoint PANSS‐N and SANS scores, with 17 trials in the short term, two in the medium term and two in the long term, with one reporting in greater than one time period. Overall, haloperidol may result in slight increase in average endpoint PANSS‐N and SANS scores compared to olanzapine (SMD 0.30, 95% CI 0.17 to 0.42; studies=20; participants=3649). There was a moderate level of heterogeneity amongst studies (Chi2=39.86; df=20; P=0.005; I2=50%; Analysis 4.20).
4.20.1 short term
The evidence from 17 trials suggests that in the short term, haloperidol may result in an increase in average endpoint PANSS‐N score slightly compared to olanzapine (SMD 0.32, 95% CI 0.18 to 0.46; participants=3244). There was a moderate level of heterogeneity amongst studies (Chi²=33.20, df=16.0; P=0.007; I²=52%).
4.20.2 medium term
The evidence from two trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (SMD 0.09, 95% CI ‐0.13 to 0.32; participants=310).
4.20.3 long term
The evidence from two trials suggests that in the long term, haloperidol may result in an increase in average endpoint PANSS‐N and SANS scores compared to olanzapine (SMD 0.40, 95% CI 0.17 to 0.42; participants=95).
4.21 Mental state: 5e. Specific ‐ negative symptoms ‐ average endpoint score (various scales, high=poor, skewed data)
These continuous data (five RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.21.
4.22 Mental state: 5f. Specific ‐ negative symptoms ‐ average change scores ‐ long term (PANSS‐N, high=poor, skewed data)
These continuous data (single RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.21.
4.23 Mental state: 6a. Specific ‐ positive symptoms ‐ clinically important change ‐ medium term (>/= 20% reduction in PANSS‐P)
Two medium term trials reported data on clinically important change in positive symptoms defined as at least 20% reduction in PANSS‐P score. The evidence suggests that haloperidol may result in little to no difference compared to olanzapine in the incidence of at least 20% reduction in endpoint PANSS‐P score (RR 1.01, 95% CI 0.85 to 1.20; participants=294; Analysis 4.23).
4.24 Mental state: 6b. Specific ‐ positive symptoms ‐ average endpoint score (PANSS‐P, high=poor)
Twenty‐three studies reported average endpoint PANSS‐P scores in the short (20 trials), medium (two trials) and long term (one trial). Overall, haloperidol may result in a slight increase in average endpoint PANSS‐P score compared to olanzapine (MD 1.03, 95% CI 0.50 to 1.55; participants=4027). There was a moderate level of heterogeneity amongst studies (Chi2=44.7; df=22.0; P=0.003; I2=51%; Analysis 4.24).
4.24.1 short term
The evidence from 20 trials suggests that in the short term, haloperidol may result in a slight increase in average endpoint PANSS‐P scores compared to olanzapine (MD 1.12, 95% CI 0.53 to 1.70; participants=3614). There was a moderate level of heterogeneity amongst studies (Chi2=43.08; df=19.0; P=0.001; I2=56%).
4.24.2 medium term
The evidence from two trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.33, 95% CI ‐0.88 to 1.54; participants=369).
4.24.3 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.26, 95% CI ‐2.9 to 3.42; participants=44).
4.25 Mental state: 6c. Specific ‐ positive symptoms ‐ average endpoint score (PANSS‐P, BPRS‐P, SMD, high=poor)
Twenty‐four studies reported average endpoint PANSS‐P and BPRS‐P scores in short (21 trials), medium (two trials) and long term (one trial). Overall, haloperidol may result in a slight increase in average endpoint PANSS‐P/BPRS‐P score compared to olanzapine (SMD 0.20, 95% CI 0.09 to 0.31; participants=4056). There was a moderate level of heterogeneity amongst studies (Chi2=45.03; df=23.0; P=0.004; I2=49%; Analysis 4.25.
4.25.1 short term
The evidence from 21 trials suggests that in the short term, haloperidol may result in a slight increase in average endpoint PANSS‐P scores compared to olanzapine (SMD 0.22, 95% CI 0.10 to 0.35; participants=3643). There was a moderate level of heterogeneity amongst studies (Chi2=42.93; df=20.0; P=0.002; I2=53%).
4.25.2 medium term
The evidence from two trials in the medium term, suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (SMD 0.06, 95% CI ‐0.15 to 0.26; participants=369).
4.25.3 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (SMD 0.05, 95% CI ‐0.54 to 0.64; participants=44).
4.26 Mental state: 6d. Specific ‐ positive symptoms ‐ average endpoint score (various scales, high=poor, skewed data)
These continuous data (seven RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.26.
4.27 Mental state: 6e. Specific ‐ positive symptoms ‐ average change score (PANSS‐P, high=poor, skewed data)
These continuous data (three RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.27.
4.28 Mental state: 7. Specific ‐ psychopathology, general ‐ average endpoint score (PANSS psychopathology, high=poor)
Sixteen studies reported average endpoint PANSS psychopathology scores in the short (14 trials) and medium term (two trials). Overall evidence suggests that haloperidol may result in a slight increase in average endpoint PANSS psychopathology score compared to olanzapine (MD 1.59, 95% CI 0.67 to 2.52; participants=3370). There was a moderate level of heterogeneity amongst studies (Chi2=34.11; df=15.0; P=0.003; I2=56%; Analysis 4.28).
4.28.1 short term
The evidence from 14 trials suggests that in the short term, haloperidol may result in a slight increase in average endpoint PANSS psychopathology score compared to olanzapine (MD 1.74, 95% CI 0.73 to 2.75; participants=3001). There was a moderate level of heterogeneity amongst studies (Chi2=32.35; df=13.0; P=0.002; I2=60%).
4.28.2 medium term
The evidence from two trials suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.46, 95% CI ‐1.59 to 2.5; participants=369).
4.29 Mental state: 8. Specific ‐ various ‐ average endpoint score ‐ short term (PANSS subscales, high=poor)
We identified four studies reporting short term data to be relevant to this outcome (Analysis 4.29).
4.29.1 anxiety‐depression
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in endpoint anxiety‐depression score (MD 1.04, 95% CI ‐2.40 to 4.48; participants=167). There was a considerable level of heterogeneity amongst studies (Chi²=11.25, df=1, P=0.0008, I²=91%)
4.29.2 cognitive function
The evidence from two trials suggests that in the short term, haloperidol may result in a large increase in cognitive function score compared to olanzapine (MD 3.39, 95% CI ‐0.40 to 7.19; participants=167). There was a considerable level of heterogeneity amongst studies (Chi2=13.0; df=1.0; P=0.0003; I2=92%).
4.29.3 excitability
The evidence from three trials suggests that in the short term, haloperidol may result in a slight increase in endpoint excitability score compared to olanzapine (MD 0.95, 95% CI 0.18 to 1.73; participants=283). There was a moderate level of heterogeneity amongst studies (Chi2=4.96; df=2.0; P=0.08; I2=60%).
4.29.4 excitation and agitation
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 1.20, 95% CI ‐0.53 to 2.93; participants=60).
4.30 Mental state: 9. Specific ‐ time to onset of effect ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.68, 95% CI ‐1.23 to 2.59; participants=240; Analysis 4.30).
4.31 Mental state: 10. Specific ‐ Needing additional benzodiazepines
Six studies reported data on incidence of the use of additional benzodiazepines for psychiatric symptoms in the short (six trials) and medium term (one trial), with one reporting in greater than one time‐period. Overall, the evidence suggests that haloperidol may increase the use of additional benzodiazepines for psychiatric symptoms compared to olanzapine (RR 1.10, 95% CI 1.04 to 1.17, participants=3030, studies=6, Analysis 4.31).
4.31.1 short term
The evidence from five trials suggests that in the short term, haloperidol may increase the use of additional benzodiazepines for psychiatric symptoms compared to olanzapine (RR 1.10, 95% CI 1.04 to 1.17, participants=2924).
4.31.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.35, 95% CI 0.04 to 3.22, participants=106)
General functioning
4.32 Functioning: 1a. General ‐ average endpoint score ‐ short term (GAF, high=good)
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.00, 95% CI ‐3.09 to 3.09; participants=54; Analysis 4.32.
4.33 Functioning: 1b. General ‐ average endpoint score medium term (GAF, high=good, skewed data)
These continuous data (one RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.33.
4.34 Functioning: 2a. Specific ‐ average endpoint score ‐ cognition ‐ long term (SCD, high=poor)
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.60, 95% CI ‐0.60 to 1.80; participants=240; Analysis 4.34).
4.35 Functioning: 2b. Specific ‐ average endpoint scores ‐ cognition ‐ short term (various domains, high=good)
We identified a single trial to be relevant to this outcome (Analysis 4.35).
4.35.1 neuro‐cognition ‐ California Verbal Learning Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 4.60, 95% CI ‐1.91 to 11.11; participants=60).
4.35.2 neuro‐cognition ‐ Controlled Oral Word Association Test
The evidence from a single trial suggests that in the short term, haloperidol may result in increase in controlled oral word association test score compared to olanzapine (MD 7.20, 95% CI 0.57 to 13.83; participants=60).
4.35.3 neuro‐cognition ‐ Degraded Stimulus Continuous Performance Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.05, 95% CI ‐0.01 to 0.11; participants=60).
4.35.4 neuro‐cognition ‐ Digit Symbol coding
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 2.60, 95% CI ‐4.01 to 9.21; participants=60).
4.35.5 neuro‐cognition ‐ Grooved Pegboard Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐14.80, 95% CI ‐42.36 to 12.76; participants=60).
4.35.6 neuro‐cognition ‐ Letter Number Span
The evidence from a single trial suggests that in the short term, haloperidol may result in large increase inLetter‐Number Span test score for cognitive function compared to olanzapine (MD 2.80, 95% CI 0.35 to 5.25; participants=60).
4.35.7 neuro‐cognition ‐ Wisconsin Card Sorting Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.80, 95% CI ‐0.15 to 1.75; participants=60).
4.35.8 social cognition ‐ Facial Emotion Identification Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.50, 95% CI ‐2.11 to 1.11; participants=60).
4.35.9 social cognition ‐ Half Profile of Nonverbal Sensitivity
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 1.80, 95% CI ‐2.67 to 6.27; participants=60).
4.35.10 social cognition ‐ Interpersonal Perception Task
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.80, 95% CI ‐0.03 to 1.63; participants=60).
4.35.11 social cognition ‐ Voice Emotion Identification Test
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.20, 95% CI ‐1.76 to 2.16; participants=60).
4.36 Functioning: 2c. Specific ‐ cognition ‐ average endpoint scores ‐ medium term (various domains, high=good)
We identified a single trial to be relevant to this outcome (Analysis 4.36).
4.36.1 attention
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐1.78, 95% CI ‐10.93 to 7.37; participants=24).
4.36.2 function ‐ executive
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 18.09, 95% CI ‐14.33 to 50.51; participants=28).
4.36.3 processing speed
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.21, 95% CI ‐2.15 to 2.57; participants=28).
4.36.4 memory ‐ visual
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 3.42, 95% CI ‐3.27 to 10.11; participants=27).
4.36.5 memory ‐ working
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.60, 95% CI ‐1.86 to 0.66; participants=28).
4.36.6 neuro‐cognition ‐ Grooved Pegboard Test
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 4.37, 95% CI ‐1.08 to 9.82; participants=48).
4.36.7 neuro‐cognition ‐ Rey Auditory Verbal Learning
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐3.09, 95% CI ‐8.90 to 2.72; participants=61).
4.36.8 neuro‐cognition ‐ Brief Test of Attention
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.76, 95% CI ‐2.45 to 0.93; participants=49).
4.36.9 neuro‐cognition ‐ Finger Tapping Test
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.27, 95% CI ‐5.0 to 5.54; participants=47).
4.36.10 neuro‐cognition ‐ FAS verbal fluency test
The evidence from a single trial suggests that in the medium term, haloperidol may result in reduction in FAS verbal fluency test score compared to olanzapine (MD ‐5.86, 95% CI ‐11.24 to ‐0.48; participants=60).
4.37 Functioning: 2d. Specific ‐ cognition ‐ average change scores ‐ medium term (various measures, high=good, skewed data)
These continuous data (three RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.37.
Note: We did not find any usable data for following outcomes related to general functioning:
Clinically important change in general functioning
Any change in general functioning
Clinically important change in specific aspects of functioning
Any change in specific aspects of functioning
General adverse events/effects
4.38 Adverse effects/events: 1a. General ‐ adverse drug reaction, requiring dose reduction or additional medication ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.10, 95% CI 0.89 to 1.36; participants=182; Analysis 4.38).
4.39 Adverse events: 1b. General ‐ severe enough to cause withdrawal from study
Twelve studies reported data for this outcome in the short (five trials), medium (five trials) and long term (two trials). The overall results suggest that in the short, medium and long term, haloperidol results in a large increase in the incidence of withdrawal from a study due to severity of adverse event (RR 2.10, 95% CI 1.52 to 2.90; participants=1967; Analysis 4.39).
4.39.1 short term
The evidence from five trials suggests that in the short term, haloperidol results in a large increase in the incidence of withdrawal from the study due to severity of adverse events (RR 3.63, 95% CI 1.76 to 7.48; participants=800).
4.39.2 medium term
The evidence from five trials suggests that in the medium term, haloperidol results in an increase in the incidence of withdrawal from the study due to severity of adverse events (RR 1.77, 95% CI 1.07 to 2.94; participants=800).
4.39.3 long term
The evidence from two trials suggests that in the long term, haloperidol may result in an increase in the incidence of withdrawal from the study due to severity of adverse events (RR 1.90, 95% CI, 95% 1.13 to 3.18; participants=367).
4.40 Adverse effects/events: 2a. General ‐ needing additional medication ‐ short term
We found seven relevant studies and categorised data into subgroups (Analysis 4.40).
4.40.1 needing some anticholinergic drugs
The evidence from six trials suggests that in the short term, haloperidol may result in large increase in the need for additional anticholinergic drugs (RR 3.47, 95% CI 2.50 to 4.83; participants=3326). There was a substantial level of heterogeneity amongst studies (Chi2=23.27; df=5.0; P=0.0003; I2=79%).
4.40.2 needing benzodiazepines
The evidence from four trials suggests that in the short term, haloperidol results in little to no difference compared to olanzapine in the need for additional benzodiazepines (RR 1.10, 95% CI 1.02 to 1.17; participants=2394).
4.40.3 needing propranolol
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the need for propranolol compared to olanzapine (RR 8.06, 95% CI 2.49 to 26.12; participants=263).
4.41 Adverse effects/events: 2b. General ‐ needing additional medication ‐ medium term
We found a single relevant study reporting data for this outcome in the medium term (Analysis 4.41).
4.41.1 needing benzodiazepines
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.35, 95% CI 0.04 to 3.22; participants=106).
4.42 Adverse effects/events: 2c. General ‐ needing additional medication ‐ long term
We found two relevant studies reporting data for this outcome (Analysis 4.42).
4.42.1 needing anticholinergic drugs
The evidence from two trials suggests that in the long term, haloperidol may result in a large increase in use of additional anticholinergic drugs compared to olanzapine (RR 4.64, 95% CI 0.48 to 45.16; participants=314). There was a substantial level of heterogeneity amongst studies (Chi2=2.89; df=1.0; P=0.09; I2=65%).
Specific adverse events/effects
4.43 Adverse effects/events: 3b. Specific ‐ extrapyramidal ‐ various specific effects ‐ short term
We identified 17 studies relevant to this outcome, the data which we divided into 11 subgroups (Analysis 4.43).
4.43.1 abnormal gait
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of abnormal gait compared to olanzapine (RR 8.88, 95% CI 2.11 to 37.34; participants=182).
4.43.2 akathisia
The evidence from 16 trials suggests that in the short term, haloperidol may result in a large increase in the incidence of akathisia compared to olanzapine (RR 3.33, 95% CI 2.79 to 3.98; participants=4038).
4.43.3 bradykinesia
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of bradykinesia compared to olanzapine (RR 8.88, 95% CI 2.11 to 37.34; participants=182).
4.43.4 dyskinetic movements
The evidence from three trials suggests that in the short term, haloperidol may result in a large increase in the incidence of dyskinetic movements compared to olanzapine (RR 2.71, 95% CI 0.79 to 9.28; participants=2777. There was a substantial level of heterogeneity amongst studies (Chi2=6.82; df=2.0; P=0.03; I2=71%).
4.43.5 acute dystonia
The evidence from seven trials suggests that in the short term, haloperidol may result in a large increase in the incidence of acute dystonia compared to olanzapine (RR 8.25, 95% CI 3.53 to 19.29; participants=3160).
4.43.6 hypertonia
The evidence from six trials suggests that in the short term, haloperidol may result in a large increase in the incidence of hypertonia compared to olanzapine (RR 4.47, 95% CI 2.29 to 8.69; participants=2948). There was a moderate level of heterogeneity amongst studies (Chi2=11.2; df=5.0; P=0.05; I2=55%).
4.43.7 hypokinesia
The evidence from two trials suggests that in the short term, haloperidol may result in a large increase in the incidence of hypokinesia compared to olanzapine (RR 2.34, 95% CI 1.82 to 3.01; participants=2023).
4.43.8 myotonia
The evidence from three trials suggests that in the short term, haloperidol may result in a large increase in the incidence of myotonia compared to olanzapine (RR 5.01, 95% CI 2.42 to 10.36; participants=256).
4.43.9 parkinsonism
The evidence from three trials suggests that in the short term, haloperidol may result in a large increase in the incidence of parkinsonism compared to olanzapine (RR 2.57, 95% CI 2.02 to 3.26; participants=2286).
4.43.10 rigidity
The evidence from a single trial suggests that in the short term, haloperidol may result in large increase in the incidence of rigidity compared to olanzapine (RR 6.80, 95% CI 1.78 to 25.92; participants=27).
4.43.11 tremor
The evidence from 13 trials suggests that in the short term, haloperidol may result in large increase in the incidence of tremor compared to olanzapine (RR 3.82, 95% CI 2.56 to 5.69; participants=4002).
4.44 Adverse effects/events: 3c. Specific ‐ extrapyramidal ‐ various specific effects ‐ medium term
We identified five studies relevant to this outcome and categorised data into six subgroups (Analysis 4.44).
4.44.1 akathisia
The evidence from five trials suggests that in the medium term, haloperidol may result in a large increase in the incidence of akathisia compared to olanzapine (RR 2.15, 95% CI 1.42 to 3.25; participants=853).
4.44.2 dyskinetic movements
The evidence from two trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.67, 95% CI 0.67 to 4.14; participants=398).
4.44.3 acute dystonia
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 3.97, 95% CI 0.16 to 96.14; participants=170).
4.44.4 parkinsonism
The evidence from a single trial suggests that in the medium term, haloperidol may result in large increase in the incidence of parkinsonism compared to olanzapine (RR 3.14, 95% CI 1.05 to 9.36; participants=313). There was a substantial level of heterogeneity amongst studies (Chi2=3.64; df=1.0; P=0.06; I2=72%).
4.44.5 dysarthria
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 3.90, 95% CI 0.19 to 78.46; participants=71).
4.44.6 tremor
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in the incidence of tremor compared to olanzapine (RR 4.77, 95% CI 1.05 to 21.68; participants=274).
4.45 Adverse effects/events: 3d. Specific ‐ extrapyramidal ‐ various specific effects ‐ long term
For this outcome we found two relevant studies, the data from which we divided into two subgroups (Analysis 4.45).
4.45.1 akathisia
The evidence from two trials suggests that in the long term, haloperidol may result in a large increase in the incidence of akathisia compared to olanzapine (RR 2.92, 95% CI 1.61 to 5.30; participants=364).
4.45.2 tremor
The evidence from a single trial suggests that in the long term, haloperidol may result in large increase in the incidence of tremor compared to olanzapine (RR 1.64, 95% CI 0.79 to 3.39; participants=256).
4.46 Adverse effects/events: 3e. Specific ‐ extrapyramidal ‐ average endpoint score ‐ medium term (BAS total, high=poor)
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in average endpoint BAS score compared to olanzapine (MD 22.75, 95% CI 20.10 to 25.40; participants=71; Analysis 4.46).
4.47 Adverse effects/events: 3f. Specific ‐ extrapyramidal ‐ average endpoint score ‐ medium term (SAS total, high=poor)
The evidence from a single trial suggests that in the medium term, haloperidol may result in large increase in average endpoint SAS score compared to olanzapine (MD 16.00, 95% CI 14.00 to 18.00; participants=71; Analysis 4.47).
4.48 Adverse effects/events: 3g. Specific ‐ extrapyramidal ‐ average endpoint score (BAS, high=poor, skewed data)
These continuous data (six RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.48.
4.49 Adverse effects/events: 3h. Specific ‐ extrapyramidal ‐ average endpoint score (SAS, high=poor, skewed data)
These continuous data (ten RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.49.
4.50 Adverse effects/events: 3i. Specific ‐ extrapyramidal ‐ average endpoint score ‐ short term (AIMS, high=poor, skewed data)
These continuous data (four RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.50.
4.51 Adverse effects/events: 3j. Specific ‐ extrapyramidal ‐ average endpoint score ‐ short term (DIEPSS, high=poor, skewed data)
These continuous data (one RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.51.
4.52 Adverse effects/events: 3k. Specific ‐ extrapyramidal ‐ average endpoint score (ESRS, high score=poor, skewed data)
These continuous data (four RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.52.
4.53 Adverse effects/events: 4b. Specific ‐ metabolic ‐ weight decrease
Two studies reported data for this outcome in the short (one trial) and medium term (one trial). Overall, haloperidol may lead to weight decrease compared to olanzapine (RR 5.64, 95% CI 1.26 to 25.36; participants=456; Analysis 4.53).
4.53.1 short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 7.31, 95% CI 0.92 to 58.26; participants=182).
4.53.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 4.24, 95% CI 0.48 to 37.46; participants=274).
4.54 Adverse effects/events: 4c. Specific ‐ metabolic ‐ weight ‐ high BMI (>=25kg/m2) ‐ medium term
The evidence from two trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.07, 95% CI 0.37 to 3.09; participants=172). For this outcome heterogeneity was substantial (Chi2=3.48; df=1.0; P=0.06; I2=71%; Analysis 4.54).
4.55 Adverse effects/events: 4d. Specific ‐ metabolic ‐ weight ‐ average endpoint (kg)
Eleven studies reported data for this outcome in the short (seven trials), medium (three trials) and long term (one trial). Overall, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.62, 95% CI ‐1.92 to 0.68; participants=2640; Analysis 4.55).
4.55.1 short term
The evidence from seven trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.29, 95% CI ‐1.65 to 1.07; participants=2478).
4.55.2 medium term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐4.25, 95% CI ‐10.68 to 2.18; participants=115).
4.55.3 long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.96, 95% CI ‐12.45 to 10.53; participants=47).
4.56 Adverse effects/events: 4e. Specific ‐ metabolic ‐ weight ‐ average increase ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in a lower weight change between baseline and endpoint compared to olanzapine (MD ‐3.53, 95% CI ‐5.79 to ‐1.28; participants=283). For this outcome heterogeneity was considerable (Chi2=6.64; df=1.0; P=0.01; I2=85%; Analysis 4.56).
4.57 Adverse effects/events: 4f. Specific ‐ metabolic ‐ weight ‐ waist circumference at endpoint ‐ short term (high=poor)
The evidence from a single trial suggests that in the short term, haloperidol may result in lower waist circumference compared to olanzapine (MD ‐5.00, 95% CI ‐8.73 to ‐1.27; Analysis 4.57).
4.58 Adverse effects/events: 4g. Specific ‐ metabolic ‐ weight ‐ waist circumference change data‐ medium term (high=poor, skewed data)
These continuous data (single RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.58.
4.59 Adverse effects/events: 4h. Specific ‐ metabolic ‐ weight ‐ average change various measures (skewed data)
These continuous data (six RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.59.
4.60 Adverse effects/events: 5a. Specific ‐ metabolic ‐ metabolism‐related final serum levels (various measures)
For this outcome we found five relevant studies, the data from which we divided into eight subgroups (Analysis 4.60).
4.60.1 cholesterol ‐ high ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.18, 95% CI 0.01 to 3.47; participants=34).
4.60.2 cholesterol ‐ high ‐ medium term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.92, 95% CI 0.63 to 1.35; participants=419).
4.60.3 glucose ‐ high ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.20, 95% CI 0.01 to 3.93; participants=464). There was a considerable level of heterogeneity amongst studies (Chi2=10.73; df=2.0; P=0.005; I2=81%).
4.60.4 glucose (>=110mg/dl) ‐ high ‐ medium term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.09, 95% CI 0.44 to 2.72; participants=416).
4.60.5 HDL ‐ low ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.61, 95% CI 0.30 to 1.21; participants=163).
4.60.6 LDL ‐ high ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.97, 95% CI 0.65 to 1.47; participants=97).
4.60.7 trygliceride ‐ high ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.46, 95% CI 0.18 to 1.16; participants=100).
4.60.8 trygliceride ‐ high ‐ medium term
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.85, 95% CI 0.56 to 1.30; participants=419).
4.61 Adverse effects/events: 5b. Specific ‐ metabolic ‐ metabolism‐related serum levels (high=poor)
We identified four studies relevant to this outcome, the data from which we divided into eight subgroups (Analysis 4.61).
4.61.1 lipids ‐ HDL‐C ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 0.05, 95% CI ‐0.11 to 0.21; participants=72).
4.61.2 lipids ‐ LDL‐C ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may reduce the level of LDL‐C compared to olanzapine (MD ‐0.34, 95% CI ‐0.51 to ‐0.17; participants=72).
4.61.3 cholesterol, total ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 21.1, 95% CI ‐6.88 to 49.08; participants=35).
4.61.4 cholesterol, total ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐7.00, 95% CI ‐27.17 to 13.17; participants=34).
4.61.5 sugar ‐ FBS ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome MD ‐0.40, 95% CI ‐8.46 to 7.66; participants=66).
4.61.6 sugar ‐ PPBS ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may reduce the level of blood glucose measured by PPBS test compared to olanzapine (MD ‐12.23, 95% CI ‐19.95 to ‐4.51; participants=101).
4.61.7 triglyceride ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐30.86, 95% CI ‐73.5 to 11.78; participants=173). There was a considerable level of heterogeneity amongst studies (Chi2=14.56; df=2.0; P=0.0; I2=86%).
4.61.8 triglyceride ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol is less likely to result in a higher average triglycerides level compared to olanzapine (MD ‐25.00, 95% CI ‐46.33 to ‐3.67; participants=34).
4.62 Adverse effects/events: 5c. Specific ‐ metabolic ‐ metabolism related HDL serum levels ‐ endpoint (high=poor)
We identified two studies relevant to this outcome. Overall, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD 3.76, 95% CI ‐11.81 to 19.33; participants=100). For this outcome heterogeneity was considerable (Chi2=10.24; df=1.0; P=0.001; I2=90.2%; Analysis 4.62).
4.62.1 short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐3.90, 95% CI ‐9.33 to 1.53; participants=66).
4.62.2 medium term
The evidence from a single trial suggests that in the medium term, haloperidol may increase the serum HDL levels compared to olanzapine (MD 12.00, 95% CI 3.92 to 20.08; participants=34).
4.63 Adverse effects/events: 5d. Specific ‐ metabolic ‐ metabolism‐related serum levels ‐ average change (high=poor, skewed data)
These continuous data (four RCTs) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We, therefore, report these data in Analysis 4.63.
4.64 Adverse effects/events: 6. Specific ‐ metabolic ‐ various binary ‐ short term
We identified three studies relevant to this outcome and categorised data into three subgroups; Analysis 4.64).
4.64.1 metabolic syndrome
The evidence from two trials suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.40, 95% CI 0.03 to 5.30; participants=107). This subgroup had substantial levels of heterogeneity (Chi2=3.03; df=1.0; P=0.08; I2=67%).
4.64.2 diabetes
The evidence from a single trial suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.85, 95% CI 0.21 to 3.49; participants=66).
4.64.3 metabolism and nutrition disorders ‐ unspecified
The evidence from a single trial suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.39, 95% CI 0.04 to 4.00; participants=48).
4.65 Adverse effects/events: 7a. Specific ‐ anticholinergic ‐ various ‐ short term
We identified 16 studies reporting data relevant to this outcome and categorised them into nine subgroups (Analysis 4.65).
4.65.1 blurred vision
The evidence from eight trials suggests that in the short term, haloperidol may increase the incidence of blurred vision compared to olanzapine (RR 1.70, 95% CI 0.99 to 2.93; participants=2475).
4.65.2 constipation
According to the consistent data across nine trials, in the short term, haloperidol may result in an increase in the incidence of constipation compared to olanzapine (RR 1.86, 95% CI 1.18 to 2.95; participants=633).
4.65.3 salivation ‐ too little
The evidence from 12 trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.19, 95% CI 0.74 to 1.92; participants=3002, studies=12). There was a substantial level of heterogeneity amongst studies (Chi2=29.60; df=11.0; P=0.002; I2=63%).
4.65.4 salivation ‐ too much
The evidence from six trials suggests that in the short term, haloperidol may result in large increase in the incidence of excessive salivation compared to olanzapine (RR 3.67, 95% CI 1.81 to 7.42; participants=2816), while there was a moderate level of heterogeneity (Chi2=11.91; df=5.0; P=0.04; I2=58%).
4.65.5 headache
The evidence from two trials suggests that in the short term, haloperidol may increase the incidence of headache compared to olanzapine (RR 1.97, 95% CI 0.89 to 4.36; participants=154).
4.65.6 nervousness
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 2.17, 95% CI 0.70 to 6.74; participants=100).
4.65.7 urination difficulties
The evidence from a single trial suggests that in the short term, haloperidol may result in large increase in the incidence of urination difficulties compared to olanzapine (RR 2.02, 95% CI 0.95 to 4.29; participants=2023).
4.65.8 hypotension
The evidence from four trials suggests that in the short term, haloperidol may result in a slight increase in hypotension compared to olanzapine in this outcome (RR 1.92, 95% CI 0.56 to 6.66; participants=340).
4.65.9 perspiration
The evidence from three trials suggests that in the short term, haloperidol may result in a slight increase in the incidence of perspiration compared to olanzapine (RR 1.96, 95% CI 1.49 to 2.6; participants=2122).
4.66 Adverse effects/events: 7b. Specific ‐ anticholinergic ‐ various ‐ medium term
A single study reported binary data for this outcome in the medium term (Analysis 4.66).
4.66.1 dysarthria
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in dysarthria compared to olanzapine in this outcome (RR 3.90, 95% CI 0.19 to 78.46; participants=71).
4.66.2 urination difficulties
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in incidence of urination difficulties compared to olanzapine (RR 3.90, 95% CI 0.19 to 78.46; participants=71).
4.66.3 rash
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large decrease in incidence of rash compared to olanzapine (RR 0.16, 95% CI 0.01 to 3.14; participants=71).
4.66.4 anaemia
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in anaemia compared to olanzapine (RR 3.90, 95% CI 0.19 to 78.46; participants=71).
4.67 Adverse effects/events: 7c. Specific ‐ anticholinergic ‐ various ‐ long term
We identified two studies relevant to this outcome, the data from which we divided into seven subgroups (Analysis 4.67).
4.67.1 salivation ‐ too little
The evidence from two trials suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.88, 95% CI 0.32 to 2.46; participants=367).
4.67.2 dizziness
The evidence from a single trial suggests that in the long term, haloperidol may increase the incidence of dizziness compared to olanzapine (RR 1.75, 95% CI 0.91 to 3.37; participants=256).
4.67.3 paranoid reaction
The evidence from two trials suggests that in the long term, haloperidol may increase the incidence of paranoid reaction compared to olanzapine (RR 1.64, 95% CI 0.71 to 3.79; participants=256).
4.67.4 abnormal thinking
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.98, 95% CI 0.37 to 2.62; participants=256).
4.67.5 constipation
The evidence from a single trial suggests that in the long term, haloperidol may increase the incidence of constipation compared to olanzapine in this outcome (RR 1.64, 95% CI 0.54 to 4.94; participants=256).
4.67.6 headache
The evidence from a single trial suggests that in the long term, haloperidol may result in a slight increase in headaches compared to olanzapine in this outcome (RR 1.21, 95% CI 0.72 to 2.04; participants=256).
4.67.7 nervousness
The evidence from a single trial suggests that in the long term, haloperidol may result in an increase in nervousness compared to olanzapine in this outcome (RR 1.55, 95% CI 0.84 to 2.86; participants=256).
4.68 Adverse effects/events: 8a. Specific ‐ arousal ‐ various [non‐sleep] measures
For this outcome we found nine relevant studies and categorised data into 18 subgroups (Analysis 4.68).
4.68.1 agitation ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in a slight increase in agitation compared to olanzapine in this outcome (RR 1.35, 95% CI 0.73 to 2.51; participants=421).
4.68.2 agitation – medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large decrease in incidence of agitation compared to olanzapine in this outcome (RR 0.27, 95% CI 0.03 to 2.34; participants=274).
4.68.3 agitation ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in an increase in agitation compared to olanzapine in this outcome (RR 1.87, 95% CI 0.70 to 5.00; participants=256).
4.68.4 anxiety ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.86, 95% CI 0.25 to 2.94; participants=282). There was a moderate level of heterogeneity amongst studies (Chi2=2.46; df=1.0; P=0.12; I2=59%).
4.68.5 anxiety ‐ medium term
The evidence from two trials suggests that in the medium term, haloperidol may increase the incidence of anxiety compared to olanzapine (RR 1.85, 95% CI 1.10 to 3.10; participants=345).
4.68.6 anxiety ‐ long term
The evidence from two trials suggests that in the long term, haloperidol may result in a slight decrease in the incidence of anxiety compared to olanzapine (RR 0.64, 95% CI 0.34 to 1.23; participants=256).
4.68.7 excitement ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.04, 95% CI 0.56 to 1.96; participants=182).
4.68.8 hostility ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in a reduced incidence of hostility compared to olanzapine (RR 0.61, 95% CI 0.27 to 1.42; participants=267).
4.68.9 slow response ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol results in large increase in the incidence of slowed response compared to olanzapine (RR 5.00, 95% CI 1.15 to 21.67; participants=100).
4.68.10 withdrawal ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may increase the incidence of study withdrawal compared to olanzapine (RR 1.72, 95% CI 0.97 to 3.07; participants=267).
4.68.11 concentration difficulty ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a decrease in incidence of concentration difficulty compared to olanzapine (RR 0.49, 95% CI 0.05 to 5.26; participants=111).
4.68.12 delusions ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.67, 95% CI 0.27 to 1.69; participants=274).
4.68.13 suicide attempt‐medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.85, 95% CI 0.23 to 3.09; participants=274).
4.68.14 hallucinations‐medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large reduction in hallucinations compared to olanzapine (RR 0.27, 95% CI 0.03 to 2.38; participants=272).
4.68.15 hallucinations‐long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.00, 95% CI 0.49 to 2.03; participants=256).
4.68.16 depression ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a decrease in the incidence of depression compared to olanzapine (RR 0.64, 95% CI 0.34 to 1.23; participants=256).
4.68.17 pain ‐ long term
The evidence from a single trial suggests that haloperidol may result in a large reduction in the incidence of pain compared to olanzapine (RR 0.57, 95% CI 0.25 to 1.31; participants=256).
4.68.18 rhinitis ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a large reduction in the incidence of rhinitis compared to olanzapine (RR 1.64, 95% CI 0.91 to 2.94; participants=256).
4.69 Adverse effects/events: 8b. Specific ‐ arousal ‐ sleep/sleepiness ‐ various binary outcomes
For this outcome we found 20 relevant studies, the data from which we divided into 11 subgroups (Analysis 4.69).
4.69.1 drowsiness ‐ short term
The evidence from 11 trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.07, 95% CI 0.84 to 1.37; participants=3064).
4.69.2 drowsiness ‐ daytime ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in large reduction in the incidence of daytime drowsiness compared to olanzapine (RR 0.05, 95% CI 0.00 to 0.87; participants=111).
4.69.3 sedation ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large reduction of sedation compared to olanzapine (RR 0.25, 95% CI 0.03 to 1.86; participants=20).
4.69.4 sleep ‐ difficulty in getting to sleep ‐ short term
The evidence from seven trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.15, 95% CI 0.76 to 1.73; participants=3124). There was a moderate level of heterogeneity amongst studies (Chi2=14.39; df=6.0; P=0.03; I2=58%).
4.69.5 sleep ‐ insomnia ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a slight increase in the incidence of insomnia compared to olanzapine (RR 1.41, 95% CI 0.50 to 3.97; participants=274).
4.69.6 sleep ‐ increased hours ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a large decrease in the incidence of this outcome compared to olanzapine (RR 0.33, 95% CI 0.04 to 3.05; participants=111).
4.69.7 somnolence ‐ long term
The evidence from two trials suggests that in the long term, haloperidol may result in large reduction in the incidence of somnolence compared to olanzapine (RR 0.18, 95% CI 0.01 to 4.58; participants=367). There was a substantial level of heterogeneity amongst studies (Chi2=5.40; df=1.0; P=0.02; I2=81%).
4.69.8 somnolence‐medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in slight reduction in the incidence of somnolence compared to olanzapine (RR 0.71, 95% CI 0.12 to 4.16; participants=274).
4.69.9 insomnia ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in large increase in the incidence of insomnia compared to olanzapine (RR 2.17, 95% CI 0.57 to 8.19; participants=100).
4.69.10 somnolence ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a slight increase in the incidence of somnolence compared to olanzapine (RR 1.44, 95% CI 0.67 to 3.12; participants=100).
4.69.11 insomnia ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a small increase in the incidence of insomnia compared to olanzapine (RR 1.26, 95% CI 0.75 to 2.13; participants=256).
4.70 Adverse effects/events: 9a. Specific ‐ cardiovascular ‐ various binary measures
We identified 18 studies relevant to this outcome, the data from which we divided into 12 subgroups (Analysis 4.70).
4.70.1 cardiac disorders ‐ unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large decrease in the incidence of cardiac disorders compared to olanzapine (RR 0.26, 95% CI 0.01 to 6.12; participants=48).
4.70.2 cardiovascular ‐ palpitations ‐ short term
The evidence from five trials suggests that in the short term, haloperidol may result in a slight increase in the incidence of palpitations compared to olanzapine (RR 1.31, 95% CI 0.82 to 2.09; participants=2312).
4.70.3 electrocardiogram abnormality ‐ short term
The evidence from four trials suggests that in the short term, haloperidol may result in an increase in EKG abnormalities compared to olanzapine (RR 1.64, 95% CI 0.52 to 5.15; participants=372).
4.70.4 hypotension ‐ postural ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.0, 95% CI 0.21 to 4.76; participants=120).
4.70.5 QTc interval prolongation >0.5s ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in large reduction in the incidence of prolonged QTc interval greater or equal to 0.5 seconds compared to olanzapine (RR 0.08, 95% CI 0.01 to 0.44; participants=398).
4.70.6 QTc interval prolongation >0.5s ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a slight decrease in the incidence of this outcome compared to olanzapine (RR 0.75, 95% CI 0.08 to 6.79; participants=62).
4.70.7 cardiovascular ‐ dizziness ‐ short term
The evidence from seven trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.13, 95% CI 0.53 to 2.37; participants=761).
4.70.8 blood hypertension ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a slight decrease in the incidence of high blood pressure compared to olanzapine (RR 0.78, 95% CI 0.12 to 5.20; participants=71).
4.70.9 cardiovascular ‐ bradycardia ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in the incidence of bradycardia compared to olanzapine (RR 3.90, 95% CI 0.19 to 78.46; participants=71).
4.70.10 blood hypertension ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in large reduction in the incidence of high blood pressure compared to olanzapine (RR 0.05, 95% CI 0.01 to 0.38; participants=66).
4.70.11 myocardial tiredness ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in large increase in the incidence of myocardial tiredness compared to olanzapine (RR 3.00, 95% CI 1.01 to 8.91; participants=160).
4.70.12 nodal tachycardia ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.13, 95% CI 0.23 to 5.48; participants=152).
4.71 Adverse effects/events: 9b. Specific ‐ cardiovascular ‐ blood pressure endpoint ‐ short term (high=poor)
We identified two studies relevant to this outcome and categorised data into two subgroups (Analysis 4.71).
4.71.1 systolic
The evidence from two trials suggests that in the short term, haloperidol may result in a lower average systolic blood pressure compared to olanzapine (MD ‐6.40, 95% CI ‐9.46 to ‐3.34; participants=126).
4.71.2 diastolic
The evidence from two trials suggests that in the short term, haloperidol may result in a slightly lower average diastolic blood pressure compared to olanzapine (MD ‐1.83, 95% CI ‐4.55 to 0.89; participants=126).
4.72 Adverse effects/events: 10a. Specific ‐ gastrointestinal
We identified ten studies relevant to this outcome and categorised data into ten subgroups (Analysis 4.72).
4.72.1 anorexia ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in a large increase in the incidence of anorexia compared to olanzapine (RR 5.25, 95% CI 2.68 to 10.30; participants=362).
4.72.2 appetite ‐ increase ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may reduce the incidence of increased appetite compared to olanzapine (RR 0.61, 95% CI 0.50 to 0.74; participants=1996).
4.72.3 diarrhoea ‐ short term
The evidence from three trials suggests that in the short term, haloperidol may result in a large decrease in the incidence of diarrhoea compared to olanzapine (RR 0.52, 95% CI 0.17 to 1.66; participants=484).
4.72.4 gastrointestinal disorders ‐ unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of gastrointestinal disorders compared to olanzapine (RR 2.33, 95% CI 0.26 to 20.85; participants=48).
4.72.5 sickness ‐ nausea ‐ short term
The evidence from five trials suggests that in the short term, haloperidol may result in a slight increase in the incidence of nausea compared to olanzapine in this outcome (RR 1.43, 95% CI 0.83 to 2.46; participants=2601).
4.72.6 nausea ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in the incidence of nausea compared to olanzapine (RR 9.54, 95% CI 0.52 to 175.46; participants=274).
4.72.7 nausea ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.89, 95% CI 0.47 to 1.66; participants=256).
4.72.8 sickness ‐ vomiting ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may increase the incidence of vomiting compared to olanzapine in this outcome (RR 1.69, 95% CI 1.28 to 2.24; participants=1996).
4.72.9 diarrhoea ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.64, 95% CI 0.84 to 3.20; participants=256).
4.72.10 vomiting ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in an increase in the incidence of vomiting compared to olanzapine (RR 2.13, 95% CI 0.97 to 4.67; participants=256)
4.73 Adverse effects/events: 10b. Specific ‐ hepatic/haematological disfunction ‐ short term
We identified six studies relevant to this outcome and categorised data into four subgroups (Analysis 4.73).
4.73.1 abnormal routine blood test
The evidence from two trials suggests that in the short term, haloperidol may result in a large increase in the incidence of abnormal routine blood test compared to olanzapine RR 4.00, 95% CI 0.87 to 18.31; participants=180).
4.73.2 abnormal liver dysfunction
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.91, 95% CI 0.14 to 6.07; participants=176).
4.73.3 transaminase increase
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.35, 95% CI 0.10 to 19.20; participants=176).
4.73.4 SGPT increase
The evidence from one trial suggests that in the short term, haloperidol may result in a large increase in the incidence of increased SGPT levels compared to olanzapine (RR 5.09, 95% CI 0.25 to 100.43; participants=68).
4.74 Adverse effects/events: 10c. Specific ‐ hormonal ‐ high prolactin levels
Two studies in total reported data for this outcome in the short (one trial) and medium term (two trials), with 1 study reporting in both time periods. Overall, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.97, 95% CI 0.69 to 1.36; participants=200; Analysis 4.74).
4.74.1 short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.01, 95% CI 0.61 to 1.69; participants=70).
4.74.2 medium term
The evidence from two trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.93, 95% CI 0.59 to 1.47; participants=130).
4.75 Adverse effects/events: 10d. Specific ‐ hormonal ‐ serum levels ‐ short term
A single study reported data for this outcome (Analysis 4.75).
4.75.1 prolactin
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase average prolactin level compared to olanzapine (MD 80.65, 95% CI 63.98 to 97.32; participants=61).
4.75.2 growth hormone
The evidence from a single trial suggests that in the short term, haloperidol may result in a slight decrease in the average growth hormone level compared to olanzapine (MD ‐0.44, 95% CI ‐1.19 to 0.31; participants=61).
4.76 Adverse effects/events: 11. Specific ‐ renal ‐ average creatinine change ‐ short term (skewed data)
These continuous data (one RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. We therefore report these data in Analysis 4.76.
4.77 Adverse effects/events: 12. Specific ‐ death ‐ during study or within 30 days of study discontinuation
For this outcome we found three relevant studies, the data from which we divided into subgroups (Analysis 4.77).
4.77.1 all causes
The evidence from two trials suggests that haloperidol may result in a reduced incidence of all cause death compared to olanzapine (RR 0.54, 95% CI 0.14 to 2.05; participants=2427).
4.77.2 suicide and accidental injury
The evidence from three trials suggests that haloperidol may result in a slight reduction in the incidence of suicide and accidental injury compared to olanzapine (RR 0.78, 95% CI 0.12 to 5.20; participants=2609).
4.77.3 other causes
The evidence from two trials suggests that haloperidol may result in a slight decrease in the incidence of death from other causes compared to olanzapine (RR 0.67, 95% CI 0.07 to 6.47; participants=2427).
4.77.4 unknown
The evidence from a single trial suggests that haloperidol may result in a large increase in death from unknown causes compared to olanzapine (RR 6.07, 95% CI 0.25 to 148.75; participants=1996).
4.78 Adverse effects/events: 13. Specific ‐ others
We identified 11 studies relevant to this outcome, the data from which we divided into subgroups (Analysis 4.78).
4.78.1 asthenia ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in an increase in the incidence of asthenia compared to olanzapine (RR 1.67, 95% CI 0.77 to 3.64; participants=127).
4.78.2 asthenia‐medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in slight decrease in the incidence of asthenia compared to olanzapine (RR 0.71, 95% CI 0.12 to 4.16; participants=274).
4.78.3 asthenia ‐ long term
The evidence from a single trial suggests that in the long term, haloperidol may result in a large decrease in the incidence of asthenia compared to olanzapine (RR 0.16, 95% CI 0.02 to 1.32; participants=111).
4.78.4 depressive syndrome ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large decrease in the incidence of depressive syndrome compared to olanzapine (RR 0.26, 95% CI 0.03 to 2.36; participants=71).
4.78.5 dysphagia ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of dysphagia compared to olanzapine (RR 3.00, 95% CI 0.13 to 71.92; participants=100).
4.78.6 eye disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large decrease in the incidence of eye disorders compared to olanzapine in this outcome (RR 0.26, 95% CI 0.01 to 6.12; participants=48).
4.78.7 general diseases, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a slight decrease in the incidence of general unspecified diseases compared to olanzapine (RR 0.78, 95% CI 0.05 to 11.72; participants=48).
4.78.8 malaise ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.04, 95% CI 0.46 to 2.39; participants=182).
4.78.9 nervous system disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a slight increase in the incidence of nervous system disorders compared to olanzapine (RR 1.36, 95% CI 0.46 to 4.04; participants=48).
4.78.10 psychiatric disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large decrease in unspecified psychiatric disorders compared to olanzapine (RR 0.39, 95% CI 0.14 to 1.12; participants=48).
4.78.11 rash ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in the incidence of rash compared to olanzapine in this outcome (RR 3.00, 95% CI 0.14 to 65.90; participants=20).
4.78.12 rash ‐ medium term
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large decrease in the incidence of rash compared to olanzapine (RR 0.16, 95% CI 0.01 to 3.14; participants=71).
4.78.13 reproductive system and breast disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large decrease in the incidence of reproductive system and breast disorders compared to olanzapine (RR 0.16 CI 0.01 to 3.11; participants=48).
4.78.14 respiratory, thoracic, mediastinal disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.16, 95% CI 0.01 to 3.11; participants=48).
4.78.15 skin and subcutaneous tissue disorders, unspecified ‐ short term
The evidence from a single trial suggests that in the short term, haloperidol may result in a large reduction in the incidence of skin and subcutaneous tissue disorders compared to olanzapine (RR 0.26, 95% CI 0.01 to 6.12; participants=48).
4.78.16 torsion‐spasm ‐ short term
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.94, 95% CI 0.10 to 9.25; participants=176).
Quality of life
4.79 Quality of life: 2a. Specific ‐ average endpoint score ‐ short term (QLS‐ Heinrich & Carpenter, high=good)
We identified two studies relevant to this outcome, the data from which we divided into six subgroups (Analysis 4.79).
4.79.1 total score
The evidence from two trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐2.89, 95% CI ‐7.88 to 2.10; participants=299).
4.79.2 interpersonal relations
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.46, 95% CI ‐2.92 to 2.00; participants=245).
4.79.3 intrapsychic foundations
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.58, 95% CI ‐2.57 to 1.41; participants=245).
4.79.4 common objects and activities
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.41, 95% CI ‐1.03 to 0.21; participants=245).
4.79.5 instrumental role
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.95, 95% CI ‐1.96 to 0.06; participants=245).
4.79.6 common objects and activities
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (MD ‐0.41, 95% CI ‐1.03 to 0.21; participants=245).
4.80 Quality of life: 2b. Specific ‐ average endpoint score ‐ short term (WHO‐QOL‐BREF, high=good)
For this outcome we found two relevant studies, the data from which we divided into four subgroups (Analysis 4.80).
4.80.1 environment
The evidence from two trials suggests that in the short term, haloperidol may result in a slight increase in this QOL subscale score compared to olanzapine (MD 2.40, 95% CI ‐4.64 to 9.45; participants=314). There was a considerable level of heterogeneity amongst studies (Chi2=8.04; df=1.0; P=0.005; I2=88%).
4.80.2 physical health
The evidence from two trials suggests that in the short term, haloperidol may result in a slight increase in this QOL subscale score compared to olanzapine (MD 1.87, 95% CI ‐6.72 to 10.47; participants=314). There was a considerable level of heterogeneity amongst studies (Chi2=12.99; df=1.0; P=0.0003; I2=92%).
4.80.3 psychological health
The evidence from two trials suggests that in the short term, haloperidol may result in a decrease in this QOL subscale score compared to olanzapine (MD ‐4.66, 95% CI ‐12.26 to 2.94; participants=314). There was a considerable level of heterogeneity amongst studies (Chi2=9.25; df=1.0; P=0.002; I2=89%).
4.80.4 social relationships
The evidence from two trials suggests that in the short term, haloperidol may result in an increase in this QOL subscale score compared to olanzapine (MD 4.91, 95% CI ‐5.81 to 15.63; participants=314). There was a considerable level of heterogeneity amongst studies (Chi2=16.26; df=1.0; P=0.0001; I2=94%).
4.81 Quality of life: 2c. Specific ‐ various subscales ‐ average endpoint score (SF‐36) ‐ short term (high=good)
For this outcome we found two relevant studies, the data from which we divided into 11 subgroups (Analysis 4.81).
4.81.1 physiological function
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐8.83, 95% CI ‐24.03 to 6.37; participants=1255). There was a considerable level of heterogeneity amongst studies (Chi²=13.02, df=1.0; P=0.0003; I²=92%)
4.81.2 physical role
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐15.48, 95% CI ‐36.32 to 5.35; participants=1255). There was a considerable level of heterogeneity amongst studies (Chi²=10.23, df=1; P=0.001; I²=90%).
4.81.3 somatic pain
The evidence from two trials suggests that in the short term, haloperidol may result in little to no improvement in the somatic pain subscale compared to olanzapine (MD ‐3.59, 95% CI ‐6.55 to ‐0.63; participants=1255).
4.81.4 general health
The evidence from two trials suggests that in the short term, haloperidol may result in little to no improvement in the general health subscale compared to olanzapine (MD ‐2.93, 95% CI ‐5.31 to ‐0.55; participants=1255).
4.81.5 life vitality
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐6.80, 95% CI ‐10.93 to ‐2.68; participants=1255).
4.81.6 social function
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐5.70, 95% CI ‐12.20 to 0.81; participants=1255). There was a moderate level of heterogeneity amongst studies (Chi²=2.01, df=1.0; P=0.16; I²=50%).
4.81.7 emotional function
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐11.30, 95% CI ‐19.31 to ‐3.30; participants=1255). There was a moderate level of heterogeneity amongst studies (Chi²=1.85, df=1.0; P=0.17; I²=46%).
4.81.8 mental health
The evidence from two trials suggests that in the short term, haloperidol may result in a slight decrease in this subscale score compared to olanzapine (MD ‐5.11, 95% CI ‐7.28 to ‐2.94; participants=1255).
4.81.9 health change
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this subscale (MD ‐2.00, 95% CI ‐11.21 to 7.21; participants=100).
4.81.10 total score
The evidence from a single trial suggests that in the short term, haloperidol results in a large decrease in the total score compared to olanzapine (MD ‐14.20, 95% CI ‐20.50 to ‐7.90; participants=100).
4.81.11 health ‐ current
The evidence from a single trial suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this subscale (MD ‐0.02, 95% CI ‐0.57 to 0.53; participants=71).
4.82 Quality of life: 2d. Specific ‐ average endpoint score ‐ short term (QLS total, high=good, skewed data)
These continuous data (one RCT) had such large standard deviations as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present them in Analysis 4.82.
Note: We did not find any usable data for following outcomes related to the quality of life:
Average change score in quality of life
Leaving the study early
4.83 Leaving the study early: 1. Any reason
Thirty‐three total studies reported data for this outcome in the short (18 trials), medium (13 trials) and long term (six trials) ‐ with four studies reporting in more than one time‐period. Overall, haloperidol may result in a slight increase in the incidence of leaving the study early due to any reason, compared to olanzapine (RR 1.25, 95% CI 1.15 to 1.35; participants=8837). There was a substantial level of heterogeneity amongst studies (Chi2=119.67; df=36.0; P<0.00001; I2=70%; Analysis 4.83).
4.83.1 short term
The evidence from 18 trials suggests that in the short term, haloperidol may result in a slight increase in the incidence of leaving the study early due to any reason compared to olanzapine (RR 1.27, 95% CI 1.09 to 1.48; participants=4143). There was a moderate level of heterogeneity amongst studies (Chi2=29.43; df=17.0; P=0.03; I2=42%).
4.83.2 medium term
The evidence from 13 trials suggests that in the medium term, haloperidol may result in slight increase in the incidence of leaving the study early due to any reason compared to olanzapine (RR 1.40, 95% CI 1.16 to 1.69; participants=1609). There was a moderate level of heterogeneity amongst studies (Chi2=25.61; df=12.0; P=0.01; I2=53%).
4.83.3 long term
The evidence from six trials suggests that in the long term, haloperidol may result in little to no difference compared increase in leaving the study early due to any reason compared to olanzapine (RR 1.11, 95% CI 1.03 to 1.21; participants=3105). There was a substantial level of heterogeneity amongst studies (Chi2=23.6; df=5.0; P=0.0003; I2=79%).
4.84 Leaving the study early: 3a. Various reasons ‐ short term
We identified 21 studies relevant to this outcome, the data from which we divided into 15 subgroups (Analysis 4.84).
4.84.1 clinical deterioration
The evidence from five trials suggests that in the short term, haloperidol may result in an increase in clinical deterioration compared to olanzapine (RR 1.93, 95% CI 0.76 to 4.87; participants=227).
4.84.2 death
The evidence from two trials suggests that in the short term, haloperidol may result in a large reduction in death compared to olanzapine (RR 0.31, 95% CI 0.03 to 2.90; participants=324).
4.84.3 lack of efficacy
The evidence from 13 trials suggests that in the short term, haloperidol may result in a slight increase compared to olanzapine in this outcome (RR 1.29, 95% CI 0.93 to 1.80; participants=3722).
4.84.4 loss to follow‐up
The evidence from seven trials suggests that in the short term, haloperidol may result in a slight increase in loss to follow‐up compared to olanzapine (RR 1.22, 95% CI 0.84 to 1.77; participants=3092).
4.84.5 non‐compliance
The evidence from six trials suggests that in the short term, haloperidol may result in a slight increase in this outcome compared to olanzapine (RR 1.23, 95% CI 0.83 to 1.83; participants=2509).
4.84.6 not eligible/eligible but unwilling to continue
The evidence from three trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.11, 95% CI 0.93 to 1.33; participants=2694). There was a considerable level of heterogeneity amongst studies (Chi2=21.08; df=2.0; P=0.0001; I2=91%).
4.84.7 patient's decision
The evidence from seven trials suggests that in the short term, haloperidol may result in a large increase in the incidence of leaving the study early due to patient’s decision compared to olanzapine (RR 2.00, 95% CI 1.40 to 2.85; participants=2514).
4.84.8 physician decision
The evidence from four trials suggests that in the short term, haloperidol may result in an increase in leaving the study early due to physician decision compared to olanzapine (RR 1.97, 95% CI 0.71 to 5.49; participants=461).
4.84.9 protocol violation
The evidence from three trials suggests that in the short term, haloperidol may result in a large reduction in the incidence of leaving the study early due to protocol violation compared to olanzapine (RR 0.44, 95% CI 0.13 to 1.51; participants=606).
4.84.10 unspecified
The evidence from a single trial suggests that in the short term, haloperidol may result in an increase in leaving the study early for unspecified reasons compared to olanzapine (RR 1.54, 95% CI 0.97 to 2.46; participants=52).
4.84.11 violent behaviour
The evidence from a single trial suggests that in the short term, haloperidol may result in a large increase in leaving the study early due to violent behaviour compared to olanzapine (RR 2.55, 95% CI 0.11 to 58.60; participants=35).
4.84.12 withdrawal of informed consent
The evidence from four trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.12, 95% CI 0.46 to 2.70; participants=529).
4.84.13 personal conflict
The evidence from a single trial suggests that in the short term, haloperidol may result in a slight decrease in incidence of leaving study early due to a personal conflict compared to olanzapine in this outcome (RR 0.78, 95% CI 0.25 to 2.40; participants=276).
4.84.14 sponsor decision
The evidence from three trials suggests that in the short term, haloperidol may result in a slight decrease in incidence of leaving the study early due to sponsor decision, compared to olanzapine (RR 0.71, 95% CI 0.18 to 2.72; participants=2127).
4.84.15 withdrawal of informed consent
The evidence from four trials suggests that in the short term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.12, 95% CI 0.46 to 2.70; participants=529).
4.85 Leaving the study early: 3b. Various reasons ‐ medium term
We identified six medium term studies relevant to this outcome, the data from which we divided into 13 subgroups (Analysis 4.85).
4.85.1 diagnosis change
The evidence from a single trial suggests that in the medium term, haloperidol may result in a large increase in leaving the study early due to change in diagnosis, compared to olanzapine (RR 4.76, 95% CI 0.58 to 39.40; participants=46).
4.85.2 death
The evidence from two trials suggests that in the medium term, haloperidol may result in a large increase in leaving the study early due to death compared to olanzapine (RR 2.86, 95% CI 0.46 to 17.88; participants=346).
4.85.3 lack of efficacy
The evidence from six trials suggests that in the medium term, haloperidol may result in an increase in leaving the study early due to lack of efficacy compared to olanzapine (RR 1.71, 95% CI 0.92 to 3.17; participants=1109). There was a substantial level of heterogeneity amongst studies (Chi2=15.93; df=5.0; P=0.007; I2=69%).
4.85.4 loss to follow‐up
The evidence from two trials suggests that in the medium term, haloperidol may result in a slight decrease in leaving the study early due to loss to follow‐up compared to olanzapine (RR 0.80, 95% CI 0.35 to 1.81; participants=346).
4.85.5 non‐compliance
The evidence from a single trial suggests that in the medium term, haloperidol may result in a slight increase in leaving the study early due to non‐compliance compared to olanzapine (RR 1.25, 95% CI 0.64 to 2.48; participants=208).
4.85.6 patient's decision
The evidence from three trials suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.07, 95% CI 0.65 to 1.77; participants=546).
4.85.7 physician decision
The evidence from a single trial suggests that in the medium term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.86, 95% CI 0.37 to 2.01; participants=275).
4.85.8 protocol violation
The evidence from two trials suggests that in the medium term,haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.95, 95% CI 0.31 to 2.88; participants=346).
4.85.9 unspecified
The evidence from four trials suggests that medium term, haloperidol may result in a slight decrease in leaving the study early for unspecified reasons compared to olanzapine (RR 0.76, 95% CI 0.35 to 1.67; participants=863).
4.85.10 withdrawal/loss to follow up, patient’s decision
The evidence from two trials suggests that medium term, haloperidol may increase the incidence of leaving study early due to study withdrawal/loss to follow up due to the patient’s decision compared to olanzapine (RR 1.61, 95% CI 1.07 to 2.42; participants=254).
4.85.11 withdrawal of informed consent
The evidence from two trials suggests that medium term, haloperidol may result in a slight increase in the incidence of consent withdrawal of informed consent compared to olanzapine (RR 1.38, 95% CI 1.02 to 1.88; participants=517).
4.86 Leaving the study early: 3c. Various reasons ‐ long term
For this outcome we found six relevant studies, the data from which we divided into 7 subgroups (Analysis 4.86).
4.86.1 Loss to follow up
The evidence from a single trial suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 0.82, 95% CI 0.34 to 1.96; participants=256).
4.86.2 lack of efficacy
The evidence from six long term trials suggests that in the long term, haloperidol may result in a slight increase in leaving the study early due to lack of efficacy compared to olanzapine (RR 1.29, 95% CI 0.98 to 1.70; participants=1379).
4.86.3 patient decision
The evidence from two long term trials suggests that in the long term, haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.04, 95% CI 0.59 to 1.81; participants=300).
4.86.4 non‐compliance
The evidence from three long term trials suggests that in the long term, haloperidol may result in a slight increase in leaving the study early due to non‐compliance compared to olanzapine in this outcome (RR 1.38, 95% CI 0.64 to 2.96; participants=411).
4.86.5 physician decision
The evidence from two trials suggests that in the long term, haloperidol may result in an increase in leaving the study early due to physician decision compared to olanzapine in this outcome (RR 1.59, 95% CI 0.35 to 7.28; participants=300).
4.86.6 sponsor decision
The evidence from a single trial suggests that in the long term, haloperidol results in a decrease in leaving the study early due to sponsor decision, compared to olanzapine (RR 0.54, 95% CI 0.02 to 13.23; participants=256).
4.86.7 withdrawal, loss to follow up, patient decision
The evidence from a single trial suggests that in the long term, haloperidol may result in slight decrease in incidence of withdrawal of leaving the study early for various reasons (withdrawal, loss to follow‐up, patient decision) compared to olanzapine (RR 0.71, 95% CI 0.31 to 1.64; participants=111).
4.87 Leaving study early: 4a. Average time until discontinuation ‐ medium term (months)
The evidence from two trials suggests that in the medium term, haloperidol results in a considerably shorter average time until discontinuation compared to olanzapine (MD ‐4.53, 95% CI ‐5.18 to ‐3.88; participants=201; Analysis 4.87).
4.88 Leaving study early: 4b. Average time until discontinuation ‐ long term (months, skewed data)
Continuous data from one long term trial had such large standard deviation as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present a descriptive analysis in Analysis 4.88.
Service use
4.89 Service use: 1a. Admission to hospital after randomisation
The evidence from a single trial suggests that haloperidol may result in little to no difference compared to olanzapine in this outcome (RR 1.08, 95% CI 0.58 to 2.01; participants=153; Analysis 4.89).
4.90 Service use: 1b. Hospitalisation (skewed data)
Continuous data from one trial had such large standard deviation as to suggest that analysis within RevMan Web would be inadvisable. Therefore, we present a descriptive analysis in Analysis 4.90.
Note: We did not find any usable data for following outcomes related to service use:
Days in hospital
Economic outcomes
We did not find any study reporting usable data for economic outcomes.
Appendix 3. Dose comparison haloperidol versus olanzapine
Corresponding data, tables and figures for these additional analyses can be found at https://github.com/aellosa2024/Haloperidol_Olanzapine.
4.1 Global effect: clinically important change ‐ short‐term
We identified 17 studies relevant to this outcome and categorised the data into five subgroups (Analysis 5.1).
4.1.1 Any dose of olanzapine
We found three trials to be relevant to this subgroup. For this subgroup, we did not find a statistically significant difference between the two treatments (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.58 to 1.2; 2694 participants). For this outcome, heterogeneity was high (Chi2 = 14.92; df = 2.0; P = 0.0; I2 = 86%).
4.1.2 ‐ 1 mg olanzapine
There was a single trial in this subgroup. For this subgroup, we did not find a statistically significant difference between the two treatments (RR 1.18, 95% CI 0.83 to 1.67; 169 participants).
4.1.3 ‐ 5 mg olanzapine
There were two relevant trials in this subgroup. There was no significant difference between the two treatments within this subgroup (RR 1.09, 95% CI 0.84 to 1.42; 302 participants).
4.1.4 ‐ 10 mg olanzapine
There were two relevant trials in this subgroup. For this subgroup, we did not find a statistically significant difference between the two treatments (RR 0.96, 95% CI 0.75 to 1.23; 300 participants).
4.1.5 ‐ 15 mg olanzapine
We found two trials to be relevant to this subgroup. There was no significant difference between the two treatments within this subgroup (RR 0.86, 95% 0.75 to 0.98; 692 participants).
Data and analyses
Comparison 1. Comparison haloperidol vs olanzapine: main outcomes.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1.1 Global state: clinically important change | 6 | 3078 | Risk Ratio (IV, Random, 95% CI) | 0.84 [0.69, 1.02] |
| 1.1.1 Short‐term | 5 | 3007 | Risk Ratio (IV, Random, 95% CI) | 0.82 [0.66, 1.03] |
| 1.1.2 Medium‐term | 1 | 71 | Risk Ratio (IV, Random, 95% CI) | 0.95 [0.70, 1.30] |
| 1.2 Global state: relapse | 7 | 1499 | Risk Ratio (IV, Random, 95% CI) | 1.42 [1.00, 2.02] |
| 1.2.1 Short‐term | 1 | 350 | Risk Ratio (IV, Random, 95% CI) | 2.17 [1.48, 3.20] |
| 1.2.2 Medium‐term | 4 | 720 | Risk Ratio (IV, Random, 95% CI) | 1.06 [1.00, 1.12] |
| 1.2.3 Long‐term | 2 | 429 | Risk Ratio (IV, Random, 95% CI) | 2.04 [1.37, 3.03] |
| 1.3 Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score) | 13 | 1210 | Risk Ratio (IV, Random, 95% CI) | 0.70 [0.60, 0.81] |
| 1.3.1 Short‐term | 12 | 1008 | Risk Ratio (IV, Random, 95% CI) | 0.76 [0.64, 0.91] |
| 1.3.2 Medium‐term | 1 | 202 | Risk Ratio (IV, Random, 95% CI) | 0.55 [0.41, 0.73] |
| 1.4 Mental state: overall ‐ average endpoint score (PANSS, BPRS total scores, SMD, high = poor) | 40 | 5459 | Std. Mean Difference (IV, Random, 95% CI) | 0.41 [0.29, 0.53] |
| 1.4.1 Short‐term (PANSS, BPRS total scores) | 26 | 4144 | Std. Mean Difference (IV, Random, 95% CI) | 0.34 [0.21, 0.47] |
| 1.4.2 Medium‐term (PANSS, BPRS total scores) | 13 | 1271 | Std. Mean Difference (IV, Random, 95% CI) | 0.57 [0.28, 0.86] |
| 1.4.3 Long‐term (PANSS total score only) | 1 | 44 | Std. Mean Difference (IV, Random, 95% CI) | 0.38 [‐0.22, 0.97] |
| 1.5 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect | 14 | 3920 | Risk Ratio (IV, Random, 95% CI) | 3.38 [2.28, 5.02] |
| 1.5.1 Short‐term | 11 | 3530 | Risk Ratio (IV, Random, 95% CI) | 4.02 [2.58, 6.24] |
| 1.5.2 Medium‐term | 3 | 390 | Risk Ratio (IV, Random, 95% CI) | 1.75 [0.54, 5.73] |
| 1.6 Adverse effects/events: specific ‐ metabolic ‐ weight increase | 18 | 4302 | Risk Ratio (IV, Random, 95% CI) | 0.47 [0.35, 0.61] |
| 1.6.1 Increase ‐ short‐term | 14 | 3547 | Risk Ratio (IV, Random, 95% CI) | 0.46 [0.32, 0.66] |
| 1.6.2 Increase ‐ medium‐term | 2 | 388 | Risk Ratio (IV, Random, 95% CI) | 0.59 [0.46, 0.75] |
| 1.6.3 Increase ‐ long‐term | 2 | 367 | Risk Ratio (IV, Random, 95% CI) | 0.15 [0.05, 0.47] |
| 1.7 Quality of life: clinically important change in quality of life (≥ 20% increase in QLS endpoint score) | 1 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 1.7.1 Short‐term | 1 | 828 | Risk Ratio (IV, Random, 95% CI) | 0.72 [0.57, 0.91] |
| 1.7.2 Long‐term | 1 | 539 | Risk Ratio (IV, Random, 95% CI) | 0.79 [0.63, 1.00] |
| 1.8 Quality of life: overall ‐ average endpoint total score (various scales, SMD, high = good) | 11 | 1213 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.38 [‐0.66, ‐0.09] |
| 1.8.1 Short‐term ‐ GQOLT, Q‐LES‐Q, QLS, SF‐36 scales, high = good | 8 | 746 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.50 [‐0.87, ‐0.12] |
| 1.8.2 Medium‐term ‐ MANSA, QoL, S‐QoL scales (high = good) | 3 | 467 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.07 [‐0.40, 0.25] |
| 1.9 Leaving the study early: adverse effects | 21 | 5047 | Risk Ratio (IV, Random, 95% CI) | 1.99 [1.60, 2.47] |
| 1.9.1 Short‐term | 12 | 3527 | Risk Ratio (IV, Random, 95% CI) | 2.00 [1.49, 2.68] |
| 1.9.2 Medium‐term | 6 | 1109 | Risk Ratio (IV, Random, 95% CI) | 1.95 [1.25, 3.03] |
| 1.9.3 Long‐term | 3 | 411 | Risk Ratio (IV, Random, 95% CI) | 2.01 [1.24, 3.27] |
Comparison 2. Comparison haloperidol vs olanzapine: sensitivity analyses.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 2.1 Global state: clinically important change; sensitivity analysis (inadequate randomised, high attrition rate data excluded) | 5 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 2.1.1 Short‐term | 5 | 3007 | Risk Ratio (IV, Random, 95% CI) | 0.82 [0.66, 1.03] |
| 2.2 Global state: clinically important change; sensitivity analysis (fixed‐effect model applied) | 6 | 3078 | Risk Ratio (IV, Fixed, 95% CI) | 0.76 [0.69, 0.83] |
| 2.2.1 Short‐term | 5 | 3007 | Risk Ratio (IV, Fixed, 95% CI) | 0.74 [0.67, 0.81] |
| 2.2.2 Medium‐term | 1 | 71 | Risk Ratio (IV, Fixed, 95% CI) | 0.95 [0.70, 1.30] |
| 2.3 Global state: relapse: sensitivity analysis (inadequate randomised, high attrition rate data excluded) | 5 | 1227 | Risk Ratio (IV, Random, 95% CI) | 1.34 [0.91, 1.99] |
| 2.3.1 Short‐term | 1 | 350 | Risk Ratio (IV, Random, 95% CI) | 2.17 [1.48, 3.20] |
| 2.3.2 Medium‐term | 3 | 649 | Risk Ratio (IV, Random, 95% CI) | 1.06 [1.00, 1.12] |
| 2.3.3 Long‐term | 1 | 228 | Risk Ratio (IV, Random, 95% CI) | 2.12 [1.28, 3.51] |
| 2.4 Global state: relapse: sensitivity analysis (fixed‐effect model applied) | 7 | 1499 | Risk Ratio (IV, Fixed, 95% CI) | 1.09 [1.03, 1.16] |
| 2.4.1 Short‐term | 1 | 350 | Risk Ratio (IV, Fixed, 95% CI) | 2.17 [1.48, 3.20] |
| 2.4.2 Medium‐term | 4 | 720 | Risk Ratio (IV, Fixed, 95% CI) | 1.06 [1.00, 1.12] |
| 2.4.3 Long‐term | 2 | 429 | Risk Ratio (IV, Fixed, 95% CI) | 2.04 [1.37, 3.03] |
| 2.5 Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (inadequate randomised, high attrition rate data excluded) | 9 | 861 | Risk Ratio (IV, Random, 95% CI) | 0.71 [0.60, 0.84] |
| 2.5.1 Short‐term | 8 | 659 | Risk Ratio (IV, Random, 95% CI) | 0.80 [0.66, 0.98] |
| 2.5.2 Medium‐term | 1 | 202 | Risk Ratio (IV, Random, 95% CI) | 0.55 [0.41, 0.73] |
| 2.6 Mental state: overall ‐ clinically important change in overall mental state (≥ 50% reduction in PANSS endpoint score): sensitivity analysis (fixed‐effect model applied) | 13 | 1210 | Risk Ratio (IV, Fixed, 95% CI) | 0.70 [0.60, 0.81] |
| 2.6.1 Short‐term | 12 | 1008 | Risk Ratio (IV, Fixed, 95% CI) | 0.76 [0.64, 0.91] |
| 2.6.2 Medium‐term | 1 | 202 | Risk Ratio (IV, Fixed, 95% CI) | 0.55 [0.41, 0.73] |
| 2.7 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (inadequate randomised, high attrition rate data excluded) | 8 | 3440 | Risk Ratio (IV, Random, 95% CI) | 2.98 [2.04, 4.37] |
| 2.7.1 Short‐term | 7 | 3166 | Risk Ratio (IV, Random, 95% CI) | 3.38 [2.16, 5.31] |
| 2.7.2 Medium‐term | 1 | 274 | Risk Ratio (IV, Random, 95% CI) | 1.67 [0.67, 4.17] |
| 2.8 Adverse effects/events: specific ‐ extrapyramidal ‐ any effect: sensitivity analysis (fixed‐effect model applied) | 14 | 3920 | Risk Ratio (IV, Fixed, 95% CI) | 2.39 [2.13, 2.69] |
| 2.8.1 Short‐term | 11 | 3530 | Risk Ratio (IV, Fixed, 95% CI) | 2.42 [2.15, 2.73] |
| 2.8.2 Medium‐term | 3 | 390 | Risk Ratio (IV, Fixed, 95% CI) | 1.79 [0.98, 3.30] |
| 2.9 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (inadequate randomised trials excluded) | 14 | 3863 | Risk Ratio (IV, Random, 95% CI) | 0.46 [0.35, 0.60] |
| 2.9.1 Increase ‐ short‐term | 11 | 3364 | Risk Ratio (IV, Random, 95% CI) | 0.42 [0.29, 0.60] |
| 2.9.2 Increase ‐ medium‐term | 2 | 388 | Risk Ratio (IV, Random, 95% CI) | 0.59 [0.46, 0.75] |
| 2.9.3 Increase ‐ long‐term | 1 | 111 | Risk Ratio (IV, Random, 95% CI) | 0.14 [0.02, 1.10] |
| 2.10 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (high attrition rate data excluded) | 15 | 3939 | Risk Ratio (IV, Random, 95% CI) | 0.40 [0.28, 0.57] |
| 2.10.1 Increase ‐ short‐term | 12 | 3310 | Risk Ratio (IV, Random, 95% CI) | 0.41 [0.27, 0.63] |
| 2.10.2 Increase ‐ medium‐term | 1 | 262 | Risk Ratio (IV, Random, 95% CI) | 0.52 [0.34, 0.81] |
| 2.10.3 Increase ‐ long‐term | 2 | 367 | Risk Ratio (IV, Random, 95% CI) | 0.15 [0.05, 0.47] |
| 2.11 Adverse effects/events: specific ‐ metabolic ‐ weight increase: sensitivity analysis (fixed‐effect model applied) | 18 | 4302 | Risk Ratio (IV, Fixed, 95% CI) | 0.51 [0.44, 0.59] |
| 2.11.1 Increase ‐ short‐term | 14 | 3547 | Risk Ratio (IV, Fixed, 95% CI) | 0.49 [0.40, 0.58] |
| 2.11.2 Increase ‐ medium‐term | 2 | 388 | Risk Ratio (IV, Fixed, 95% CI) | 0.59 [0.46, 0.75] |
| 2.11.3 Increase ‐ long‐term | 2 | 367 | Risk Ratio (IV, Fixed, 95% CI) | 0.15 [0.05, 0.47] |
| 2.12 Leaving the study early: adverse effects: sensitivity analysis (inadequate randomised trials excluded) | 16 | 4301 | Risk Ratio (IV, Random, 95% CI) | 1.96 [1.55, 2.48] |
| 2.12.1 Short‐term | 9 | 3108 | Risk Ratio (IV, Random, 95% CI) | 1.88 [1.39, 2.54] |
| 2.12.2 Medium‐term | 5 | 1038 | Risk Ratio (IV, Random, 95% CI) | 1.90 [1.21, 2.97] |
| 2.12.3 Long‐term | 2 | 155 | Risk Ratio (IV, Random, 95% CI) | 2.66 [1.33, 5.33] |
| 2.13 Leaving the study early: adverse effects: sensitivity analysis (fixed‐effect model applied) | 21 | 5047 | Risk Ratio (IV, Fixed, 95% CI) | 1.99 [1.60, 2.47] |
| 2.13.1 Short‐term | 12 | 3527 | Risk Ratio (IV, Fixed, 95% CI) | 2.00 [1.49, 2.68] |
| 2.13.2 Medium‐term | 6 | 1109 | Risk Ratio (IV, Fixed, 95% CI) | 1.95 [1.25, 3.03] |
| 2.13.3 Long‐term | 3 | 411 | Risk Ratio (IV, Fixed, 95% CI) | 2.01 [1.24, 3.27] |
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Altamura (HGBQ) 1999.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, blocks for each investigator 1:1, concealed from investigators Blindness: double, medication kits issued Duration: 14 weeks (preceded by screening phase, unspecified) Design: multicentre, 1 week washout period | |
| Participants | Diagnosis: schizophrenia, paranoid (DSM‐IV) History: informed consent obtained N = 28* Age: not reported Sex: not clearly reported Setting: not reported Inclusion criteria: partial or non‐responders to treatment according to preset criteria | |
| Interventions |
|
|
| Outcomes | Leaving the study early Unable to use: Global state: CGI (no data) Mental state: BPRS, SANS (no usable data) Adverse events: AIMS, BAS, SAS (no usable data), weight gain (unpublished data with unclear denominator) |
|
| Notes | *Data supplied by company suggests 48 people were randomised and presents detailed results. Professor Altamura, however, in a personal communication suggests that these are projected figures and not true ratings. Unpublished data was received by previous review authors. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomisation schedule was generated based on block size, number of treatments, and number of investigative sites included in the study. The study drugs were assigned to medication kits by a computer‐generated random sequence in such a way that there was a 1:1 ratio of olanzapine‐ to haloperidol‐treated patients" |
| Allocation concealment (selection bias) | Low risk | Quote: "Patient numbers were assigned at Visit I of the study. Patients who met the inclusion criteria at Visit 2 were randomly allocated to double‐blind therapy groups olanzapine 1 or haloperidol at Visit 2 by the assignment of a unique kit number. The kit contained double‐blind study medication for the patient." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Patient numbers were assigned at Visit I of the study. Patients who met the inclusion criteria at Visit 2 were randomly allocated to double‐blind therapy groups olanzapine 1 or haloperidol at Visit 2 by the assignment of a unique kit number. The kit contained double‐blind study medication for the patient." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "In order to preserve the blinding of the study, a minimum number of Lilly personnel saw the randomization table and codes before the study was complete. Personnel at the study site did not have access to the study randomization list. Actual randomization was executed by the allocation of blinded study drug medication kits." |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Quote: "For the purpose of this study we considered only patients who had completed at least 4 weeks of treatment (N=24). The final sample thus included 13 patients (6 males, 7 females) assigned to olanzapine (mean dose 12.4 + 3.2 mg/day), and 11 patients (7 males, 4 females) assigned to haloperidol (mean dose 12.3 + 3.3 mg/day" |
| Selective reporting (reporting bias) | Unclear risk | Study protocol is not available. |
| Other bias | Low risk | No evidence of other bias |
Avasthi 2001.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: open‐label Duration: 12 weeks Design: parallel groups, with washout period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 27 Age: between 18 and 65 years Sex: male and female Setting: hospital and community Inclusion criteria: ≥ 3 on the CGI severity scale Excluded: hepatitis, jaundice, current agranulocytosis | |
| Interventions | 1. Olanzapine: dose range 5 to 20 mg/day (N = 17) 2. Haloperidol: dose range 5 to 20 mg/day (N = 10) | |
| Outcomes | Leaving the study early
Global state: CGI
Mental state: BPRS, PANSS‐P, PANSS‐N, MADRS, SANS
Adverse events: BAS, SAS, treatment emergent side effects
Quality of life: QoL
Weight gain Unable to use: Mental state: HAM‐S (no usable data) Adverse events: UKU (no data) |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "27 patients were randomised to treatment group" |
| Allocation concealment (selection bias) | Unclear risk | Unclear if the allocation was concealed. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "This was an open label study" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "This was an open label study" |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Initially, 30 patients were randomised, then 3 patients dropped out and it seems randomisation was repeated with 27 patients overall. Quote: "10 patients were randomized to haloperidol and 17 patients were randomized to olanzapine. In haloperidol group 7 patients completed the protocol, 2 patients were lost to follow up and 1 patient was dropped from the study as he developed severe side effects. In olanzapine group 16 patients completed the trial as per protocol and 1 patient was lost to follow up. Thus, 23 patients completed the protocol, 7 in haloperidol group and 16 in olanzapine group." It is unclear how this influenced the effect estimate. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol is not available. |
| Other bias | Unclear risk | There is no evidence of other bias. |
Barak 2002.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: open‐label Duration: 3 months Design: parallel‐group | |
| Participants | Diagnosis: schizophrenia (DSM IV); elderly History: mean length of illness 35.3 years, informed consent obtained N = 20 Age: range 68 to 83, mean 72.7 years Sex: 10 M, 10 F Setting: hospitalised Inclusion criteria: PANSS total score of > 50 | |
| Interventions | 1. Olanzapine: range: 5 to 25, dose 13.1 mg/day (N = 10) 2. Haloperidol: dose 7.2 mg/day (N = 10) | |
| Outcomes | Leaving the study early Global state: CGI Mental state: PANSS Weight change Additional medication | |
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients were then randomly assigned to either olanzapine (n=10) or haloperidol (n=10) treatment." |
| Allocation concealment (selection bias) | Unclear risk | It is unclear if the allocation was concealed. Quote: "The present open‐label study was conducted from January 1999 to January 2001 and included 20 elderly schizophrenic patients" |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "The present open‐label study was conducted from January 1999 to January 2001 and included 20 elderly schizophrenic patients" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "The present open‐label study was conducted from January 1999 to January 2001 and included 20 elderly schizophrenic patients" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The study reported levels and reasons for attrition. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Funded by pharmaceutical company. Quote: "This study was supported by an educational grant from Eli Lilly, Israel." |
Beasley (E003) 1997.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated ‐ blocks of 5, concealed from investigators Blindness: double, medication kits issued Duration: 6 weeks (preceded by placebo lead‐in of 4 to 7 days: 46 week extension for responders) Design: multicentre, 50 sites, Europe, South Africa, Israel and Australia | |
| Participants | Diagnosis: schizophrenia (DSM‐III‐R) History: informed consent obtained N = 431 Age: 18 to 65 Sex: 275 M, 156 F Setting: initially all in hospital* Inclusion criteria: BPRS > 23, CGI > 3, off neuroleptics prior to entering study, lead‐in period responders (BPRS total decreased by > 24%/< 24) excluded Excluded: substance misuse within last 3 months, suicide risk, Parkinson's disease, myasthenia gravis, hepatitis, jaundice, history of seizures, leukopenia | |
| Interventions | 1. Olanzapine (OLZ‐1): dose 1 mg/day (N = 88)
2. Olanzapine (OLZ‐L): dose 2.5 to 7.5 mg/day (N = 87)
3. Olanzapine (OLZ‐M): dose 7.5 to 12.5 mg/day (N = 86)
4. Olanzapine (OLZ‐H): dose 12.5 to 17.5 mg/day** (N = 89)
5. Haloperidol (HAL): dose 10 to 20 mg/day (N = 81) Up to 10 mg/day benzodiazepine (day 1 to 21) and biperiden up to 6 mg/day as required |
|
| Outcomes | Leaving the study early
Global state: CGI‐S
Mental State: BPRS***, needing additional benzodiazepines, PANSS
Death****
Adverse events: AIMS, BAS, requiring benztropine, SAS, COSTART list, weight change Unable to use: Hospital status: (no data) Global state: PGI (no data) Laboratory tests and physiological measures: (no data) |
|
| Notes | * Eligible for discharge if BPRS total decreased by > 24% from baseline or was < 24. ** Chosen as the comparator with other trials as mean dose = 13.2 mg/day. *** BPRS (scored 0 to 6) extracted from PANSS ‐ no reference given for validity of procedure. *** A priori efficacy > 39 decrease from baseline or to < 19 total. ****Deaths reported during the study or within 30 days of discontinuation. Unpublished data were received by previous review authors. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This randomized, double‐blind placebo‐controlled, parallel study compared olanzapine..." |
| Allocation concealment (selection bias) | Low risk | Quote: "This randomized, double‐blind placebo‐controlled, parallel study compared olanzapine..." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "This randomized, double‐blind placebo‐controlled, parallel study compared olanzapine..." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "This randomized, double‐blind placebo‐controlled, parallel study compared olanzapine..." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Quote: "There were relatively few discontinuations because of adverse events from all treatment groups." All attritions are reported with reasons. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Study funded by a pharmaceutical company. Quote: "The studies were sponsored by Eli Lilly and Company". |
Beasley (HGAD) 1996a.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, block by investigator, concealed from investigator Blindness: double, medication kits issued Duration: 6 weeks (preceded by placebo lead‐in of 4 to 7 days; 46‐week extension for responders) Investigators: trained on BPRS and SANS Design: dosage study | |
| Participants | Diagnosis: schizophrenia (DSM‐III‐R) History: acute exacerbation, informed consent obtained N = 335 Age: mode ~ 30s, range 18 to 65 Sex: ~ 90% M Setting: hospital and community Inclusion criteria: BPRS > 23, CGI > 3, off neuroleptics prior to study, lead‐in period responders (BPRS total decreased by > 24%/< 24) excluded Excluded: substance misuse within 3 months, serious suicidal risk, unstable medical illness, Parkinson's disease, myasthenia gravis, hepatitis, jaundice, history of seizures, leukopenia | |
| Interventions | 1. Olanzapine low: dose 2.5 to 7.5 mg/day (N = 65)
2. Olanzapine medium: dose 7.5 to 12.5 mg/day (N = 64)
3. Olanzapine high: dose 12.5 to 17.5 mg/day* (N = 69)
4. Haloperidol: dose 10 to 20 mg/day (N = 69)
5. Placebo (N = 68) Up to 10 mg/day lorazepam (day 1 to 21) and benztropine 6 mg/day as required |
|
| Outcomes | Leaving the study early
Global effect: CGI‐S
Mental state: BPRS‐anchored version**, needing additional benzodiazepines, SANS
Adverse events: AIMS, BAS, SAS, requiring benztropine, COSTART list, weight change Unable to use: Hospital status: (no data) Laboratory tests and physiological measures: (no data) |
|
| Notes | * Chosen as comparator with other trials as mean dose = 13.2 mg/day. ** A priori efficacy > 39 decrease from baseline or to < 19 BPRS total. Unpublished data were received by previous review authors. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "After the placebo lead‐in phase, patients eligible to continue the study were assigned by random allocation to one of 6 double‐blind treatment arms" |
| Allocation concealment (selection bias) | Low risk | Quote: "After the placebo lead‐in phase, patients eligible to continue the study were assigned by random allocation to one of 6 double‐blind treatment arms" |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "After the placebo lead‐in phase, patients eligible to continue the study were assigned by random allocation to one of 6 double‐blind treatment arms" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "After the placebo lead‐in phase, patients eligible to continue the study were assigned by random allocation to one of 6 double‐blind treatment arms" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data were available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | High risk | Study funded by a pharmaceutical company. Quote: "The studies were sponsored by Eli Lilly and Company". |
Bernardo (HGDD) 2001.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: double Duration: 4 weeks Design: parallel‐group | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: all experiencing acute psychosis (n = 11, first episode, neuroleptic naive), (n = 16 neuroleptic free after minimum washout of 7 days), informed consent obtained N = 27 Age: range 19 to 44 years, mean 28 Sex: M 17, F 10 Setting: inpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early Global improvement: CGI Mental state: BPRS, PANSS, PANSS‐P, PANSS‐N Adverse events: SAS, BAS | |
| Notes | Contact information to request additional data was out of date. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "4‐week prospective, randomised, double‐blind, parallel and comparative clinical trial" |
| Allocation concealment (selection bias) | Unclear risk | No information about allocation concealment |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | "4‐week prospective, randomised, double‐blind, parallel and comparative clinical trial" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | "4‐week prospective, randomised, double‐blind, parallel and comparative clinical trial" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data were available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "This research was supported by a grant from Lilly S.A. (Protocol F‐1D‐SP‐HGDD) to the Nuclear Psychiatric Group of IDIBAPS (Institut d’Investigacions Biomediques August Pi i Sunyer)." |
Boulay 2002.
| Study characteristics | ||
| Methods | Allocation: randomised (5 participants were pseudo‐randomised) Blindness: double Duration: 8 weeks Design: single centre, parallel treatment groups with 3 days washout period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: 5 years of disease (early phase), informed consent obtained N = 25* Age: 18 to 65, mean age HAL = 35, OLA = 33 years Sex: M 18, F 7 Setting: outpatient and inpatient Inclusion criteria: 1) early phase of disease (5 years of diagnosis), 2) in a medication transition phase, 3) PANSS total score of 60 to 100 Exclusion criteria: 1) a history of seizure disorder, 2) a history of traumatic brain injury resulting in loss of consciousness, 3) current alcohol or drug abuse, 4) having received depot neuroleptic treatment within the past 6 months, 5) developmental delay | |
| Interventions |
|
|
| Outcomes | Neurocognitive battery: 12 tests Mental state: PANSS Adverse effects: ESRS |
|
| Notes | *27 patients were initially randomised; 2 patients were lost to follow‐up. Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Because this trial is ongoing and remains blinded, these preliminary results focus on the four assessments prior to randomization", "Fourteen were randomized to olanzapine and 11 to haloperidol." |
| Allocation concealment (selection bias) | Low risk | Quote: "Patients in the current study were randomized to double‐blind treatment." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Because this trial is ongoing and remains blinded, these preliminary results focus on the four assessments prior to randomization" |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data on outcomes are available for all participants randomised |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "SPONSOR: Zyprexa Research Fund" |
Buchanan 2003.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no details Blindness: double Duration: 16 weeks Design: multicentre, parallel treatment groups, 2 weeks of washout period | |
| Participants | Diagnosis: schizophrenia or schizoaffective disorder (DSM‐IV) History: residual positive and/or negative symptoms, informed consent obtained N = 63 Age: not specified, mean 46, 42 years Sex: M 46, F 17 Setting: outpatient Inclusion criteria: 1) BPRS positive ≥ 8, 2) SANS negative ≥ 20, 3) partial response after 4‐week trial of 20 mg fluphenazine Exclusion criteria: 1) drug abuse or alcoholism, 2) organic brain disorders or mental retardation | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S Quality of life: QLS Mental state: BPRS, SANS Adverse effects: SAS, Maryland Psychiatric Research Center Tardive Dyskinesia Scale |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients who met the retrospective criteria for partial response and continued to meet admission criteria on completion of the 4‐ week open‐label fluphenazine trial were randomly assigned to a 16‐week double‐blind, parallel‐groups comparison of olanzapine versus haloperidol" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "16‐week double‐blind, parallel‐groups comparison of olanzapine versus haloperidol" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "These ratings were made by a nonblind pharmacist. All raters other than the nonblind pharmacist were blind to treatment assignment and deficit/nondeficit categorization." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Dropouts were clearly reported with corresponding reasons. Quote: "There were three non‐completers in each treatment group. In the olanzapine group, two patients met criteria for a clinically significant worsening of their symptoms and one patient was withdrawn because of alcohol abuse. In the haloperidol group, three patients met criteria for a clinically significant worsening of their symptoms." |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "Funded in part by the VA Capitol Network (VISN 5) Mental Illness Research, Education, and Clinical Center and by NIMH grants MH‐45074 and MH‐40279. Double‐blind medications were provided by Eli Lilly and Company." |
Chaudhry 2003.
| Study characteristics | ||
| Methods | Allocation: randomised, number assigned drug kits according to a randomisation list Blindness: double Duration: 24 weeks Design: multicentre, parallel treatment groups with washout period | |
| Participants | Diagnosis: schizophrenia (DSM IV) History: informed consent obtained N = 276 Age: 18 to 65, mean age Hal = 41.5, Olan = 40.7 years Sex: M 194, F 80 Setting: outpatient or inpatient Inclusion criteria: 1) women with negative urinary pregnancy test following reliable contraceptive method during the study, 2) BPRS total score of > 18 Exclusion criteria: not specified | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S Quality of life: QLS, WHOQOL‐BREF Mental state: PANSS, BPRS Adverse effects: SAS, BAS, AIMS, weight gain |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Drug kits were assigned a number according to a randomisation list produced onsite, then these numbered kits were consecutively allocated to patients in blocks of four stratified by country". |
| Allocation concealment (selection bias) | Low risk | Allocation sequence was concealed until participants were recruited and assigned to interventions. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "All personnel and patients involved in the present study were blinded to the treatment assigned until data analysis, at which point the data were unblinded to authorized personnel to allow analysis" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "All personnel and patients involved in the present study were blinded to the treatment assigned until data analysis, at which point the data were unblinded to authorized personnel to allow analysis" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data for reported outcomes are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "The present study was supported by Eli Lilly and Company" |
Crespo‐Facorro 2006.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: open‐label Duration: 3 years Design: 3 treatment groups, preceded by washout period if needed | |
| Participants | Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder, brief reactive psychosis or not otherwise specified psychosis (DSM‐IV) History: drug‐naive patients with first episode psychosis, informed consent obtained N = 174* Age: 15 to 60, mean 27 years Sex: M 108, F 66 Setting: inpatient or outpatient Inclusion criteria: no prior treatment with antipsychotic medication or, if previously treated, a total lifetime of adequate antipsychotic treatment of less than 6 weeks Exclusion criteria: mental retardation or substance dependence (except nicotine dependence) |
|
| Interventions |
|
|
| Outcomes | Global state: CGI Mental state: SANS, BPRS, SAPS Depression: H‐DRS, CDSS, Various tests on cognitive function Adverse effects: UKU, SARS, BAS, weight gain, ESRS, metabolic |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This is a prospective, randomised, flexible‐dose, open‐label study. Patients who agreed to participate were randomly assigned to treatment." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "open label", "First, as a practical clinical trial, patients and observers (BC‐F, IM, RP‐I) were not blinded to treatments in our study." |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "open label", "First, as a practical clinical trial, patients and observers (BC‐F, IM, RP‐I) were not blinded to treatments in our study." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The outcomes were available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | Different scales and measurements were prespecified, but no specific data were reported. |
| Other bias | Low risk | There is no evidence of other bias. |
Cui 2016e.
| Study characteristics | ||
| Methods | Allocation: randomised, random number table Blindness: not reported Duration: 6 weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: average PANSS positive and negative score in OLA group 96.07 ± 16.21, in HAL group 98.27 ± 15.49 N = 160 Age: mean 56.5 years Sex: M 93, F 67 Setting: inpatients and outpatients Inclusion criteria: no allergy, serious body diseases or women who are pregnant or lactating | |
| Interventions |
* No use of other antipsychotics in the trial. |
|
| Outcomes | Leaving the study early: 0/160 Mental state: (PANSS) Unable to use: Adverse events: 36/80 in HAL group and 41/80 in OLA group; no specific adverse events Weight gain reported as BMI mean value; HDL and TG increase also reported as mean value |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomisation was performed using a random number table. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not reported. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Not reported. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data were available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
de Hann 2003.
| Study characteristics | ||
| Methods | Allocation: randomised, block design Blindness: double Duration: 6 weeks Design: parallel‐group | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: recent onset schizophrenia, informed consent obtained N = 24 Age: 17 to 28 years Sex: male and female Setting: hospital and community Inclusion criteria: not reported Excluded: neurological or endocrine disease, mental retardation, use of adjunctive medication such as mood stabilisers or antidepressants, history of clozapine treatment, or history of unresponsiveness to haloperidol or olanzapine and intramuscular antipsychotic treatment within a year | |
| Interventions |
Additional medication: benzodiazepine, oxazepine, oxazepam |
|
| Outcomes | Leaving the study early
Mental state: PANSS, MADRS
Subjective Wellbeing Under Neuroleptic Scale Unable to use: Global state: CGI (no usable data) Adverse events: SAS, BAS (no usable data) |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This prospective, randomized, double‐blind study was conducted..." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double‐blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "double‐blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data were available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Dhar 2010.
| Study characteristics | ||
| Methods | Allocation: randomised based on table; concealment not applicable Blindness: open‐label Duration: 6 months Design: 2 treatment groups | |
| Participants | Diagnosis: schizophrenia (ICD‐10) History: drug‐naive patients, psychosis, informed consent obtained N = 40 Age: 18 to 65 Sex: male and female Setting: inpatient or outpatient Inclusion criteria: 1) patients having normal intelligence, 2) patients should have been drug naive for at least 2 weeks prior to the baseline assessments Exclusion criteria: 1) history of poor response or hypersensitivity to olanzapine or haloperidol, 2) co‐morbid substance related disorders except nicotine and caffeine, 3) chronic medical illness, neurological disorders, head injury, tumours, movement disorder, pregnant and lactating females, 4) any condition which affected the quality of life | |
| Interventions |
|
|
| Outcomes | Mental state: effective (≥ 50% decline in total score of PANSS) Adverse effects: ESRS, metabolic, sexual Physiological measures: serum electrolytes, QTc interval Quality of life: WHOQOL‐BREF Hindi |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "20 patients each were assigned to haloperidol and olanzapine group based on random table". |
| Allocation concealment (selection bias) | Unclear risk | Quote: "It was an open label comparative longitudinal study with an intent to treat analysis" |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "It was an open label comparative longitudinal study with an intent to treat analysis" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "It was an open label comparative longitudinal study with an intent to treat analysis" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data for reported outcomes are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Ding 2013.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: single hospital Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: used more than 2 antipsychotics in last 5 years, to CPZ equivalent to 600 mg, continuously used for 6 weeks with no improvement or low efficacy; socially disabled; PANSS scores ≥ 60 N = 76 Age: average 27 ± 6 years Sex: male 42, female 34 Setting: hospitalised Excluded: patients with serious diseases of liver, brain, heart, kidney | |
| Interventions | 1. Olanzapine: dose 5 mg/d, range 10 to 25 mg/d (N = 38)
2. Haloperidol: dose 6 mg/d, range 20 to 40 mg/d (N = 38) Benzodiazepine as required to treat serious insomnia |
|
| Outcomes | Leaving the study early: 0/76 Global state: no clinical improvement Mental state: PANSS Adverse effects: sleepy, dry mouth, weight gain, blurred vision, palpitations, nausea, constipation, insomnia, akathisia, hypermyotonia, tremor, elevated transaminase |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No evidence of blinding. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Gründer (NeSSy) 2012.
| Study characteristics | ||
| Methods | Allocation: randomised by random number table, concealed drug packages Blindness: double Duration: 24 weeks Design: multicentre, 4 treatment blocks | |
| Participants | Diagnosis: schizophrenia (ICD 10 F20.X) History: informed consent obtained N = 136* Age: 18 to 65, mean age 35 years Sex: M 92, F 44 Setting: inpatient** Inclusion criteria: 1) history of schizophrenia with occurrence of the first psychotic episode between 1 and 20 years, 2) necessity to establish new or change antipsychotic treatment due to unsatisfying results or side effects Exclusion criteria: 1) hypersensitivity to drugs, 2) acute suicidal tendency, 3) "Einwilligungsvorbehalt (BGB)" or "Unterbringung (PsychKG)", 4) organic psychosis, 5) Parkinson disease, 6) dementia, 7) history of malignant neuroleptic syndrome, 8) QTc interval ≥ 0.5 s/history of congenital QTc prolongation | |
| Interventions |
|
|
| Outcomes | Global state: CGI score Contentment with treatment: SF36 Health Survey Mental state: PANSS General functioning: FAS, SWN‐K, PSP Physiological measures: ECG, cholesterol, glucose, triglycerides |
|
| Notes | *149 patients were randomly assigned, 136 were included in analysis **Not specified Some additional data and clarifications made through contact with the corresponding author of the study. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomisation process for an individual patient was done in two steps prepared by one combined random number table and the allocation concealment was ensured by blinded drug package supply." |
| Allocation concealment (selection bias) | Low risk | Quote: "the allocation concealment was ensured by blinded drug package supply" |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double blind", "the allocation concealment was ensured by blinded drug package supply" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "double blind", "the allocation concealment was ensured by blinded drug package supply" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data available for all randomised participants. |
| Selective reporting (reporting bias) | High risk | The study did not report the results of some outcome measures that were detailed in the methods section. There was evidence of selective reporting. |
| Other bias | Unclear risk | Reported conflict of interest. |
HGCJ (Hong Kong) 1998.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, blocks, 1:1 for each investigator, concealed from investigators Blindness: double, medication kits issued Duration: 14 weeks Design: parallel groups | |
| Participants | Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder (DSM‐IV) History: not reported N = 31 Age: not reported Sex: not reported Setting: inpatients and outpatients Inclusion criteria: screening used, no further details | |
| Interventions |
|
|
| Outcomes | Leaving the study early
Global state: CGI‐S
Mental state: BPRS, MADRS, PANSS
Adverse events: COSTART list, weight change Unable to use: Adverse events: extrapyramidal (no data) |
|
| Notes | Unpublished data were received by previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was performed on the basis of clusters, or blocks, for each investigator, such that patients within a block for a given investigator were randomised in a 1:1 ratio" |
| Allocation concealment (selection bias) | Low risk | Quote: "The randomisation schedule was internally computer‐generated at Eli Lilly & Company using permuted block randomisation. The randomisation scheme was generated based on block size, number of treatments, and number of investigative sites included in the study.", "Patient numbers were assigned at Visit 1 of the study. Patients who met all criteriafor enrolment were randomly allocated to double‐blind therapy groups olanzapine or haloperidol at Visit 2 by the assignment of a unique kit number. The kit contained double‐blind study medication for the patient." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "were randomly allocated to double‐blind therapy groups olanzapine or haloperidol" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "were randomly allocated to double‐blind therapy groups olanzapine or haloperidol" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
HGCU (Taiwan) 1998.
| Study characteristics | ||
| Methods | Allocation: randomised, blocks, computer‐generated, 1:1 for each investigator, concealed from investigators Blindness: double, medication kits issued Duration: 14 weeks Design: multicentre, 4 sites | |
| Participants | Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder (DSM‐IV) History: not reported N = 54 Age: not reported Sex: not reported Setting: inpatients and outpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early
Global state: CGI‐S
Mental state: BPRS, MADRS, PANSS
Adverse events: COSTART list, weight change Unable to use: Adverse events: extrapyramidal (no data) |
|
| Notes | Unpublished data were received by previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This was a randomised, double‐blind study consisting of two study periods" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Quote: "The severity of illness and demographics among treatment groups were comparable at the baseline" |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Double blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
HGFH (Korea) 1998.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, blocks for each investigator, 1:1 Blindness: open‐label Duration: 6 weeks (preceded by washout phase, unspecified; extension for responders) Design: single centre, Korea | |
| Participants | Diagnosis: schizophrenia, schizophreniform and schizoaffective disorder (DSM‐IV) History: not reported N = 104 Age: not reported Sex: not reported Setting: inpatients and outpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early Adverse events: COSTART list, weight gain | |
| Notes | Unpublished data were received by previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomised, computer‐generated, blocks for each investigator. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "open label" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "open label" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | There is no evidence of other bias. |
Hu 2014i.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not mentioned Duration: 12 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3), BPRS ≥ 35 History: average course of diseases 1.5 ± 0.3 years, informed consent N = 100 Age: 62 to 74 years Sex: male = 57, female = 43 Setting: inpatients Excluded: not reported | |
| Interventions |
|
|
| Outcomes | Adverse events: extrapyramidal symptoms Leaving the study early: 0/100 Unable to use: Mental state: BPRS (no numerical data) |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data were available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Ishigooka 2001.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: double Duration: 8 weeks Design: multicentre, 67 investigative institutions in Japan | |
| Participants | Diagnosis: schizophrenia (ICD‐10) History: informed consent obtained N = 182 Age: 18 to 65 years Sex: male and female Setting: inpatients and outpatients. Inclusion criteria: not reported Excluded: previous olanzapine treatment or haloperidol within the previous 2 weeks, serious illness, seizures, pregnancy, leukopenia, granulocytopenia, Parkinson's disease | |
| Interventions |
|
|
| Outcomes | Leaving the study early Mental state: BPRS, PANSS, PANSS‐N, PANSS‐P Adverse events: ADR, DIEPSS, treatment emergent side effects Death Unable to use: Global state: FGIR (scale not validated) Physiological measurements: (no SD) |
|
| Notes | Contact with author for further information from previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients (n = 182) were randomly assigned to treatment with olanzapine or haloperidol over a period of 8 weeks." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Quote: "double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Quote: "double blind". No further details were specified. |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Outcome data are not available for all randomised participants. A considerable number of participants were lost to follow‐up. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "This study was sponsored by Eli Lilly and Company." |
Jiang 2009b.
| Study characteristics | ||
| Methods | Allocation: randomised, randomly divided into 2 groups Blindness: not reported Duration: 3 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: PANSS ≥ 60, PANSS excitation ≥ 4, at least 2 of the 4 scores of PANSS should be qualified as P4 (excitability) ≥ 4, G8 (noncooperation) ≥ 4, P7 (hostility) ≥ 4, G14 (impulse control disorder) ≥ 4 N = 116 Age: mean 32 years Sex: male = 66, female = 50 Setting: inpatients Excluded: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early: 0/116 Global state: no improvement Mental state: (PANSS and PANSS‐excitation scores) Adverse events: TESS |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomised, randomly divided into 2 groups. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Jones 1998 (P022).
| Study characteristics | ||
| Methods | Allocation: random, computer‐generated, blocks by investigator, concealed from investigator Blindness: double Duration: 54 weeks (preceded by 1‐month stabilisation phase followed by 1‐week washout, screening period) Design: multicentre, Canada | |
| Participants | Diagnosis: schizophrenia History: 'early phase', first 5 years of illness N = 65 Age: mean 28.9 years Sex: male and female Setting: outpatients Inclusion criteria: not reported Excluded: PANSS > 90 | |
| Interventions |
|
|
| Outcomes | Leaving the study early Mental state: PANSS Adverse events: treatment emergent side effects, ESRS, COSTART list, weight change Unable to use: Cost: (no data) Cognitive function: CGI‐S, neuropsychological test battery (no usable data) |
|
| Notes | Unpublished data were received by previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A computer‐generated random number table was used to assign each medication to a subject number assigned in sequential order of recruitment" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Quote: "There were no significant differences at baseline between the olanzapine, haloperidol, or risperidone treatment groups with respect to age, sex, education, premorbid intellect, age of onset, or duration of illness (Table1 )." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double‐blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "double‐blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all randomised participants. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Kahn (EUFEST) 2005.
| Study characteristics | ||
| Methods | Allocation: randomised, computer generated, ratio 1:1:1:1:1 Blindness: open‐label Duration: 12 months Design: 5 treatment groups | |
| Participants | Diagnosis: schizophrenia, schizophreniform disorder, schizoaffective disorder (DSM‐IV) History: first episode psychosis, informed consent obtained N = 498* Age: 18 to 40, mean 26 years Sex: M 298, F 200 Setting: inpatient or outpatient Inclusion criteria: 1) duration of illness less than 2 years, 2) no prior treatment with antipsychotic medication or, if previously treated, a total lifetime of adequate antipsychotic treatment of less than 6 weeks Exclusion criteria: 1) known to be intolerant to the study drugs, 2) the presence of one or more contraindications against the study drugs | |
| Interventions |
|
|
| Outcomes | Global state: CGI Relapse Mental state: SANS, BPRS, SAPS Depression: H‐DRS, CDSS, SDS Quality of life: MANSA Functioning: RAVLT Adverse effects: UKU, SARS, BAS, weight gain, ESRS |
|
| Notes | Some additional data and clarifications were received through contact with the corresponding authors of the study. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients were randomly assigned by a dedicated web‐based online system—which was developed in house by the Data Management Department of the Julius Center for Health Sciences and Primary Care (version 1.2)—to daily doses of: haloperidol 1–4 mg, amisulpride 200–800 mg, olanzapine 5–20 mg, quetiapine 200–750 mg, or ziprasidone 40–160 mg." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "Patients and their treating physicians were not blinded to the assigned treatment.", "Our trial was an open trial, in which patients may respond better to treatment than in double‐blind trials." |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "Patients and their treating physicians were not blinded to the assigned treatment", "Our trial was an open trial, in which patients may respond better to treatment than in double‐blind trials." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data were available for all randomised participants. Also, the number of observed outcome events is much lower than the missing outcome data. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "Funding/support: This study was funded by the European Group for Research in Schizophrenia (EGRIS; Utrecht, the Netherlands) with grants from 3 pharmaceutical companies: AstraZeneca (Södertälje, Sweden), Pfizer (New York, NY), and sanofi‐aventis (Paris, France)." |
Kinon 2004.
| Study characteristics | ||
| Methods | Allocation: randomised, 1:1 ratio Blindness: double Duration: 3 weeks Design: multicentre, parallel‐group study with 24 hours washout period | |
| Participants | Diagnosis: schizophrenia or schizoaffective disorder (unspecified classification) History: acutely agitated, informed consent obtained N = 100 Age: 18 to 50, mean age 39 years Sex: M 71, F 29 Setting: inpatient Inclusion criteria: 1) acutely agitated patients, 2) CGI‐S > 4, 3) PANSS agitation > 20 Exclusion criteria: 1) pregnant or lactating women, 2) serious unstable illnesses (hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, neurologic, immunologic or haematologic disease) | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S Mental state: OAS, PANSS Adverse effects: BAS, SAS Other: mTS (modified tranquilisation scale) Leaving the study early |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "One hundred newly admitted inpatients were randomised 1:1 into two treatment groups: olanzapine plus lorazepam as needed or haloperidol plus lorazepam as needed". |
| Allocation concealment (selection bias) | Unclear risk | Quote: "Double blind" |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Double blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Data are available for all randomised participants. |
| Selective reporting (reporting bias) | High risk | The study did not report the results of all outcome measures that were detailed in the methods section. There was evidence of selective reporting. |
| Other bias | Low risk | There is no evidence of other bias. |
Krakowski 2006.
| Study characteristics | ||
| Methods | Allocation: randomised, 3 treatment blocks, concealed from investigator Blindness: double Duration: 12 weeks with 2‐week washout period Design: single centre | |
| Participants | Diagnosis: schizophrenia or schizoaffective disorder (DSM‐IV) History: physical assault and aggressive event, informed consent obtained N = 110 Age: 18 to 60, mean age (Hal) 33, (Olan) 35 years Sex: M 90, F 20 Setting: inpatient Inclusion criteria: 1) confirmed episode of physical assault, 2) persistence of aggression, 3) PANSS ≥ 4 Exclusion criteria: 1) over 1 year of hospitalisation, 2) prior non‐response or intolerance to the medications, 3) non‐compliant medical conditions, 4) received depot antipsychotics within 30 days before randomisation | |
| Interventions |
The first 6 weeks were escalation and fixed‐dose period and the last 6 weeks were variable‐dose period. |
|
| Outcomes | Mental state: MAOS, PANSS General functioning: CGI Adverse effects: ESRS, metabolic changes Leaving the study early |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients were randomly assigned to one of the 3 treatment arms", "The study used a block randomisation scheme with block size of 3". |
| Allocation concealment (selection bias) | Low risk | Quote: "Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)", Quote: "Raters blind to treatment group performed all clinical research assessments. Study procedures were identical for all three groups to conceal medication assignment." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)" |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Some outcomes have considerable dropouts. Quote: "When we define a substantial weight gain as an increase of 7% or more in body weight, we find that 20.6% (7 out of 34) of the clozapine patients, 30% (9 out of 30) of the olanzapine patients and 0% (none out of 31) of the haloperidol patients evidenced a substantial weight gain." |
| Selective reporting (reporting bias) | High risk | The study did not report the results of some prespecified outcomes. |
| Other bias | Unclear risk | Quote: "Eli Lilly and Company and Novartis Pharmaceuticals Corporation provided medications for the study. Eli Lilly and Company contributed supplemental funding for encapsulation of the medications. Overall experimental design, data acquisition, statistical analyses, and interpretation of the results were implemented with no input from any of the pharmaceutical companies. Neither Dr Krakowski nor Dr Czobor have any conflict of interest to report." |
Lahti 2007.
| Study characteristics | ||
| Methods | Allocation: randomised; no further details Blindness: double Duration: 6 weeks, with 2 weeks of pre‐randomisation washout period Design: single centre | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 29 Age: 19 to 60, mean age (Hal) 38, (Olan) 36 years Sex: M 22, F 7 Setting: inpatient Inclusion criteria: diagnosis of schizophrenia by DSM‐IV Exclusion criteria: comorbid diseases; no further details | |
| Interventions |
|
|
| Outcomes | Mental state: BPRS Adverse effects: extrapyramidal H215O PET scanning |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients who completed the off‐drug scan were blindly randomised to one of the following four groups: (1) haloperidol fixed dose (10 mg) for 6 days followed by haloperidol optimal dose (range 10–20 mg) for 5 weeks (HAL–HAL), (2) olanzapine fixed dose (12.5 mg) for 6 days followed by olanzapine optimal dose (range 12.5–25 mg) for 5 weeks (OLZ–OLZ)," |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Patients who completed the off‐drug scan were blindly randomised to one of the following four groups:" Quote: "Medications were prepared in similar‐looking capsules by the hospital pharmacist. Medication adjustments were made blindly by the treated psychiatrists in increments of 5mg for haloperidol and 6mg for olanzapine." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Patients who completed the off‐drug scan were blindly randomised to one of the following four groups:" Quote: "Medications were prepared in similar‐looking capsules by the hospital pharmacist. Medication adjustments were made blindly by the treated psychiatrists in increments of 5mg for haloperidol and 6mg for olanzapine." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "This work was supported by the National Institute of Mental Health grants RO1MH57971 andMH081014 (ACL)." |
Li 2005f.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 2 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: acute phrase of schizophrenia (CCMD‐3) with excitation and agitation symptoms, History: PANSS ≥ 60, PANSS excitation ≥ 4, at least 1 of the 5 scores of PANSS non‐cooperation/hostile/nervousness/pretension/mannerism ≥ 4, average course of diseases in OLA group = 80.7 ± 7.9 months, in HLA group = 77.2 ± 6.5 months N = 60 Age: mean 34 years Sex: male = 27, female = 33 Setting: inpatients Excluded: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early: 0/60 Global state: no improvement Mental state: (PANSS and PANSS‐excitation and agitation scores) Adverse events: TESS |
|
| Notes | No contact information was available to request additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Baseline differences between intervention groups do not suggest a problem with the randomisation process. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was reported. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding was reported. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Lieberman (HGDH) 2003.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: double Duration. 12 weeks (acute phase) Design: multicentre, 14 sites, North America and Europe | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: first episode schizophrenia, informed consent obtained N = 263 Age: 16 to 40 Sex: M 215, F 48 Setting: not clear Inclusion criteria: scored ≥ 4 on at least 2 positive and negative syndrome scale and CGI ≥ 4 Exclusion criteria: 1 month of substance abuse; previously received antipsychotics for more than 16 cumulative weeks, had been treated with clozapine at any time, or had a depot neuroleptic within 3 dosing intervals before study entry; pregnancy/nursing; serious unstable illness | |
| Interventions |
Additional medication: chloral hydrate, lorazepam, diazepam, benztropine, biperiden, propranolol, procyclidine |
|
| Outcomes | Leaving the study early Global state: CGI Mental state: PANSS, MADRS Adverse events: requiring anticholinergics, benzodiazepines, propranolol, treatment‐emergent parkinsonism, akathisia, weight gain |
|
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Patients currently receiving antipsychotics underwent a washout period of between 2 and 14 days, depending on their clinical status, after which they were randomly assigned to treatment with olanzapine or haloperidol" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Patients currently receiving antipsychotics underwent a washout period of between 2 and 14 days, depending on their clinical status, after which they were randomly assigned to treatment with olanzapine or haloperidol under double‐blind conditions." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Patients currently receiving antipsychotics underwent a washout period of between 2 and 14 days, depending on their clinical status, after which they were randomly assigned to treatment with olanzapine or haloperidol under double‐blind conditions." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. No evidence of selective reporting. |
| Other bias | Unclear risk | Quote: "This research was funded by Eli Lilly & Co, which did not participate in the design and conduct of the study, collection management, analysis, interpretation of the data, or preparation of the manuscript. The final manuscript was sent to the Eli Lilly for review and approval, however this did not change the data analysis or results presented. The study was additionally supported by NIH grant MH085948." |
Lilly (HGGN) 2000.
| Study characteristics | ||
| Methods | Allocation: randomised; no further details Blindness: double Duration: 52 weeks Design: multicentre, parallel treatment groups with 3 study periods with washout period | |
| Participants | Diagnosis: schizophrenia, schizoaffective disorder (DSM‐IV) History: informed consent obtained N = 414 Age: 18 to 55, mean age 39 years Sex: M 194, F 80 Setting: outpatient or inpatient Inclusion criteria: 1) PANSS total score ≥ 4 for each subscale, 2) BPRS total score ≥ 18, 3) illness duration of at least 2 years, 4) women of childbearing potential using proper contraception Exclusion criteria: 1) previously participated in the present study, 2) any significant neurological disorder, 3) QTc interval greater than 450 ms, 4) uncorrected hypo‐ or hyperthyroidism, current agranulocytosis, 5) female patients who were either pregnant or nursing, 6) allergic reaction to study medication, 7) DSM‐IV substance dependence, 8) treatment with depot antipsychotics, 9) reversible monoamine oxidase inhibitor within 2 weeks, or clozapine or electroconvulsive therapy | |
| Interventions |
|
|
| Outcomes | Relapse: ≥ 20% increase in PANSS score Neurocognitive domain: various scales Mental state: response (≥ 20% decline in total score of positive sub‐scales PANSS) Adverse effects: SAS, BAS, AIMS Physiological measures: cholesterol, glucose, triglycerides |
|
| Notes | *There were difficulties with recruitment. Contacting the corresponding study authors for additional data was unsuccessful. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Patients (N =414) were double‐blind randomised (1 :1:1 ratio) to 52 weeks of treatment with olanzapine (5 to 20 mg/day), risperidone (2 to 10 mg/day), or haloperidol (2 to 19 mg/day)." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Baseline differences between intervention groups do suggest a problem with the randomisation process. Quote: "These baseline characteristics (demographic) were not significantly different when comparing patients randomised before versus after the haloperidol arm was dropped. However, mean PANSS positive score for patients randomised prior to dropping the haloperidol arm was significantly lower when compared to patients randomised after the haloperidol arm was dropped (20.8 vs 22.1, respectively; t(412)=2.7, p =0.007)." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Patients (N =414) were double‐blind randomised (1 :1:1 ratio) to 52 weeks of treatment " |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Quote: "Patients (N =414) were double‐blind randomised (1 :1:1 ratio) to 52 weeks of treatment ". Blinding of outcome assessment was not clearly reported. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. |
| Other bias | Unclear risk | Quote: "The studies were sponsored by Eli Lilly and Company". |
Lilly (S029) 2007.
| Study characteristics | ||
| Methods | Allocation: randomised no further details Blindness: double Duration: 12 months Design: multicentre, parallel treatment groups with 3 study periods with washout period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 275 Age: 18 to 65, mean age Hal = 41.5, Olan = 40.7 years Sex: M 194, F 80 Setting: outpatient or inpatient Inclusion criteria: 1) women with negative urinary pregnancy test following reliable contraceptive method during the study, 2) received a stable dose of the same conventional antipsychotic drug ≥ 8 weeks before 3) PANSS score ≥ 49 Exclusion criteria: 1) schizophreniform or a schizo‐affective disorder (DSM‐IV), 2) substance dependence or substance abuse, 3) receiving atypical antipsychotic drug during the 8 weeks preceding, 4) history of resistance to antipsychotic drugs, 5) hospitalisation in a psychiatric unit or in a psychiatric emergency department within the preceding 8 weeks, 6) presence of serious unstable disease | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S, CGI‐I, CGI‐distress Relapse: hospitalisation, ≥ 25% increase in PANSS score, CGI score = 6/7, suicide attempt Quality of life: social interactions measurement tool, SCD, S‐QoL Mental state: effective (≥ 30% decline in total score of positive sub‐scales PANSS) Adverse effects: SAS, the Barnes Akathisia Scale, AIMS, weight gain Physiological measures: ECG, cholesterol, glucose, triglycerides |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This study was a multi‐centre double‐blind, randomised, parallel‐group study with three study periods". |
| Allocation concealment (selection bias) | Low risk | The allocation sequence was possibly concealed until participants were recruited and assigned to interventions. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "This study was a multi‐centre, double‐blind, randomised, parallel‐group study with three study periods." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Outcome assessors may become aware of the intervention received by study participants due to obvious adverse effects. Quote: "This study was a multi‐centre, double‐blind, randomised, parallel‐group study with three study periods." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Unclear risk | Quote: "The study was sponsored by Eli Lilly and Company". |
Lilly 2006a.
| Study characteristics | ||
| Methods | Allocation: randomised, ratio 1:1 Blindness: open‐label Duration: 9 months Design: multicentre, parallel treatment groups with 3 study periods with washout period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: schizophrenia less than 10 years, informed consent obtained N = 71 Age: 18 to 55, mean 31 years Sex: M 43, F 28 Setting: inpatient and outpatient Inclusion criteria: schizophrenia less than 10 years Exclusion criteria: existence of physical and significant hepatic, cardiovascular, renal, gastroenterological, respiratory, endocrine, neurological, immunological or haematological disease or cancer | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S Relapse: a significant increase in CGI‐S scale Quality of life: QoLI Mental state: BPRS, PANSS Adverse effects: SAS, BAS Physiological measures: ECG |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "A total of 71 patients were randomly assigned in a 1:1 ratio to either of the two treatment groups. Thirty‐one patients entered the olanzapine group and 40 entered the haloperidol group". Sample size in intervention groups differs; in addition, there are statistically significant differences in baseline PANSS and characteristics. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Sample size in intervention groups differs; in addition, there are statistically significant differences in baseline PANSS and characteristics. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "This was a prospective, open‐label, randomised..." |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "This was a prospective, open‐label, randomised" |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | For some outcomes, data are not available for 20% of participants in the olanzapine group and 17.1% of participants in the haloperidol group. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Unclear risk | Quote: "The studies were sponsored by Eli Lilly and Company". |
Lin 2008.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 6 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: first‐episode schizophrenia History: course of disease 1 to 12 months, PANSS ≥ 60, first‐onset schizophrenic patients without systemic antipsychotic treatment N = 150 Age: 16 to 60 years Sex: male = 81, female = 69 Setting: inpatients and outpatients Excluded: not reported | |
| Interventions |
|
|
| Outcomes | Global state: no improvement Mental state: (PANSS) Unable to use: Adverse events: liver dysfunction, weight gain, drowsiness, constipation in olanzapine group, drowsiness, dry mouth, blurred vision. All have no data. |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Comments: stated as randomised but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Lindenmayer 2007.
| Study characteristics | ||
| Methods | Allocation: randomised (1:1 ratio); no further details Blindness: double Duration: 12 weeks Design: parallel treatment groups with cross‐titration period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV‐TR) History: predominant negative symptoms, informed consent obtained N = 35 Age: 18 to 60, mean age HAL = 40, OLA = 39 years Sex: M 34, F 2 Setting: outpatient and inpatient Inclusion criteria: 1) PANSS ≥ 50, 2) PANSS negative subscale ≥ 20 Exclusion criteria: 1) PANSS depression scale, 2) PANSS positive ≥ 20, 3) SAS akinesia ≥ 2, 4) history of resistance to antipsychotic drugs, 5) presence of serious unstable disease, 6) substance dependence or substance abuse, 7) pregnant or breastfeeding women and women of childbearing age not using adequate contraception | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S, CGI‐I, HAM‐depression Mental state: PANSS Adverse effects: SAS, AIMS Cognitive: CGI Physiological measures: weight, cholesterol, glucose, triglycerides |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "patients were randomly assigned (ratio 1:1) to a fixed dose of either olanzapine 15mg daily or haloperidol 15 mg daily" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double blind" No significant differences in baseline characteristics are reported. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Low risk | There is no evidence of other bias. |
Liu 2010l.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 8 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: average course of disease in OLA group 8.6 ± 5.9 years, in HAL group 8.7 ± 6.4 years, PANSS ≥ 60 N = 100 Age: 20 to 62 years Sex: male = 76, female = 24 Setting: inpatients and outpatients Exclusion criteria: mental disorders caused by obvious brain organic diseases and somatic diseases | |
| Interventions |
*Low‐dose benzodiazepines for insomnia and anxiety patients. *Symptomatic treatment of severe side effects. *Prohibition of the use of other antipsychotic drugs. |
|
| Outcomes | Leaving the study early: 0/100 Global state: no improvement Mental state: (PANSS) Adverse effects: (TESS) Unable to use: Laboratory tests: blood biochemical examination, electrocardiogram, electroencephalogram, urinary examination; no data |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Stated as "randomized," but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Liu 2011i.
| Study characteristics | ||
| Methods | Allocation: randomly divided into 2 groups Blindness: not reported Duration: 8 weeks Design: hospitalised | |
| Participants | Diagnosis: first‐episode schizophrenia (CCMD‐3), PANSS positive and negative scores ≥ 60 History: no use of antipsychotic drugs 2 weeks before entry N = 50 Age: mean 32 years Sex: M 27, F 23 Setting: inpatients Inclusion criteria: informed consent, achromatopsia, no women who are pregnant or lactating, no serious somatic diseases, no organic mental disorder, no patients undergoing interventional therapy | |
| Interventions |
* No use of other antipsychotics. |
|
| Outcomes | Leaving the study early: 0/50 Global state: make clear progress Unable to use: WCST scale |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomly divided into two groups according to admission time. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Liu 2012ao.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3, BPRS ≥ 35) History: age of initial onset ≥ 60 years, average course of disease in OLA group 1.3 ± 1.5 years, in HAL group 1.5 ± 1.9 years N = 76 Age: mean 66 years Sex: male = 39, female = 37 Setting: inpatients Exclusion criteria: drug abuse/serious body disease | |
| Interventions |
*Anticholinergics and benzodiazepines as required when necessary in individual cases. *Need to undergo 1‐week drug cleaning period before entry. |
|
| Outcomes | Leaving the study early: 0/76 Global state: no improvement Mental state: BPRS Adverse effects: TESS Unable to use: Laboratory tests: blood biochemical examination, liver function, kidney function, electrocardiogram, weight, urinary examination; no data |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence on blinding process was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence on blinding process was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Luo 2012d.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 6 weeks Design: hospitalised | |
| Participants | Diagnosis: first‐episode schizophrenia (CCMD‐3), PANSS ≥ 60 History: general course of disease ≤ 5 years, no systemic antipsychotic treatment N = 80 Age: mean 33 years Sex: M 46, F 34 Setting: inpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early: 0/80 Global state: no improvement Mental state: PANSS Unable to use: **Adverse events: liver dysfunction/weight gain in olanzapine group and extrapyramidal symptoms/dizzy/dry mouth/blurred vision in haloperidol group |
|
| Notes | *No data were presented. Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Ma 2005d.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 8 weeks Design: hospitalised | |
| Participants | Diagnosis: first‐episode schizophrenia (CCMD‐3), PANSS positive and negative scores > 60 History: no use of antipsychotic drugs 2 weeks before entry N = 80 Age: mean 26 years Sex: M 51, F 29 Setting: inpatients Inclusion criteria: no women who are pregnant or lactating, no serious somatic diseases, no drug allergy | |
| Interventions |
*Short‐term use of low‐dose benzodiazepines as required when insomnia, anxiety occurs. *No use of other antipsychotics. |
|
| Outcomes | Leaving the study early: 0/80 Global state: no improvement and time to onset of effect Mental state: PANSS Quality of life: GQOLI Unable to use: Adverse events ‐ no data Adverse events in olanzapine group: drowsiness, constipation, weight gain, dry mouth and no extrapyramidal symptoms. Adverse events in haloperidol group: tremor, akathisia, dry mouth, constipation, tachycardia, myotonia. |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Malyarov 1999.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: not reported Duration: 6 months Design: 3 treatment groups | |
| Participants | Diagnosis: schizophrenia (ICD‐10) History: acute psychotic state N = 43 Age: mean 24.5 years Sex: M 28, F 15 Setting: inpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Leaving the study early Unable to use: Mental state: PANSS (no SD) Global state: GAF (no SD) |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "were randomly assigned to haloperidol (HP) 5‐20 mg/day (18 patients) or to atypical antipsychotics (AAP) ‐ olanzapine 5‐15 mg/day (15 patients) or to risperidone 3‐6 mg/day (10 patients)." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "The results of the treatment were measured at the baseline, after 2 weeks, 1st month, 3rd month and at the endpoint with the Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) by three independent observers ‐ senior psychiatrists, who were blind to the assigned medications." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | 38 patients out of 43 completed the trial. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. Only a single abstract was available. |
| Other bias | Unclear risk | Not enough information for judgement. |
Mousavi 2013.
| Study characteristics | ||
| Methods | Allocation: random, generated by third party physician using tables of random numbers Blindness: double Duration: 2 weeks Design: single centre, Iran; 4 treatment groups | |
| Participants | Diagnosis: schizophrenia, schizoaffective disorder, schizophreniform disorder, substance induced, psychotic disorder, psychotic disorder (DSM‐IV) History: acute psychosis, informed consent obtained N = 40 Age: 15 to 60, mean 32 years Sex: M 20, F 20 Setting: inpatient Inclusion criteria: 1) onset of psychotic symptoms during recent 30 days, 2) scored ≥ 4 on at least 2 positive or scored ≥ 5 on at least one positive sub‐scales of PANSS Exclusion criteria: 1) any serious medical condition that may interfere with safe study participation; 2) receiving any antipsychotic treatment for more than 7 days during the last 30 days; 3) receiving any long acting antipsychotic during last 3 months; 4) incidence of acute psychosis in the context of mood disorders; 5) pregnancy or nursing in women; 6) history of severe drug adverse reaction; 7) simultaneous use of anticonvulsants, antidepressants or mood stabiliser drugs | |
| Interventions |
|
|
| Outcomes | Mental state: effective (≥ 30% decline in PANSS positive sub‐scales PANSS) Adverse effects: EPS, AIMS Physiological measures: haematology, ECG, LFT, FBS, blood pressure, body weight, BMI |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This study is a randomised, double‐blind, controlled clinical trial with four active medication conditions" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double blind", "Care providers and physician assessing outcomes were blinded for each other works and results." |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "double blind", "Care providers and physician assessing outcomes were blinded for each other works and results." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Unclear risk | Quote: "Funding source: Isfahan University of Medical Sciences, Behavioral Sciences Research Center". |
Nag 2013.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: open‐label Duration: 12 weeks Design: single centre, 4 treatment groups, 2 weeks of titration phase | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: stable schizophrenia, informed consent obtained N = 40 Age: 15 and over, mean 36 (HAL) and 27 (OLA) years Sex: M 28, F 12 Setting: outpatient Inclusion criteria: 1) BPRS severity of illness scores ≥ 24, 2) CGI ≥ 4 Exclusion criteria: 1) women of reproductive age without adequate contraception, 2) pregnant or lactating mothers, 3) serious medical illness, 4) history of leucopenia without a clear aetiology, 5) history of severe allergies or multiple adverse drug reactions, 5) epilepsy, 6) neurological or organic syndrome, 7) abnormal ECG, 8) history of drug abuse including alcohol, 9) liver and kidney diseases | |
| Interventions |
|
|
| Outcomes | Global state: CGI Mental state: BPRS, PANSS Depression: MADRS |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This open label randomised study was conducted in the out patient Department of psychiatry" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "This open label randomised study was conducted in the out patient Department of psychiatry" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "This open label randomised study was conducted in the out patient Department of psychiatry" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Not enough evidence for judgement. |
Namjoshi 2002.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: double‐blind Duration: 1 year Design: 3 treatment groups; 6 participants were randomised, but not reported on in the study reports; we have made an assumption that 2 were missing from each group and added them back in. | |
| Participants | Diagnosis: schizophrenia History: not reported N = 364 Age: mean 39.4 years Sex: male and female Setting: outpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Hospital admission
Relapse Unable to use: Mental state: PANSS (no usable data) Cost‐effectiveness: no usable data |
|
| Notes | Unpublished data were received by previous review authors. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients (n=364) with schizophrenia were randomized to treatment with olanzapine (5‐20 mg/day), risperidone (2‐10 mg/day), or haloperidol (2‐19 mg/day)" |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. Quote: "There are no significant differences at baseline between the three treatments groups." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence on blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Pan 2005.
| Study characteristics | ||
| Methods | Allocation: randomised; randomly divided into 2 groups Blindness: not reported Duration: 1 week Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: PANSS ≥ 60, PANSS excitation factors ≥ 14 (including excitability/non‐cooperation/hostility/impulse control disorder/nervous, at least one of them ≥ 4), first time using olanzapine, with informed consent, no antipsychotic or sedative hypnotic drugs used at least 3 days before entry N = 84 Age: 18 to 50 years Sex: male = 46, female = 38 Setting: inpatients Exclusion criteria: serious somatic disease/organic brain diseases/alcohol and drug addict/allergy/women who are pregnant or lactating | |
| Interventions |
|
|
| Outcomes | Global state: no improvement Mental state: PANSS and PANSS‐excitation scores Adverse events: TESS Leaving the study early: 0/84 | |
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomised, randomly divided into 2 groups |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Study was possibly open‐label. Participants had to sign informed consent for the first time to use olanzapine. |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Study was possibly open‐label. Outcome assessors may have become aware of the intervention received by study participants. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Parabiaghi (GiSAS) 2010.
| Study characteristics | ||
| Methods | Allocation: randomised, ratio 1:1:1, computer‐generated random sequence, central randomisation by telephone Blindness: open‐label Duration: 12 months Design: multicentre, 3 treatment groups with 4 weeks of dose titration period | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 300 Age: 18 years and over, mean 43 years Sex: M 175, F 125 Setting: inpatient and outpatient Inclusion criteria: patients entering the study should have a condition appropriate for changing current antipsychotic treatment Exclusion criteria: 1) diagnosis of metabolic syndrome, 2) abdominal obesity (waist circumference > 102 cm in men and > 88 cm in women), 3) fasting triglycerides (Tg) ≥ 150 mg/dL, 4) high density lipoprotein (HDL) < 40 mg/dL in men or < 50 mg/dL in women, 5) high blood pressure ≥ 130/85 mmHg or on antihypertensive medication, 6) fasting glucose ≥ 110 mg/dL or on insulin or hypoglycaemic medication, 7) diagnosis of diabetes mellitus type II, 8) any organic condition clearly contraindicating treatment (e.g. pregnancy or breastfeeding), 9) known ineffectiveness or intolerance of one of the study drugs, 10) the patient has never been exposed to antipsychotic drugs, 11) according to clinician’s opinion, it is unlikely that the patient can be followed up for the whole duration of the study (1 year) | |
| Interventions |
|
|
| Outcomes | Tolerability: developing metabolic syndrome during study period Effectiveness: all‐cause discontinuation General functioning: GAF Mental state: BPRS Adverse effects: metabolic, LUNSERS Physiological measures: ECG |
|
| Notes | Some additional data and clarifications were made through contact with the corresponding authors of the study. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Eligible patients were randomised 1 : 1: 1 to non‐blind oral monotherapy with one of the study drugs: aripiprazole, olanzapine, and haloperidol." |
| Allocation concealment (selection bias) | Low risk | Quote: "The computer‐generated allocation sequence was site‐stratified in fixed blocks (first block was of nine, followed by blocks of three) and was registered before trial start, Concealment was achieved by central randomisation by telephone registration with an interactive voice response system." |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "non‐blind oral monotherapy", "open‐label" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "All people involved in trial coordination, primary outcome assessment, and data analysis were blinded. Masking was maintained by omitting in case report forms any clue that could reveal the study drug and using a masked code for treatment groups in all analyses. Study investigators and monitors were specifically instructed to never mention the name of the study drug." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Low risk | No evidence of other bias. |
Qi 2013b.
| Study characteristics | ||
| Methods | Allocation: randomised, random number table Blindness: not reported Duration: 6 weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia History: course of disease 2 to 17 years N = 96 Age: mean 35 years Sex: M 49, F 47 Setting: inpatients and outpatients Inclusion criteria: not reported | |
| Interventions |
|
|
| Outcomes | Global state: no improvement Leaving the study early: 0/96 Unable to use: No data for specific adverse events. Total adverse events in haloperidol group for 11, including extrapyramidal symptoms/tremor/akathisia/myotonia, total adverse events in olanzapine group for 8, including insomnia/drowsiness/dry mouth/blurred vision/tachycardia/weight gain/dizzy/hyper excitation/agitation |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Study used a random number table for randomisation. No further details. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Not enough information for judgement. |
Qin 2006a.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: not reported | |
| Participants | Diagnosis: schizophrenia (CCMD‐2‐R) History: PANSS scores > 60 N = 80 Age: 16 to 60 years Sex: M 48, F 32 Setting: not reported Exclusion criteria: children, pregnant or lactating women, and patients with severe liver, kidney, heart or haematological diseases, cancer or glaucoma | |
| Interventions |
*Symptomatic treatment as required for adverse events. |
|
| Outcomes | Leaving the study early: 0/80 Global state: time to onset of effect Mental state: (SCI‐PANSS) Adverse effects: (TESS and myocardial tiredness) Unable to use: Laboratory tests: blood biochemical examination, liver function, kidney function (no data) Average dose, effective dose (not prespecified outcomes) |
|
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | States randomised but no further information |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Outcome data are not available for a considerable number of participants who were randomised. No explanations were given. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | Trial details are not well reported in the article. |
Raposo 2011.
| Study characteristics | ||
| Methods | Allocation: randomised, naturalistic study; no further details Blindness: not specified Duration: 9 months Design: multi‐centre, 2 treatment groups | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 34 Age: 18 to 60, mean 35 years Sex: M 34 Setting: not specified Inclusion criteria: ≥ 60 points on PANSS Exclusion criteria: not specified | |
| Interventions |
|
|
| Outcomes | Mental state: PANSS Physiological measures: body weight, BMI, leptin, NYP, adiponectin, lipids profile, triglyceride, cholesterol |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "In this 9‐month, randomised and naturalist study". No further details. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | Quote: "This work was supported by grants from Associate Beneficíente Alzira Denise Hertzog da Silva (ABADHS), from Fundado de Amparo á Pesquisa do Estado de Sao Paulo (FAPESP) and from Coordenaqao de Aperfeiqoamento de Pessoal de Nivel Superior (CAPES)." |
Rosenheck (HGFI) 2003.
| Study characteristics | ||
| Methods | Allocation: randomised, random sequence numbers Blindness: double, medication kits issued Duration: 12 months Design: parallel‐group | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained N = 309 Age: mean age 46.5 years Sex: M 153, F 144 Setting: hospital and community Inclusion criteria: BPRS score > 36 Excluded: previous participation in olanzapine research | |
| Interventions |
|
|
| Outcomes | Leaving the study early Unable to use: (> 50% lost to follow in both arms) Global state: CGI Mental state: PANSS Quality of life Adverse events: SAS, AIMS, BAS, checklists Assessment of health care costs |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Between June 1998 and june 2000, patients at 17 Department of Veterans Affairs (VA) medical centres were randomly assigned to olanzapine or haloperidol. Medication kits were prepared in sets of 4 (2 olanzapine and 2 haloperidol) and each was labelled with a random sequence number." |
| Allocation concealment (selection bias) | Low risk | Quote: "Patients were assigned a kit at the end of a telephone conversation with the coordinating centre." |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Quote: "double blind" |
| Incomplete outcome data (attrition bias) All outcomes | High risk | All randomised participants were included in analysis. Some data provided have a high attrition level. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Quote: "Funding/Support: This study was supported by Lilly, which provided study drug and placebo, and the VA Cooperative Studies Program. Role of the Sponsor: Employees of Lilly (Alan Breier, MD, Robert Obenchain, PhD, and John Kreuger) participated in the study design and commented on the analyses and on the manuscript. The analyses and writing of the manuscript were carried out by the authors independent of the sponsor." |
Saddichha 2007.
| Study characteristics | ||
| Methods | Allocation: randomised, concealed from investigator Blindness: double Duration: 6 weeks Design: single centre; 3 treatment groups | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: drug‐naive patients, first‐episode schizophrenia patients, informed consent obtained N = 99 Age: 18 to 40, mean 26 years Sex: M 52, F 47 Setting: inpatient Inclusion criteria: 1) diagnosis (DSM‐IV) ‐ no further details Exclusion criteria: 1) psychiatric co‐morbidity status, 2) history of severe physical illness, 3) alcohol and substance abuse or dependence, 4) pre‐existing diabetes, 5) hypertension or family history of hypertension or diabetes | |
| Interventions |
|
|
| Outcomes | Adverse effects: metabolic syndrome (ATP III A), weight gain, diabetes Physiological measures: weight, BMI, SBP, DBP, FBS, TGL, HDL, WC |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Patients included in the study were randomised to receive either one of three drugs‐olanzapine, risperidone or haloperidol based on every 1st patient receiving haloperidol, every 2nd patient receiving risperidone and every 3rd patient olanzapine". |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "The participating patient, supervising senior resident (SA) as well as the primary investigator (SS) were blind to both diagnosis and treatment of subject under study" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "The participating patient, supervising senior resident (SA) as well as the primary investigator (SS) were blind to both diagnosis and treatment of subject under study" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Quote: "The number of patients enrolled was 110, out of which complete data was available for 99, which have been reported here. There were no differences between the 99 reported and the 11 that dropped out." |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Low risk | There is no evidence of other bias. |
San 2012.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, centralised, ratio: 1:1:1:1:1 Blindness: open‐label Duration: 12 months Design: multicentre; 5 treatment groups | |
| Participants | Diagnosis: schizophrenia, schizoaffective disorder, schizophreniform disorder, substance‐induced, psychotic disorder, brief psychotic disorder, bipolar disorder, substance‐induced psychosis (DSM‐IV‐TR) History: first episode psychosis, informed consent obtained N = 114 Age: ≥ 18 years, mean 26 years Sex: M 85, F 29 Setting: inpatient and outpatient Inclusion criteria: 1) ≥ 4 score on PANSS positive scale, 2) being naive to any psychotropic medication Exclusion criteria: 1) major medical or neurological disease or mental retardation, 2) substance use directly contributing to the emergence of symptoms (not merely a comorbid condition), 3) previous treatment with antidepressant/mood stabiliser or antipsychotic drugs | |
| Interventions |
|
|
| Outcomes | Treatment discontinuation Mental state: PANSS Depression scale: CDSS |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A computer‐generated randomisation centralized for the three centres assigned patients 1:1:1:1:1 into the 5 treatment groups." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "Therefore, the goal of this study was to perform a pragmatic, open‐label, randomised clinical trial comparing the 12‐ month effectiveness" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "Therefore, the goal of this study was to perform a pragmatic, open, randomised clinical trial comparing the 12‐ month effectiveness" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for nearly all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | There is no evidence of other bias. |
Sergi 2007.
| Study characteristics | ||
| Methods | Allocation: randomised, ratio 1:1:1; 2 different random assignments were used Blindness: double Duration: 8 weeks Design: parallel treatment groups, no washout period | |
| Participants | Diagnosis: schizophrenia, schizoaffective disorder (DSM‐IV) History: informed consent obtained N = 100 Age: 18 to 60, mean 49 years Sex: M 65, F 35 Setting: outpatient Inclusion criteria: 1) relevant diagnosis, 2) informed consent Exclusion criteria: 1) identifiable neurological conditions or mental retardation, 2) alcohol or substance dependence in the last 6 months | |
| Interventions |
|
|
| Outcomes | Mental state: BPRS Specific functioning: social cognitive measures |
|
| Notes | *Used two‐way random assignment. We did not receive any response to the request for additional data. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "In this 8‐week double‐blind study, patients were randomly assigned to 4 mg of risperidone, 15 mg of olanzapine, or 8 mg of haloperidol." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Double blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Unclear risk | Possible conflict of interest and funding. Quote: "The authors disclose consulting over the last 2 years to any company that makes an antipsychotic medication...." Supported by a Veterans Affairs Merit Grant, the VA VISN‐22 Mental Illness Research Education Clinical Center, NIMH Translational Study Grant MH042228 (to Dr. Braff), and an investigator‐initiated grant from Janssen and Forest Pharmaceuticals. Medications for this study were provided by Janssen and Forest Pharmaceuticals, and Eli Lilly." |
Song 2009c.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: hospitals in Shanghai, China | |
| Participants | Diagnosis: schizophrenia (CCMD‐III) History: informed consent obtained, PANSS scores ≥ 60 N = 100 Age: 10 to 60 years Sex: female Setting: inpatients and outpatients Exclusion criteria: serious body disease, alcohol and drug addict | |
| Interventions |
*Artane as required when adverse events of extrapyramidal system occurs; hypnotic as required when insomnia occurs. |
|
| Outcomes | Leaving the study early: 0/100 Mental state: PANSS Adverse effects: TESS Quality of life: SF‐36 Unable to use: Serum prolactin, not prespecified outcome |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | States randomised but no further information. |
| Allocation concealment (selection bias) | Unclear risk | Nodetails of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | Not enough information for judgement. Methods are not clearly reported. |
Taraskina 2017.
| Study characteristics | ||
| Methods | Allocation: randomised ‐ no further details Blindness: not specified Duration: 4 weeks Design: 2 treatment groups | |
| Participants | Diagnosis: schizophrenia (ICD‐10) History: acute psychosis, drug naive, informed consent obtained N = 60 Age: 18 to 55, mean age (Hal) 29.4 years, mean age (Olan) 26.4 years Sex: only male Setting: not specified Inclusion criteria: 1) diagnosed with a spectrum disorder of acute psychosis, 2) drug‐naïve, first‐episode, 3) able to comprehend the procedure and aims of the study Exclusion criteria: 1) mental retardation (IQ ≤ 70), 2) history of head trauma, 3) serious neurologic disorder (epilepsy, stroke, Parkinson’s disease or dementia), 4) co‐morbid diagnosis of substance abuse disorder | |
| Interventions |
|
|
| Outcomes | Global state: CGI‐S, CGI‐I Mental state: PANSS Adverse effects: SAS, ESRS |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "After randomisation, the patients were assigned to one of two treatment groups: olanzapine (n = 30) or haloperidol (n = 30) (control group)." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding was available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment was available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | High risk | The study did not report the results of some prespecified outcomes. |
| Other bias | Low risk | Quote: "The study was supported with the grant of Russian Science Foundation (n°14‐15‐00904)." |
Tollefson (HGAJ) 1997.
| Study characteristics | ||
| Methods | Allocation: randomised, computer‐generated, blocks, ratio 2:1, concealed from investigators Blindness: double Duration: 6 weeks (preceded by a screening phase of 2 to 9 days, maintenance phase of 46/52 for responders) and a 3‐year, double‐blind extension phase Design: multicentre, 174 sites in 17 countries | |
| Participants | Diagnosis: schizophrenia, schizophreniform or schizoaffective disorder (DSM‐III‐R) History: informed consent obtained N = 1996 Age: mean ~ 39 years Sex: male and female Setting: inpatient and outpatient Inclusion criteria: > 18 BPRS and/or intolerant of current antipsychotics | |
| Interventions |
Benztropine and benzodiazepine as required. |
|
| Outcomes | Leaving the study early Global state: CGI Mental state: BPRS*, needing additional benzodiazepines, MADRS, PANSS Quality of life: QLS scale (clinically important change ≥ 20% improvement) Death** Adverse effects: AMDP, Barnes Akathisia Scale, requiring benztropine, SAS Other adverse events: COSTART list, weight change Unable to use: Hospital status: no data Laboratory tests and physiological measures: no data Weight loss: undefined subgroup reported from 3‐year extension phase |
|
| Notes | *BPRS (scored 0 to 6) extracted from PANSS ‐ no reference given for validity of procedure. *A priori efficacy response was 40% improvement in BPRS score and 3 weeks in study. **Deaths reported during the study or within 30 days of discontinuation. Unpublished data were received by previous review authors. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "A total of 2,223 patients entered the screening phase of the study. Of these, 1,996 were subsequently randomly assigned to treatment over a 14‐month period" There is a large difference in the number of patients between intervention groups and there is also a significant difference in the baseline PANSS total score between the two groups. |
| Allocation concealment (selection bias) | Low risk | The allocation sequence was possibly concealed until participants were recruited and assigned to interventions. |
| Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "Double blind" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "Double blind" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all randomised participants. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section and protocol. |
| Other bias | Unclear risk | "The studies were sponsored by Eli Lilly and Company". |
Vedam 2022.
| Study characteristics | ||
| Methods | Allocation: prospective, randomised, parallel‐group interventional trial Blindness: open‐label Duration: 4 weeks Design: parallel treatment groups with 2 study periods | |
| Participants | Diagnosis: participants with newly diagnosed schizophrenia (DSM‐IV) History: informed consent obtained N = 40 Age: 15 to 45, mean age 34.40 OLA vs 37.05 HAL years Sex: M 25, F 15 Setting: outpatient or inpatient Inclusion criteria: 1) PANSS score = minimal, mild, moderate Exclusion criteria: 1) allergic reactions to olanzapine or haloperidol, liver failure, kidney failure, pregnant women, lactating mothers and participants enrolled in other investigational drug trials | |
| Interventions |
|
|
| Outcomes | Mental state: BPRS score Adverse effects: AIMS, BMI Physiological measures: homocysteine levels, TGL, RBS ECG: QTc interval |
|
| Notes | Contacting the corresponding study authors for additional data was unsuccessful. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "prospective, randomized, parallelgroup interventional trial", "Participants were randomized into two groups by computer randomization software (R software)" |
| Allocation concealment (selection bias) | Low risk | Quote: "Participants were randomized into two groups by computer randomization software (R software)". Allocation seems to be concealed. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "This was an open‐label, prospective, randomized, parallel group interventional trial" |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Quote: "This was an open‐label, prospective, randomized, parallel group interventional trial" |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all randomised participants. |
| Selective reporting (reporting bias) | Low risk | There was no evidence of selective reporting. The study protocol is available. Study reported all prespecified outcomes. |
| Other bias | Low risk | There is no evidence of other bias. |
Walther 2014.
| Study characteristics | ||
| Methods | Allocation: randomised, allocation concealed Blindness: rater‐blinded Duration: 5 days Design: 3 treatment groups | |
| Participants | Diagnosis: schizophrenia, schizophreniform or schizoaffective disorder (DSM‐III‐R) History: severely agitated patients, informed consent obtained N = 43 Age: 18 to 55, mean age 34.4 years Sex: M = 31, F = 12 Setting: inpatient Inclusion criteria: 1) age, 2) diagnosis. No further details. Exclusion criteria: 1) medical or neurological disorders, 2) pregnant, 3) ongoing intake of illicit drugs and alcohol | |
| Interventions |
|
|
| Outcomes | Mental state: PANSS, PANSS‐PAS Adverse effects: SAS, AIMS, BARS |
|
| Notes | We did not receive any response to the request for additional data. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Participants were randomly assigned to receive either daily haloperidol 15 mg, olanzapine 20 mg, or risperidone 2 to 6 mg over 5 days." |
| Allocation concealment (selection bias) | Low risk | Quote: "Randomization was performed by creating 3 sets of random numbers between 1 and 60 using a computer‐based research randomiser (www.randomizer.org). The order of inclusion determined allocation to treatment group. The randomisation list was locked in the office of the principal investigator (T.J.M.), who was engaged neither in treatment nor in study assessments." |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Quote: "prospective, randomised, rater‐blinded trial" |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Quote: "The study was a prospective, randomised, rater‐blinded trial in a naturalistic treatment setting and regimen" Quote: "All ratings were performed by 1 of 2 raters who were blind to treatment allocation, had received PANSS training, and had no access to the randomisation protocol." |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. No evidence of selective reporting. |
| Other bias | Low risk | Quote: "S. W has received speaker’s fees from Sandoz and Janssen‐Cilag. EM. has received speaker’s fees from Lilly and Novartis. H.H. has received speaker’s fees from Eli Lilly, Janssen." |
Wang 2012k.
| Study characteristics | ||
| Methods | Allocation: randomised, block randomisation, ratio 2:1 Blindness: not reported Duration: 6 weeks Design: multi‐hospitals in 4 cities of China Country: China | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained, PANSS scores ≥ 60, average course of disease in olanzapine group 72 months, in haloperidol group 53 months N = 375 Age: 18 to 45 years Sex: male and female, ratio 1:1 Setting: hospitalisation Exclusion criteria: diagnosis of other axis I mental disorders (DSM‐IV), serious unstable diseases, 1 month before entry used long‐acting antipsychotics (RisperdalConsta for injection requires a 5‐week interval or regular use of clozapine or electroconvulsive therapy | |
| Interventions |
*Benzodiazepines can be used temporarily or for a short period of time, lasting no more than 1 week. |
|
| Outcomes | Leaving the study early: 78/375 Mental state: (PANSS) Unable to use: Laboratory tests by rating scale for extrapyramidal side effects, Barnes Akathisia Rating Scale, abnormal involuntary movement scale, BMI |
|
| Notes | *3 people excluded because of not taking allocated medication before trial. *78 people left the study early, using the LOCF and ITT methods to analyse the efficacy and adverse events. Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Randomised, block randomisation, ratio 2:1. Stated as randomised, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | 78 participants left study early ‐ 20.8% while ITT analyses were performed. |
| Selective reporting (reporting bias) | High risk | The study did not report the results of some prespecified outcomes. |
| Other bias | Low risk | No evidence of other bias. |
Wang 2013az.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia History: not reported N = 64 Age: mean 27.6 years Sex: M 36, F 28 Setting: inpatients Inclusion criteria: not reported | |
| Interventions |
*Symptomatic treatment as required for adverse events. *No use of other antipsychotic drugs. *Benzodiazepines used in patients with insomnia. |
|
| Outcomes | Leaving the study early: 0/64 Global state: no improvement Mental state: (PANSS) Unable to use: **Adverse events: only 4/32 in OLA group nodal tachycardia, other adverse events including weight gain, extrapyramidal symptoms, anticholinergic symptoms and cardiovascular reactions |
|
| Notes | **No data available. Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Xianzhen 2004.
| Study characteristics | ||
| Methods | Allocation: randomised, random number table Blindness: patients and assessors are all double‐blinded Duration: 6 months Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: PANSS positive and negative scores ≥ 60 N = 120 Age: mean 27 years Sex: M 69, F 51 Setting: inpatients Inclusion criteria: no women who are pregnant or lactating, no serious somatic diseases, no alcoholism or drug addiction | |
| Interventions |
*Clonazepam, carotene, Antam, propranolol as required. *No use of other antipsychotics. |
|
| Outcomes | Leaving the study early: 0/120 Mental state: PANSS Adverse effects: TESS Quality of life: GQOLT Unable to use: Some of the adverse events are reported only in one group. In the haloperidol group, anticholinergic in 48/60, drowsiness in 19/60, drug‐induced depression in 5/60; in the olanzapine group, insomnia in 12/60, weight gain in 5/60. Contact information to request additional data was not available. |
|
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Used a random number table for randomisation. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Participants and assessor are both blinded. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Xu 2014n.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 3 months Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: PANSS scores ≥ 60 N = 64 Age: 18 to 55 years Sex: M 34, F 30 Setting: inpatients and outpatients Exclusion criteria: alcoholism, drug dependence, women who are pregnant or lactating, serious body diseases | |
| Interventions |
*Symptomatic treatment as required for adverse events. *No use of other antipsychotic drugs. *Benzodiazepines used in patients with insomnia. |
|
| Outcomes | Leaving the study early: 0/64 Global state: no improvement Mental state: PANSS Quality of life: GQOLI Only used the general GQOLI score |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Stated as randomised but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhang 2005g.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (CCMD‐3, ICD‐10) History: schizophrenia N = 61 Age: 18 to 45 years Sex: male and female Setting: inpatients and outpatients Inclusion criteria: not taking antipsychotics at least 1 week before entry, no alcohol, no drug dependence, no women who are pregnant or lactating, no diseases of heart/liver/kidney/metabolism | |
| Interventions |
*No use of other antipsychotic drugs. |
|
| Outcomes | Leaving the study early: 0/61 Adverse events: changes in the serum levels of prolactin and growth hormone. |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhang 2010ad.
| Study characteristics | ||
| Methods | Allocation: randomly divided into 3 groups Blindness: not reported Duration: 8 weeks Design: hospitalised | |
| Participants | Diagnosis: first‐episode schizophrenia (CCMD‐3) History: no use of antipsychotic drugs before entry N = 130 Age: mean 28 years Sex: M 75, F 55 Setting: inpatients Inclusion criteria: informed consent, no women who are pregnant or lactating, no serious somatic diseases, no alcohol or drug addiction, no serious aggression or attempted suicide | |
| Interventions |
*No use of other antipsychotics. |
|
| Outcomes | Global state: no improvement Mental state: PANSS Leaving the study early: 0/130 Unable to use: Adverse events: TESS |
|
| Notes | Only input the data for olanzapine and haloperidol groups; no data for quetiapine. Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhang 2010ae.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: not reported | |
| Participants | Diagnosis: schizophrenia History: average course of disease in OLA group 1.5 ± 3 years, in HAL group 2.2 ± 3 years N = 80 Age: mean 28 ± 6 years Sex: M 48, F 32 Setting: not reported Inclusion criteria: not reported | |
| Interventions |
*Symptomatic treatment as required for adverse events. |
|
| Outcomes | Leaving the study early: 0/80 Global state: time to onset of effect, no clinical improvement Mental state: PANSS Adverse effects: TESS and myocardial tiredness Unable to use: PANSS score reduction rate and factors: reported as percentage, no mean or SD |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhang 2013m.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: not reported | |
| Participants | Diagnosis: schizophrenia (DSM‐IV) History: informed consent obtained, PANSS scores ≥ 60, average course in disease in OLA group 9.11 ± 2.69 years, in HAL group 9.46 ± 1.98 years N = 70 Age: 16 to 60 years Sex: M 38, F 32 Setting: hospitalisation Exclusion criteria: functional organ dysfunction, dementia, malignant tumour, using antipsychotics 1 month before entry | |
| Interventions |
*Symptomatic treatment as required for adverse events temporarily. |
|
| Outcomes | Leaving the study early: 0/70 Global state: no clinical improvement Mental state: PANSS |
|
| Notes | Contact information to request additional data was not available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhang 2016al.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 8 weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (CCMD‐3) History: average course of disease in OLA group 3.4 ± 0.9 years, in HAL group 2.9 ± 0.6 years N = 72 Age: mean 37 years Sex: M 43, F 29 Setting: inpatients Inclusion criteria: no drug contraindication, no risk of loss to follow‐up, no serious somatic diseases, estimated survival < 1 year, informed consent | |
| Interventions | 1. Olanzapine: dose 10 mg/d range 10 to 20 mg/d (N = 36) 2. Haloperidol: dose 2 to 4 mg 2 to 3 times/d range 4 to 20 mg/d (N = 36) | |
| Outcomes | Leaving the study early: 0/72 Mental state: PANSS Adverse events: serum lipid levels (TG/TC/HDL‐C/LDL‐C) Quality of life: WHOQOL‐BREF Unable to use: Gastrointestinal symptoms, no specific symptom data; only shows 2/32 in OLA group and 1/32 in HAL group 1/32 rash only reported in OLA group 1/32 drowsiness only reported in HAL group |
|
| Notes | Time point 1: period of medication 8 weeks Time point 2: evaluate quality of life by WHOQOL‐BREF after 6 months Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zheng 2003b.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 6 weeks Design: hospitalised | |
| Participants | Diagnosis: schizophrenia (CCMD‐3), PANSS ≥ 60, PANSS positive ≥ 12 History: average course of disease in OLA group 3.3 ± 1.6 years, in HAL group 4.2 ± 2.7 years, PANSS score in OLA group 81.71 ± 14.7, in HAL group 79.96 ± 13.29 N = 68 Age: 18 to 55 years Sex: M 35, F 33 Setting: inpatients Inclusion criteria: no allergy, no drug dependence, no serious body diseases, never treated with olanzapine or haloperidol | |
| Interventions |
*Patients who had ever been treated with olanzapine or haloperidol needed to undergo a 5‐day drug cleaning period. *Artane, benzodiazepine, propanolol as required if necessary. |
|
| Outcomes | Leaving the study early: 0/68 Global state: no improvement Mental state: PANSS Adverse events: nodal tachycardia Unable to use: **Adverse events: 12/34 in the OLA group had slight drowsiness, weakness, dry mouth, dizziness and all in the HAL group had extrapyramidal symptoms to different degrees. |
|
| Notes | *No data available Contact information to request additional data was not available. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zhu 2014f.
| Study characteristics | ||
| Methods | Allocation: randomised, random number table Blindness: not double‐blind Duration: 24 weeks Design: hospitalised Country: China | |
| Participants | Diagnosis: schizophrenia (ICD‐10) History: schizophrenia < 10 years; informed consent obtained N = 60 Age: 18 to 45 years Sex: male = 37, female = 23 Setting: inpatients and outpatients Inclusion criteria: no chronic diseases of nervous system, no abuse of psychoactive substances and no history of electroconvulsive therapy in the last 3 months, informed consent, no course of disease ≤ 10 years, no systemic treatment with olanzapine or haloperidol 1 month before entry | |
| Interventions |
*During the experiment, diphenhydrazole hydrochloride was not given prophylactically, but 2 to 4 mg/d was given only in the case of extrapyramidal reaction. |
|
| Outcomes | Leaving the study early: 0/60 Mental state: PANSS Quality of life: Q‐LES‐Q |
|
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Stated as randomised using a random numbers table, but no further information is given. |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Only mentioned that it was blind evaluation. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Unclear risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
Zubair 2020.
| Study characteristics | ||
| Methods | Allocation: randomised Blindness: not reported Duration: 12 weeks Design: single centre, parallel treatment groups | |
| Participants | Diagnosis: schizophrenia (ICD‐10 DCR) History: not reported; informed consent obtained N = 350* Age: 18 to 55, mean age (both groups): 34.25 ± 16.74 years Sex: undefined Setting: inpatient and outpatient Inclusion criteria: undefined Exclusion criteria: 1) hypersensitivity to study drugs, 2) severe organic illness or depression, 3) substance abuse, 4) inability to receive oral medication | |
| Interventions |
|
|
| Outcomes | Mental State: PANSS Adverse events: EPS Relapse |
|
| Notes | *Outcomes were not defined. We did not receive any response to the request for additional data. |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "This randomized controlled trial was conducted at the psychiatry department of a tertiary care hospital of Pakistan between June–November 2015", "One hundred and seventy‐five patients were allocated to each group via lottery method." |
| Allocation concealment (selection bias) | Unclear risk | No details of allocation concealment are available. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | No evidence of blinding of participants is available. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | No evidence of blinding of outcome assessment is available. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome data are available for all participants randomised. |
| Selective reporting (reporting bias) | Low risk | The study reported the results of all outcome measures that were detailed in the methods section. The study protocol was not available. |
| Other bias | Low risk | No evidence of other bias. |
ADR: adverse drug reaction; AIMS: Abnormal Involuntary Movement Scale; AMDP: Association for Methodology and Documentation in Psychiatry; BAS: Barnes Akathisia Scale; BMI: body mass index; BPRS: Brief Psychiatric Rating Scale; CCMD‐3: Chinese Classification of Mental Disorders, 3rd Edition; CDSS: Calgary Depression Scale for Schizophrenia; CGI: Clinical Global Impression; CI: confidence interval; COSTART: Coding Symbols for Thesaurus of Adverse Reaction Terms; CPZ: chlorpromazine; d: day; DBP: diastolic blood pressure; DIEPSS: Drug‐Induced Extrapyramidal Symptom Scale; DSM‐III/DSM‐IV: Diagnostic and Statistical Manual of Mental Disorders III/IV; ECG: electrocardiogram; EPS: extrapyramidal symptoms; ESRS: Extrapyramidal Symptom Rating Scale; F: female; FAS: phonemic verbal fluency test; FBS: fasting blood sugar; FGIR: Final Global Improvement Rating Scale; GAF: Global Assessment of Functioning; GCI‐S: Global Clinical Impression of Severity; GQOLI: Generic Quality of Life Inventory; GQOLT: Generic Quality of Life Tool; HAL: haloperidol; HAMA: Hamilton Anxiety Rating Scale; HAS: Hillside Akathisia Scale; H‐DRS: Hamilton Depression Rating Scale; HDL: high‐density lipoprotein; ICD‐10: International Classification of Diseases ‐ 10th Revision; ITT: intention‐to‐treat; LFT: Liver Function Test; LDL: low‐density lipoprotein; LOCF: last observation carried forward; LUNSERS: Liverpool University Neuroleptic Side Effect Rating Scale; M: male; MADRS: Montgomery Asberg Depression Rating Scale; MANSA: Manchester Short Assessment of Quality of Life; MARS: Medication Adherence Rating Scale; NNTB/NNTH: number needed to treat for an additional beneficial/harmful outcome; NYP: neuropeptide Y; OAS: Overt Aggression Scale; OLA: olanzapine; PANSS: Positive and Negative Syndrome Scale; PET: positron emission tomography; PGI: Patient Global Impression; PSP: Personal and Social Performance Scale; Q‐LES‐Q: Quality of Life Enjoyment and Satisfaction Questionnaire; QLS: Quality of Life Scale; QOLI: Quality of Life Inventory; QoL: quality of life; RAVLT: Rey Auditory Verbal Learning Test; RBS: red blood cells; RCT: randomised controlled trial; RR: risk ratio; SANS: Scale for the Assessment of Negative Symptoms; SAPS: Scale for the Assessment of Positive Symptoms; SAS: Simpson Angus Scale; SBP: systolic blood pressure; SCD: Schizophrenia Cognition Deficit; SD: standard deviation; SF‐36: Short Form (36) Health Survey; S‐QoL: Subjective Quality of Life; SWN‐K: Subjective Well‐being under Neuroleptics; TC: total cholesterol; TESS: Treatment Emergent Symptom Scale; TG/TGL: triglycerides; WC: waist circumference; WCST: Wisconsin Card Sorting Test; WHOQOL‐BREF: WHO Quality of Life‐BREF
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
|---|---|
| Addington 1998 | Allocation: not randomised |
| Allan 1998 | Allocation: not randomised |
| Allison 1998 | Allocation: not randomised, meta‐analysis |
| Alvarez 2005 | Allocation: two‐step randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol and risperidone Outcomes: no usable data |
| Apicella 2001 | Allocation: not described |
| Apiquian 2003 | Allocation: not randomised |
| Aquila 2000 (HGEC) | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus 'comparator antipsychotic' versus risperidone Outcomes: no usable data |
| Arango 2001 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Arous 2016 | Allocation: not described Participants: people with schizophrenia Intervention: haloperidol versus olanzapine and risperidone Outcomes: no usable data |
| Awad 2002b | Allocation: randomised Participants: people with schizophrenia Intervention: participants switched to ziprasidone |
| Baker 2003 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine dosage study |
| Baldacara 2011 | Allocation: randomised Participants: people with schizophrenia and bipolar disorder Intervention: olanzapine versus haloperidol + midazolam, haloperidol + promethazine, haloperidol Outcomes: no usable data |
| Barak 2005 | Allocation: not randomised |
| Bayar 2005 | Intervention: intramuscular olanzapine versus IM haloperidol |
| Beasley 1996c | Allocation: not randomised, meta‐analysis |
| Beasley 2003 (HGGI) | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus clozapine Outcomes: no usable data |
| Beuzen 1996 (HGCE) | Allocation: randomised Participants: healthy elderly volunteers |
| Birkett 1994 | Allocation: not randomised |
| Bourin 2007 | Allocation: randomised Participants: people with schizophrenia Intervention: bifeprunox versus placebo plus active comparators: olanzapine, haloperidol Outcomes: no usable data |
| Britto 2002 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus ziprasadone Outcomes: no usable data |
| Buchsbaum 2004 | Allocation: randomised Participants: people with schizophrenia Intervention: haloperidol versus olanzapine Outcomes: no usable data |
| Burgoyne 1996 | Allocation: not described |
| Castilla 2002 | Allocation: randomised Participants: children with psychosis |
| Chetvertnykh 2008 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Clouth 1999 | Allocation: not randomised, economic drug analysis |
| Corya 2002 (HGGA) | Allocation: randomised Participants: major depression with psychosis |
| Cutler 2002 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus ziprasidone Outcomes: no usable data |
| Dalheim 1997 | Allocation: randomised cross‐over study |
| Daskalakis 2003 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Davis 1998 | Allocation: not randomised, meta‐analysis |
| Devanand 1998 | Allocation: randomised Participants: people with dementia |
| Docherty 2002 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus risperidone Outcomes: no usable data |
| Dolnak 2000 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Dossenbach 1997 | Allocation: not randomised |
| Erinfolami 2009 | Allocation: unclear Participants: people with schizophrenia Interventions: olanzapine, haloperidol, risperidone Outcomes: no usable data |
| Esel 2001 | Allocation: quasi‐randomised |
| Fallahi 2011 | No reports found other than protocol |
| Finzen 2002 | Allocation: not randomised |
| Fleming 1999 | Allocation: unclear Participants: people with schizophrenia Interventions: olanzapine versus placebo Outcomes: no usable data |
| Freeman 2009 | Allocation: not randomised, retrospective analysis of patient records Participants: people with schizophrenia Interventions: intramuscular haloperidol versus intramuscular olanzapine |
| Gallinat 2001 | Allocation: double‐blind Participants: people with schizophrenia and healthy volunteers Interventions: olanzapine or clozapine (schizophrenia group) versus healthy volunteers Outcomes: data for treatment group (olanzapine or clozapine) not differentiated |
| Goldman 2004 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Gothelf 2003 | Allocation: not randomised |
| Grecu 2006 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus haloperidol, quetiapine, risperidone Outcomes: no usable data |
| Harrigan 2004 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine, haloperidol, quetiapine, risperidone, thioridazine, ziprasidone Outcomes: no usable data |
| Hazlett 2009 | Allocation: randomised Participants: adolescents with schizophrenia Intervention: olanzapine versus haloperidol Outcomes: no usable data |
| Hrdlicka 2001 | Allocation: not randomised, retrospective analysis of patient records |
| Hsu 2010 | Allocation: randomised Participants: people with schizophrenia Interventions: intramuscular haloperidol versus intramuscular olanzapine, oral risperidone |
| Irwin 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone Outcomes: no usable data |
| Jarboe 2001 | Allocation: not randomised |
| Javitt 2001 | Allocation: randomised Participants: people with schizophrenia Intervention: current antipsychotic medication and glycine versus current antipsychotic medication and placebo |
| Jerrell 2002 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperisone versus haloperidol Outcomes: no usable data |
| Kalali 2000 | Allocation: not randomised |
| Kasthurip 2012 | Allocation: randomised Participants: people with schizophrenia. Age of patients was not specified. Interventions: olanzapine versus haloperidol. Doses were not specified. Outcomes: no usable data |
| Kinon (HGFW) | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine switching to conventional antipsychotics |
| Kinon 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: current therapy or risperidone versus olanzapine |
| Knegtering 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone Outcomes: no usable data |
| Kolff 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone Outcomes: no usable data |
| Kong 2009 | Interventions: intramuscular olanzapine and haloperidol |
| Krakowski 2021 | Allocation: randomised Participants: assaultive schizophrenia patients Intervention: clozapine, olanzapine or haloperidol Outcomes: PANSS scale, MOAS scale. Outcomes were grouped by conduct disorder, which does not allow any further use of the data. Outcome data were not provided separately for each intervention group. |
| Kucerova 2002 | Allocation: not randomised, case reports |
| Lahti 1999a | Allocation: not randomised |
| Lilly (HGBM) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGCL) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGCV) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGDU) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGDZ) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGEP) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGFM) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
| Lilly (HGHB) 2005 | Allocation: randomised, double‐blind, single‐arm study of intramuscular olanzapine and haloperidol |
| Lilly (HGHV) 2005 | Allocation: randomised, double‐blind, single‐arm study of intramuscular olanzapine and haloperidol |
| Lilly (TW‐S025) 2006 | Allocation: randomised Participants: people with schizophrenia Interventions: intramuscular olanzapine and haloperidol Outcomes: CGI, PANSS, BAS, BPRS, SAS |
| Lima 2003 (HGHS) | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus conventional antipsychotics Outcomes: no usable data |
| Lindenmayer 1998 | Allocation: not randomised, review |
| Lindenmayer 2001 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Loza 2001 | Allocation: randomised Participants: people with schizophrenia Interventions: several typical antipsychotics versus several atypical antipsychotics Outcomes: no usable data, full publication pending in Psychiatricia, ISSN 1643/0956 |
| Lu 2022 | Allocation: randomised Participants: people with schizophrenia Intervention: aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone, or one of the first‐generation antipsychotics, haloperidol or perphenazine Outcomes: genome‐wide association study, no extractable data found The corresponding authors were contacted for additional data, but no response was received. |
| Mahmoud 1999 | Allocation: randomised Participants: not described |
| Marder 1998 | Allocation: not randomised, case series |
| Maurer 2002 | Allocation: not described |
| Mauri 2002 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus quetiapine Outcomes: no usable data |
| McCue 2006 | Allocation: randomised Participants: people with schizophrenia Interventions: intramuscular haloperidol versus intramuscular olanzapine, risperidone, aripiprazole, quetiapine, ziprasidone |
| McElroy 1998 | Allocation: not randomised, review |
| McGurk 1998 | Allocation: not described |
| Meltzer 2003 | Allocation: not randomised |
| Mintzer 1998 | Allocation: not randomised, review |
| Mitchell 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine dosage study, no comparator drug |
| Mosolov 1998 | Allocation: not randomised, review |
| Mulqueen 2000 | Allocation: not described |
| Naber 1997 | Allocation: not randomised |
| Narendran 2003 | Allocation: not randomised |
| NCT00419653 | Study was terminated |
| Oliemeulen 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus clozapine Outcomes: no usable data |
| Ortega‐Solo (HGBS) | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone Outcomes: no usable data |
| Ortho‐McNeil 2010 | Study was terminated |
| Paquet 2001 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data. |
| Parellada 1999 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Patel 2022 | Allocation: electronic health records, not randomised Participants: people with schizophrenia Intervention: olanzapine, quetiapine, haloperidol, risperidone, aripiprazole Outcomes: monotherapy vs treatment switches |
| Perez 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol, risperidone Outcomes: no usable data |
| Perro 1999 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone versus zotepine versus sertindole Outcomes: no usable data |
| Pivac 2002 | Allocation: not randomised |
| Rasmussen 2016 | Allocation: randomised Participants: people with schizophrenia and manic (bipolar) Interventions: olanzapine versus haloperidol |
| Ratakonda 1998 | Allocation: not randomised |
| Reus 1997 | Allocation: not randomised, review |
| Rosebush 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Sacchetti 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone versus quetiapine Outcomes: no data available |
| Sacristan (HGGS) | Allocation: not randomised |
| Sangar 1998 (HGEH) | Allocation: unclear Participants: those with rapid‐cycling bipolar disorder |
| Sayers 2005 | Allocation: randomised Participants: people with schizophrenia and cocaine addiction Interventions: olanzapine versus haloperidol |
| Sharma 2003 | Allocation: unclear Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no data available |
| Sheitman 1997 | Allocation: not randomised, case series |
| Sheitman 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone Outcomes: no usable data |
| Sikich 2004 | Allocation: randomised Participants: people with schizophrenia (8 to 19 years) |
| Smarek 2003 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Smelson 2003 | Allocation: randomised Participants: people with schizophrenia and cocaine addiction Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Smith 1998 | Allocation: not randomised |
| Smith 2001 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Soutullo 1998 | Allocation: not randomised, case series |
| Stephenson 2000 | Allocation: not randomised, review article |
| Sun 2022 | Allocation: data obtained from multicentre randomised clinical trial Participants: people with schizophrenia Intervention: quetiapine Outcomes: PANSS scale |
| Szafranski 1999 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus perphenazine Outcomes: no usable data |
| Tamura 1996 (F1D‐JE) | Allocation: not randomised, testing a questionnaire |
| Tang 2003 | Allocation: randomised Participants: people with schizophrenia Intervention: olanzapine versus risperidone Outcomes: no usable data |
| Tang 2004 | Allocation: quasi‐randomised (by order of admission) Participants: people with schizophrenia Interventions: haloperidol versus olanzapine Outcomes: no usable data |
| Tohen 2000b (HGGW) | Allocation: randomised Participants: not described |
| Tran 1998 (HGEJ) | Allocation: not randomised, case series |
| Trandafir 1998 | Allocation: randomised Participants: people with drug‐induced psychosis |
| Tsuang 2002 | Allocation: not described Participants: people with schizophrenia and cocaine addiction Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Uzun 2002 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus ziprasidone Outcomes: no usable data |
| Uzun 2006 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Villari 2008 | Allocation: quasi‐randomised |
| Volavka 2002 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus clozapine versus haloperidol versus risperidone Outcomes: olanzapine arm added during study without equal randomisation |
| Voruganti 2002 | Allocation: naturalistic cohort study |
| Wang 2018 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Woods 2002 (HGGF) | Allocation: randomised Participants: people with suspected prodromal schizophrenia |
| Woodward 2001 | Allocation: not randomised |
| Wright 2003 (HGAB) | Allocation: randomised Participants: people with schizophrenia Interventions: IM olanzapine, followed by oral olanzapine versus IM haloperidol followed by oral haloperidol |
| Wudarsky 1999 | Allocation: double‐blind and open Participants: childhood onset schizophrenia |
| Yagdiran 2000 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus risperidone versus amisulpride, clozapine Outcomes: no usable data |
| Yan 2022 | Allocation: randomised, multicentre, controlled trial Participants: acutely agitated patients Intervention: intramuscular midazolam, intramuscular olanzapine, intramuscular haloperidol Outcomes: cost‐effectiveness |
| Zabotina 2020 | Allocation: randomised Participants: people with schizophrenia Interventions: olanzapine versus haloperidol Outcomes: no usable data |
| Zhang 1999 | Allocation: not randomised, open‐label Participants: people with schizophrenia Interventions: single‐arm study of olanzapine Outcomes: no usable data |
| Ziherl (HGCZ) 1999 | Allocation: not randomised, open‐label, single‐arm study of olanzapine |
ACES: Agitation‐Calmness Evaluation Scale BPRS: Brief Psychiatric Rating Scale BAS: Barnes Akathisia Scale CGI: Clinical Global Impression IM: intramuscular MOAS: Modified Overt Aggression Scale PANSS: Positive and Negative Syndrome Scale SAS: Simpson Angus Scale
Differences between protocol and review
We renamed the term 'schizophrenia‐like disorders' as 'schizophrenia‐spectrum disorders' in the title and throughout the review.
We renamed the terms 'effects' and 'safety' as benefits and harms, respectively, throughout the review.
For binary outcomes, along with the calculation of risk ratio (RR), we calculated the number needed to treat for an additional beneficial outcome (NNTB) and the number needed to treat for an additional harmful outcome (NNTH), to take into account the ease of use of these tools for clinicians' and readers' understanding.
We re‐organised and re‐named the outcomes to conform with the names and details (e.g. scales, cut‐off criteria) of outcomes identified during the review process.
We replaced some prespecified summary of findings outcomes due to unavailability of findings.
Adverse effects or events: specific ‐ incidence of clinically important metabolic effects; replaced with: Adverse effects or events: specific ‐ metabolic ‐ weight increase.
Leaving study early due to discontinuation; replaced with: Leaving the study early: adverse effects.
We added one additional subgroup analysis comparing equivalent therapeutic doses of haloperidol and olanzapine.
Contributions of authors
Khasan Ibragimov: protocol development, study selection, data extraction, study appraisal, statistical analyses, writing the report.
Gregory Keane: protocol development, study selection, study appraisal, writing the report, providing a clinical and policy perspective.
Cristina Carreño: protocol development, study selection, writing the report, providing a clinical and policy perspective.
Jie Cheng: study selection, data extraction, study appraisal.
Augusto Llosa: protocol development, study selection, data extraction, study appraisal, statistical analyses, writing the report, guarantor of the review.
Sources of support
Internal sources
-
Médecins Sans Frontières (MSF), France
This review was funded in full by the non‐profit organisation Médecins Sans Frontières, through internal funds.
External sources
-
None, Other
There was no external support for this review.
Declarations of interest
Khasan Ibragimov: none known Gregory Keane: none known Cristina Carreño: none known Jie Cheng: none known Augusto Llosa: none known
New
References
References to studies included in this review
Altamura (HGBQ) 1999 {published and unpublished data}5242
- Altamura AC, Eli Lilly Data Compilers. HGBQ - Olanzapine verus haloperidol in partial responder schizophrenic patients. Supplied by Eli Lilly 2000.
- Altamura AC, Velona I, Curreli R, Bravi D. Olanzapine in the treatment of paranoid schizophrenia. European Neuropsychopharmacology 1999;9(Suppl 5):S297. [CSZG: 5951] [Google Scholar]
- Altamura AC, Velona I, Curreli R, Mundo E, Bravi D. Is olanzapine better than haloperidol in resistant schizophrenia? A double-blind study in partial responders. International Journal of Psychiatry in Clinical Practice 2002;6(2):107-11. [CSZG: 10021] [EMBASE 2002201401; CN-00443300.] [DOI] [PubMed] [Google Scholar]
Avasthi 2001 {published data only}7309
- Avasthi A, Kulhara P, Kakkar N. Olanzapine in the treatment of schizophrenia: an open label comparative trial from North India. Indian Journal of Psychiatry 2001;43(3):257-63. [CSZG: 10100] [PMC free article] [PubMed] [Google Scholar]
Barak 2002 {published data only}6903
- Barak Y, Shamir E, Zemishlani H, Mirecki I, Toren P, Weizman R. Olanzapine vs. haloperidol in the treatment of elderly chronic schizophrenia patients. Progress in Neuro-Psychopharmacology & Biological Psychiatry 2002;26:1199-202. [CSZG: 9250] [MEDLINE: ] [PMID 12452546] [DOI] [PubMed] [Google Scholar]
Beasley (E003) 1997 {published and unpublished data}14618
- Baker R W, Julier B, Stauffer V. Manic-like symptoms in schizophrenic patients treated with olanzapine, haloperidol and placebo. In: 7th World Congress of Biological Psychiatry; 2001 Jul 1-6; Berlin, Germany. 2001. [CSZG: 7566]
- Beasley CM Jr, Dellva MA, Tamura RN, Morgenstern H, Glazer WM, Ferguson K, et al. A randomized, double-blind comparison of the incidence of tardive dyskinesia during long-term treatment with olanzapine or haloperidol. British Journal of Psychiatry 1999;174:23-30. [CSZG: 3447] [DOI] [PubMed] [Google Scholar]
- Beasley CM Jr, Hamilton SH, Crawford AM, Dellva MA, Tollefson GD, Tran PV, et al. Olanzapine versus haloperidol: acute phase results of the international double-blind olanzapine trial. European Neuropsychopharmacology 1997;7:125-37. [CSZG: 1844] [DOI] [PubMed] [Google Scholar]
- Beasley CM Jr, Tollefson GD, Tran PV. Safety of olanzapine. Journal of Clinical Psychiatry 1997;58(Suppl 10):13-7. [PubMed] [Google Scholar]
- Beasley CM, Sayler ME, Kiesler GM, Potvin JH, Sanger TM, Tollefson GD. The influence of pharmacotherapy on self-directed and externally-directed aggression in schizophrenia. Schizophrenia Research 1998;29(1-2):28. [CSZG: 9191] [Google Scholar]
- Dellva MA, Tran P, Tollefson GD, Wentley AL, Beasley CM Jr. Standard olanzapine versus placebo and ineffective-dose olanzapine in the maintenance treatment of schizophrenia. Psychiatric Services 1997;48:1571-7. [CSZG: 3185] [DOI] [PubMed] [Google Scholar]
- Edgell ET, Hamilton SH, Revicki DA, Genduso LA, Tollefson GD. Costs of olanzapine treatment compared with haloperidol for schizophrenia: results from a randomized clinical trial. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; 1998 July 12-16; Glasgow, Scotland, UK. 1998. [CSZG: 3199]
- Nemeroff CB. Quality of life and new antipsychotics. In: Xth World Congress of Psychiatry; August 23-28; Madrid, Spain. 1996. [CSZG: 2150]
- Revicki D, Genduso L. Olanzapine versus haloperidol therapy for chronic schizophrenia: impact on deficit syndrome. In: 8th European College of Neuropsychopharmacology Congress; Sep 30-Oct 4; Venice; Italy. 1995. [CSZG: 3758]
- Street JS, Tamura R, Sanger T, Tollefson G. Long-term treatment-emergent dyskinetic symptoms in patients treated with olanzapine and haloperidol. Psychopharmacology Bulletin 1996;32(3):522. [Google Scholar]
- Tamura RN, Beasley CM, Dellva MA, Glazer WM, Morgenstern H, Tollefson GD. What is the differential risk of tardive dyskinesia with the novel antipsychotic olanzapine? Schizophrenia Research 1998;29(1-2):176. [CSZG: 2808] [Google Scholar]
- Tollefson GD, Beasley CM Jr, Tamura RN, Tran PV, Potvin JH. Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. American Journal of Psychiatry 1997;154(9):1248-54. [CSZG: 5284] [DOI] [PubMed] [Google Scholar]
- Tran P, Beasley C, Tollefson G, Crawford A, Dellva M, Gusman S, et al. Acute and long-term results of the dose ranging double-blind olanzapine trial. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne, Australia. 1996. [CSZG: 2849]
- Tran PV, Beasley CM, Tollefson GD, Beuzen JN, Holman SL, Sanger TM, et al. Olanzapine: a promising atypical antipsychotic agent. Schizophrenia Research 1995;15(1,2):169. [CSZG: 3692] [CSG NO. 4030] [Google Scholar]
- Tran PV, Dellva MA, Tollefson GD, Beasley CM Jr, Potvin JH, Kiesler GM. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. Journal of Clinical Psychiatry 1997;58(5):205-11. [CSZG: 5308] [DOI] [PubMed] [Google Scholar]
- Tran PV, Dellva MA, Tollefson GD, Wentley AL, Beasley C Jr. Oral olanzapine versus oral haloperidol in the maintenance tratement of schizophrenia and related psychoses. British Journal of Psychiatry 1998;172:499-505. [CSZG: 18350] [DOI] [PubMed] [Google Scholar]
- Wright P, Tollefson GD, Beasley CM, Tamura RN, Tran PV, Potvin JII. A blinded, controlled, long-term study of the comparative incidence of treatment-resistant tardive dyskinesia with olanzapine or haloperidol. Schizophrenia Research 1998;29(1-2):206. [CSZG: 9192] [Google Scholar]
Beasley (HGAD) 1996a {published and unpublished data}5582
- Baker R W, Julier B, Stauffer V. Manic-like symptoms in schizophrenic patients treated with olanzapine, haloperidol and placebo. In: 7th World Congress of Biological Psychiatry; 2001 Jul 1-6; Berlin, Germany. Vol. 2. 2001. [CSZG: 7566]
- Baker RW, Ames D, Umbricht DSG, Chengappa KNR, Schooler NR. Obsessive-compulsive symptoms in schizophrenia - a comparison of olanzapine and placebo. Psychopharmacology Bulletin 1996;32:89-93. [CSZG: 479] [PubMed] [Google Scholar]
- Beasley CM Jr, Tollefson G, Tran P, Satterlee W, Sanger T, Hamilton S. Olanzapine versus placebo and haloperidol: acute phase results of the North American double-blind olanzapine trial. Neuropsychopharmacology 1996;14:111-23. [CSZG: 1026] [DOI] [PubMed] [Google Scholar]
- Beasley CM Jr, Tollefson GD, Tran PV. Safety of olanzapine. Journal of Clinical Psychiatry 1997;58(Suppl 10):13-7. [CSZG: 9984] [PubMed] [Google Scholar]
- Beasley CM, Sayler ME, Kiesler GM, Potvin JH, Sanger TM, Tollefson GD. The influence of pharmacotherapy on self-directed and externally-directed aggression in schizophrenia. Schizophrenia Research 1998;29(1-2):28. [CSZG: 9191] [Google Scholar]
- Beasley CM, Tollefson GD, Beuzen JN, Dellva MA, Sanger TM, Paul S. Acute and long-term results of the North American double-blind olanzapine trial. In: Schizophrenia - Breaking down the Barriers, 4th International Conference; October 6-9; Vancouver; BC, Canada. 1996. [CSZG: 1116]
- Crawford AM, Beasley CM, Tollefson GD. Olanzapine - impact of an atypical antipsychotic candidate on prolactin release. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 4020]
- Crawford AM, Beasley CM, Tollefson GD. The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentration. In: 10th European College of Neuropsychopharmacology Congress; Sep 13-17; Vienna, Austria. 1997. [CSZG: 4021] [DOI] [PubMed]
- Crawford AM, Beasley CM, Tollefson GD. The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Journal of the European College of Neuropsychopharmacology 1997;9:P2016. [CSZG: 10012] [[NR692]] [DOI] [PubMed] [Google Scholar]
- Dellva MA, Tran P, Tollefson GD, Wentley AL, Beasley CM Jr. Standard olanzapine versus placebo and ineffective-dose olanzapine in the maintenance treatment of schizophrenia. Psychiatric Services 1997;48:1571-7. [CSZG: 3185] [DOI] [PubMed] [Google Scholar]
- Edgell ET, Hamilton SH, Revicki DA, Genduso LA, Tollefson GD. Costs of olanzapine treatment compared with haloperidol for schizophrenia: results from a randomized clinical trial. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow, Scotland, UK. 1998. [CSZG: 3199]
- Hamilton SH, Revicki DA, Genduso LA, Beasley CM Jr. Olanzapine versus placebo and haloperidol: quality of life and efficacy results of the North American double-blind trial. Neuropsychopharmacology 1998;18:41-9. [CSZG: 3717] [DOI] [PubMed] [Google Scholar]
- Martin C, Genduso L, Revicki D, Hamilton S, Tran P, Beasley C. Quality of life outcomes of olanzapine, a new atypical antipsychotic agent. Schizophrenia Research 1996;18(2,3):130. [CSZG: 3576] [CSG NO. 4087] [Google Scholar]
- Perry PJ, Lund BC, Sanger T, Beasley. Olanzapine plasma concentrations and clinical response: acute phase results of the North American Olanzapine Trial. Journal of Clinical Psychopharmacology 2001;21(1):14-20. [CSZG: 5908] [DOI] [PubMed] [Google Scholar]
- Revicki D, Genduso L. Effect of olanzapine on deficit syndrome symptoms in chronic schizophrenia. In: 8th European College of Neuropsychopharmacology Congress; Sep 30 - Oct 4; Venice; Italy. 1995. [CSZG: 3757]
- Sanger T, Tollefson GD, Lieberman JA, Tohen M. Olanzapine versus haloperidol in the treatment of first-episode psychosis. In: American Psychiatric Association. 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 3762]
- Sanger T, Tollefson GD. A controlled study on the course of primary and secondary negative symptoms. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 3761]
- Satterlee WG, Beasley CM, Tollefson GD, Moore N, Tran PV. Preclinical and clinical observations of olanzapine (a new antipsychotic). Psychopharmacology Bulletin 1994;30:638. [CSZG: 2505] [Google Scholar]
- Street J, Dellva M, Tamura R, Sanger T, Tollefson G. A comparison of extrapyramidal syndromes between olanzapine and placebo in schizophrenia. In: 9th Congress of the European College of Neuropsychopharmacology, Amsterdam, The Netherlands. 1996. [CSZG: 2755] [CSG NO. 3727]
- Street JS, Dellva MA, Tamura RN, Sanger T, Tollefson GD. Comparison of extrapyramidal syndromes between olanzapine and placebo in schizophrenia. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 2756]
- Street JS, Dellva MA, Tamura RN, Sanger T, Tollefson GD. Comparison of extrapyramidal syndromes between olanzapine and placebo in schizophrenia. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne; Australia. 1996. [CSZG: 2756]
- Street JS, Dellva MA, Tamura RN, Sanger T, Tollefson GD. Comparison of extrapyramidal syndromes between olanzapine and placebo in schizophrenia. In: Xth World Congress of Psychiatry; August 23-28; Madrid; Spain. 1996. [CSZG: 2756]
- Tollefson GD, Beasley CM Jr, Tamura RN, Tran PV, Potvin JH. Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. American Journal of Psychiatry 1997;154(9):1248-54. [CSZG: 5284] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Beasley CM, Tran PV, Sanger T. Olanzapine: an exciting atypical antipsychotic the clinical experience. In: 8th European College of Neuropsychopharmacology Congress; Sep 30-Oct 4; Venice; Italy. 1995. [CSZG: 3784]
- Tollefson GD, Sanger TM, Beasley CM, Tran PV. A double-blind, controlled comparison of the novel antipsychotic olanzapine versus haloperidol or placebo on anxious and depressive symptoms accompanying schizophrenia.. Biological Psychiatry 1998;43(11):803-10. [CSZG: 5302] [CSG NO. 4252] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Sanger TM, Beasley CM. The course of primary and secondary negative symptoms in a controlled trial with Olanzapine. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne; Australia. 1996. [CSZG: 4023]
- Tollefson GD, Sanger TM, Beasley CM. The course of primary and secondary negative symptoms in a controlled trial with olanzapine. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 4023]
- Tollefson GD, Sanger TM, Beasley CM. The course of primary and secondary negative symptoms in a controlled trial with olanzapine. Schizophrenia Research (Special Issue - The VIth International Congress on Schizophrenia Research; April 12-16; Colorado Springs; CO, USA) 1997;24:192. [CSZG: 4025] [Google Scholar]
- Tollefson GD, Sanger TM, Beasley CM. The course of primary and secondary negative symptoms in a placebo- and comparator-controlled trial of the atypical antipsychotic olanzapine. In: 9th European College of Neuropsychopharmacology Congress; Sep 21-25; Amsterdam; The Netherlands. 1996. [CSZG: 4026]
- Tollefson GD, Sanger TM. Negative symptoms: a path analytic approach to a double-blind, placebo and haloperidol controlled clinical trial with olanzapine. American Journal of Psychiatry 1997;154:466-74. [CSZG: 4022] [DOI] [PubMed] [Google Scholar]
- Tollefson GD. The value of atypical antipsychotic medications. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 4032]
- Tollefson GD. Update on new atypical antipsychotics. In: 8th European College of Neuropsychopharmacology Congress; Sep 30-Oct 4; Venice; Italy. 1995. [CSZG: 4031]
- Tran P, Beasley C, Tollefson G, Beuzen J, Dellva M, Sanger T, et al. Acute and long-term results of the North American double-blind olanzapine trial. In: 8th European College of Neuropsychopharmacology Congress. Sep 30-Oct 4, Venice, Italy. 1995. [CSZG: 1116]
- Tran PV, Beasley CM, Tollefosn GD, Sanger T, Satterlee WG. Clinical efficacy and safety of olanzapine, a new atypical antipsychotic agent. Neuropsychopharmacology 1994;10(Suppl):267S. [CSZG: 18272] [MEDLINE: ] [Google Scholar]
- Tran PV, Beasley CM, Tollefson GD, Beuzen JN, Holman SL, Sanger TM, et al. Olanzapine: a promising atypical antipsychotic agent. Schizophrenia Research 1995;15(1,2):169. [CSZG: 3692] [CSG NO. 4030] [Google Scholar]
- Tran PV, Dellva MA, Tollefson GD, Wentley AL, Beasley C Jr. Oral olanzapine versus oral haloperidol in the maintenance treatment of schizophrenia and related psychoses. British Journal of Psychiatry 1998;172:499-505. [CSZG: 18350] [DOI] [PubMed] [Google Scholar]
- Williamson DJ, Tran PV, Beasley CM, Satterlee WG, Sanger T, Paul S, et al. Additional clinical experience with olanzapine, an atyical antipsychotic. Journal of Psychopharmacology 1995;9(3):A47. [CSZG: 7416] [Google Scholar]
- Williamson DJ, Tran PV, Beasley CM, Tollefson GD, Sanger T, Satterlee WG. Clinical efficacy and safety of olanzapine, a new atypical antipsychotic agent. Journal of Psychopharmacology 1995;9(3):A47. [CSZG: 7416] [MEDLINE: ] [Google Scholar]
Bernardo (HGDD) 2001 {published data only}6127
- Bernardo M, Parellada E, Lomena F, Catafau AM, Font M, Gomez JC, et al. Double-blind olanzapine vs. haloperidol D2 dopamine receptor blockade in schizophrenic patients: a baseline-endpoint. Psychiatry Research 2001;107:87-97. [CSZG: 8180] [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Boulay 2002 {published data only}
- Boulay L. Contrasting the effects of haloperidol and olanzapine on attention and working memory in schizophrenia: a double-blind flexible dose study [[in Partial fulfillment of the requirements for the degree of Doctor of Philosophy]]. National Library of Canada 2003. [ISBN: 0-612-83513-8]
- Boulay LJ, Labelle A, Bourget D, Robertson S, Habib R, Tessier P, et al. Dissociating medication effects from learning and practice effects in a neurocognitive study of schizophrenia: olanzapine versus haloperidol. Cognitive Neuropsychiatry 2007;12(4):322-38. [DOI: 10.1080/13546800601069534] [PMID: PMID: 17558641] [DOI] [PubMed] [Google Scholar]
Buchanan 2003 {published data only}
- Buchanan RW, Ball MP, Weiner E, Kirkpatrick B, Gold J, Carpenter WT, et al. Olanzapine treatment of residual positive and negative symptoms. Journal of Psychiatry 2005;162(1):124-9. [DOI: 10.1176/appi.ajp.162.1.124] [DOI] [PubMed] [Google Scholar]
- Buchanan RW, Ball MP, Weiner E, Kirkpatrick B, Gold J, Carpenter WT. Olanzapine treatment of residual positive and negative symptoms. Schizophrenia Research 2003;60:275. [EMBASE: 2003241517] [DOI] [PubMed] [Google Scholar]
- Kelly DL, Weiner E, Ball MP, McMahon RP, Carpenter WT, Buchanan RW. Remission in schizophrenia: the relationship to baseline symptoms and changes in symptom domains during a one-year study. Journal of Psychopharmacology 2009;23(4):436-41. [DOI: 10.1177/0269881108093883] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Haan L, Beveren N. Olanzapine and haloperidol for residual symptoms. American Journal of Psychiatry 2005;162(7):1392-3. [DOI: 10.1176/appi.ajp.162.7.1392] [DOI] [PubMed] [Google Scholar]
Chaudhry 2003 {published data only}
- Chaudhry HR, Kongsakon R, Ignacio JC, Raza SB, Leynes MCR, Hasanah CI, et al. Quality of life and clinical outcomes for Asian outpatients with schizophrenia: a double-blind randomised comparison of olanzapine and haloperidol. Journal of the European College of Neuropsychopharmacology 2003;13(4):S309. [CSZG: 9857] [P.2.069] [Google Scholar]
- Chaudhry HR, Raza SB, Ismail HC, Chan B, Ignacio JC, Rodriguez SC, et al. Asian outpatients with schizophrenia: a double-blind randomized comparison of quality of life and clinical outcomes for patients treated with olanzapine or haloperidol. Journal of the Medical Association of Thailand 2006;89(8):1157-70. [PMID: PMID: 17048425] [PubMed] [Google Scholar]
Crespo‐Facorro 2006 {published data only}
- Ayesa-Arriola R, Rodríguez-Sánchez J M, Pérez-Iglesias R, Roiz-Santiáñez R, Martínez-García O, Sánchez-Moreno J, et al. Long-term (3-year) neurocognitive effectiveness of antipsychotic medications in first-episode non-affective psychosis: a randomized comparison of haloperidol, olanzapine, and risperidone. Psychopharmacology 2013;227(4):615-25. [DOI: 10.1007/s00213-013-2994-z] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Carrasco-Marín E, Pérez-Iglesias R, Pelayo-Terán JM, Fernandez-Prieto L, Leyva-Cobián F, et al. Interleukin-12 plasma levels in drug-naive patients with a first episode of psychosis: effects of antipsychotic drugs. Psychiatry Research 2008;158(2):206-16. [DOI: 10.1016/j.psychres.2006.08.005] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Perez-Iglesias R, Ramirez-Bonilla M, et al. Haloperidol, risperidone and olanzapine are similarly effective for first-episode non-affective psychosis but have differing side effects. Evidence-Based Mental Health 2007;10(3):74. [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Pérez-Iglesias R, Mata I, Caseiro O, Martínez-Garcia O, Pardo G, et al. Relapse prevention and remission attainment in first-episode non-affective psychosis. A randomized, controlled 1-year follow-up comparison of haloperidol, risperidone and olanzapine. Journal of Psychiatric Research 2011;45(6):763-9. [DOI: 10.1016/j.jpsychires.2010.11.002] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Pérez-Iglesias R, Mata I, Martínez-Garcia O, Ortiz V, Pelayo-Terán JM, et al. Long-term (3-year) effectiveness of haloperidol, risperidone and olanzapine: results of a randomized, flexible-dose, open-label comparison in first-episode nonaffective psychosis. Psychopharmacology 2012;219(1):225-33. [DOI: 10.1007/s00213-011-2392-3] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Pérez-Iglesias R, Mata I, Ramirez-Bonilla M, Martínez-Garcia O, Pardo-Garcia G, et al. Effectiveness of haloperidol, risperidone and olanzapine in the treatment of first-episode non-affective psychosis: results of a randomized, flexible-dose, open-label 1-year follow-up comparison. Journal of Psychopharmacology 2011;25(6):744-54. [DOI: 10.1177/0269881110388332] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Pérez-Iglesias R, Ramirez-Bonilla M, Martínez-García O, LLorca J, Luis JVB. A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry 2006;67(10):1511-21. [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Rodriguez-Sanchez JM, Perez-Iglesias R, Mata I, Ayesa R, Ramirez-Bonilla M, et al. Neurocognitive effectiveness of haloperidol, risperidone, and olanzapine in first-episode psychosis: a randomized, controlled 1-year follow-up comparison. Journal of Clinical Psychiatry 2009;70(5)(5):717-29. [DOI: 10.4088/JCP.08m04634] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Crespo-Facorro B, Roiz-Santiáñez R, Pérez-Iglesias R, Pelayo-Terán JM, Rodríguez-Sánchez JM, Tordesillas-Gutiérrez D, et al. Effect of antipsychotic drugs on brain morphometry: a randomized controlled one-year follow-up study of haloperidol, risperidone and olanzapine. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2008;32(8):1936-43. [DOI: 10.1016/j.pnpbp.2008.09.020] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Diaz FJ, Perez-Iglesias R, Mata I, Martínez-Garcia O, Vázquez-Barquero JL, Leon J, et al. Using structural equations to test for a direct effect of some antipsychotics on triglyceride levels in drug-naïve first-episode psychosis patients. Schizophrenia Research 2011;131(1-3):82-9. [DOI: 10.1016/j.schres.2011.06.006] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Diaz FJ, Pérez-Iglesias R, Mata I, Martínez-Garcia O, Vázquez-Barquero JL, Leon J, et al. Possible effects of some antipsychotic drugs on C-reactive protein in a drug-naïve psychotic sample. Schizophrenia Research 2010;121(1-3):207-12. [DOI: 10.1016/j.schres.2010.06.002] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Díaz I, Pelayo-Terán JM, Pérez-Iglesias R, Mata I, Tabarés-Seisdedos R, Suárez-Pinilla P, et al. Predictors of clinical remission following a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables. Psychiatry Research 2013;206(2-3):181-7. [DOI: 10.1016/j.psychres.2012.10.011] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Mata I, Crespo‐Facorro B, Pérez‐Iglesias R, Carrasco‐Marín E, Arranz MJ, Pelayo‐Terán JM, et al. Association between the interleukin‐1 receptor antagonist gene and negative symptom improvement during antipsychotic treatment. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 2006;141(8):939-43. [DOI: ] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Mata I, Perez-Iglesias R, Pelayo-Teran JM, Rodríguez-Sanchez JM, Gonzalez-Blanch C, Carrasco-Marin E, et al. Lack of influence of COMT Val158Met genotype on cognition in first-episode non-affective psychosis. Schizophrenia Research 2008;102(1-3):206-9. [DOI: 10.1016/j.schres.2008.02.011] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Pelayo-Teran JM, Diaz FJ, Perez-Iglesias R, Suarez-Pinilla P, Tabares-Seisdedos R, Leon J, et al. Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis. Psychological Medicine 2014;44(1):37-50. [DOI: ] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Pelayo-Teran JM, Perez-Iglesias R, Mata I, Moreno-Calle T, Rodriguez-Sánchez JM, Ramirez-Bonilla ML, et al. Early response to antipsychotics as a marker of treatment response of psychosis. Schizophrenia Research 2010;2(117):180. [DOI: 10.1016/j.schres.2010.02.219] [DOI] [Google Scholar]
- Pelayo-Teran JM, Perez-Iglesias R, Mata J, VazquezBourgon J, Carrasco-Marin E, Vazquez-Barquero JL, Crespo-Facorro B. Catechol-o-methyltransferase val158met in first episode psychosis: prognostic factor or negative trait marker? Psychotic Disorders and Antipsychotics - Antipsychotics (clinical) unknown;unknown:S551. [Google Scholar]
- Perez-Iglesias R, Crespo-Facorro B, Amado JA, Garcia-Unzueta MT, Ramirez-Bonilla ML, Gonzalez-Blanch C, et al. A 12-week randomized clinical trial to evaluate metabolic changes in drug-naive, first-episode psychosis patients treated with haloperidol, olanzapine, or risperidone. Journal of Clinical Psychiatry 2007;68(11):1733-40. [PMID: ] [DOI] [PubMed] [Google Scholar]
- Perez-Iglesias R, Crespo-Facorro B, Martinez-Garcia O, Ramirez-Bonilla ML, Alvarez-Jimenez M, Pelayo-Teran JM, et al. Weight gain induced by haloperidol, risperidone and olanzapine after 1 year: findings of a randomized clinical trial in a drug-naive population. Schizophrenia Research 2008;99(1-3):13-22. [DOI: 10.1016/j.schres.2007.10.022] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Perez-Iglesias R, Crespo-Facorro B, Martinez-Garcia O, Ramirez-Bonilla ML, Pelayo-Teran JM, Gonzalez-Blanch C, et al. One year randomized clinical trial of haloperidol, olanzapine or risperidone to determine weight gain pattern in a drug-naive population of first episode psychotic patients. Schizophrenia Bulletin unknown;33(2):505. [Google Scholar]
- Perez-Iglesias R, Mata I, Pelayo-Teran JM, Amado J A, Garcia-Unzueta MT, Berja A, et al. Glucose and lipid disturbances after 1 year of antipsychotic treatment in a drug-naive population. Schizophrenia Research 2009;107(2-3):115-21. [DOI: 10.1016/j.schres.2008.09.028] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Perez-Iglesias R, Vazquez-Barquero JL, Amado JA, Berja A, Garcia-Unzueta MT, Pelayo-Terán JM, et al. Effect of antipsychotics on peptides involved in energy balance in drug-naive psychotic patients after 1 year of treatment. Journal of Clinical Psychopharmacology 2008;28(3):289-95. [DOI: 10.1097/JCP.0b013e318172b8e6] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Pérez-Iglesias R, Martínez-García O, Mata I, Pelayo-Teran J, Pardo-García G, Vázquez-Barquero J, et al. Predictors of antipsychotic-induced weight gain after the first 3 years of treatment. Early Intervention in Psychiatry 2010;4:00. [Google Scholar]
- Pérez-Iglesias R, Martínez-García O, Pardo-Garcia G, Amado JA, Garcia-Unzueta MT, Tabares-Seisdedos R, et al. Course of weight gain and metabolic abnormalities in first treated episode of psychosis: the first year is a critical period for development of cardiovascular risk factors. International Journal of Neuropsychopharmacology 2014;17(1):41-51. [DOI: 10.1017/S1461145713001053] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Pérez-Iglesias R, Mata I, Martínez-García O, Garcia-Unzueta MT, Amado JA, Valdizán EM, et al. Long-term effect of haloperidol, olanzapine, and risperidone on plasma prolactin levels in patients with first-episode psychosis. Journal of Clinical Psychopharmacology 2012;32(6):804-8. [10.1097/JCP.0b013e318272688b] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Roiz-Santiáñez R, Tordesillas-Gutiérrez D, la Foz V OG, Ayesa-Arriola R, Gutiérrez A, Tabarés-Seisdedo R, et al. Effect of antipsychotic drugs on cortical thickness. A randomized controlled one-year follow-up study of haloperidol, risperidone and olanzapine. Schizophrenia Research 2012;141(1):22-8. [DOI: 10.1016/j.schres.2012.07.014] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Sanchez-Cubillo I, Rodriguez-Sanchez, JM, Crespo-Facorro B, Gonzalez-Blanch C, Pelayo-Teran JM, Barbas P, et al. Comparison between the effect of typical and atypical antipsychotics on cognition: a three-month follow up in first episodes of psychosis. Schizophrenia Bulletin 2007;33(2):574. [Google Scholar]
Cui 2016e {published data only}
- 崔明伟, 张小波. 氟哌啶醇与奥氮平治疗精神分裂症疗效探讨. 海峡药学 2016;28(6):175-6. [Google Scholar]
de Hann 2003 {published data only}6792
- Haan L, Bruggen M, Lavalaye J, Booij J, Dingemans PM, Linszen D. Subjective experience and D2 receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol: a randomized, double-blind study. American Journal of Psychiatry 2003;160:303-9. [CSZG: 9253] [MEDLINE: ] [PMID 12562577] [DOI] [PubMed] [Google Scholar]
- Haan L, van-Bruggen M, Lavalaye J, Booij J, Dingemans P, Linszen D. Subjective experience and d2 receptor occupancy in patients with schizophrenia, treated with low dose olanzapine or haloperidol; a randomized double-blind study. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:179. [CSZG: 8065] [Google Scholar]
Dhar 2010 {published data only}
- Dhar R, Chavan BS, Sidana A. Comparative efficacy of haloperidol and olanzapine in patients of schizophrenia: a 6 month follow up trial. JMHHB 2010;15:31-9. [https://pdfs.semanticscholar.org/7890/31a9cba833edd4d19fa35f42a8cd4a12104d.pdf] [Google Scholar]
Ding 2013 {published data only}
- 丁婷, 刘玉兰. Controlled study in refractory schizophrenia treatment olanzapine and haloperidol [Google Translate] [奥氮平与氟哌啶醇治疗难治性精神分裂症的对照研究]. China Journal of Health Psychology [中国健康心理学杂志] 2013;21(01):23-4. [Google Scholar]
Gründer (NeSSy) 2012 {published and unpublished data}
- Gruender G, Heinze M, Cordes J, Ruether E, Timm J. The "Neuroleptic Strategy Study" (NeSSy)-first vs. second generation antipsychotics for the treatment of schizophrenia. Neuropsychopharmacology 2014;39:S370-1. [Google Scholar]
- Gruender G, Timm J, Muehlbauer B, Handschuh D, Heinze M, Schulz C, et al. Antipsychotic Serum Concentrations in the "Neuroleptic Strategy Study"(NeSSy). Neuropsychopharmacology 2016;41:S233-4. [Google Scholar]
- Gründer G, Heinze M, Cordes J, Mühlbauer B, Juckel G, Schulz C, NeSSy Study Group. Effects of first-generation antipsychotics versus second-generation antipsychotics on quality of life in schizophrenia: a double-blind, randomised study. Lancet Psychiatry 2016;3(8):717-29. [DOI: 10.1016/S2215-0366(16)00085-7] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Schulz C, Timm J, Cordes J, Gründer G, Mühlbauer B, Rüther E, et al. Patient-oriented randomisation: a new trial design applied in the Neuroleptic Strategy Study. Clinical Trials 2016;13(3):251-9. [DOI: 10.1177/1740774516639910] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Veselinović T, Scharpenberg M, Heinze M, Cordes J, Mühlbauer B, Juckel G, et al. Disparate effects of first and second generation antipsychotics on cognition in schizophrenia–findings from the randomized NeSSy trial. European Neuropsychopharmacology 2019;29(6):720-39. [DOI: 10.1177/1740774516639910] [PMID: ] [DOI] [PubMed] [Google Scholar]
HGCJ (Hong Kong) 1998 {published and unpublished data}14101
- Tran PV, Beasley CM, Tollefson GD, Creanga D, Zhang F, Wang J, et al. Clinical experience with olanzapine in patients of African, Asian, and Hispanic descent. In: Meeting of the American Psychiatric Association. Washington, DC, USA. 1999. [CSZG: 4045]
- Tran PV, Beasley CM, Tollefson GD, Creanga D, Zhang F, Wang J, et al. Clinical experience with olanzapine in patients of African, Asian, and Hispanic descent. In: World Psychiatric Association; Hamburg, Germany. 1999. [CSZG: 7053]
- Tran PV, Cousins LM, Creanga D, Tollefson GD, Vangala S, Wang J, et al. Clinical experience with olanzapine in patients of African, Asian, and Hispanic descent. In: ACNP. Hawaii, USA. 1998.
- Tran PV, Creanga D, Zhang F, Wang J, Vangala S, Cousins L, et al. Clinical experience with olanzapine in ethnic subgroups. In: NCDEU. Boca Raton, FL, USA. 1999. [CSZG: 7042]
- Tran PV, Zhang F, Hwu HG, Liehmak F. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Taiwan and Hong Kong. In: APA Annual Meeting, May 15-20, Washington, DC. 1999. [CSZG: 4049] [CSG NO. 4118]
- Vangala S, Zhang F, Tran P, Sze S. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Hong Kong. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow, Scotland, UK. 1998. [CSZG: 2927]
- Zhang F, Tran PV, Taylor C, Hwu GH, Chen YS, Chang WH, et al. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Taiwan and Hong Kong. In: World Psychiatric Association; Hamburg, Germany. 1999. [CSZG: 18834]
HGCU (Taiwan) 1998 {published and unpublished data}2841
- Tran PV, Creanga D, Zhang F, Wang J, Vangala S, Cousins L, et al. Clinical experience with olanzapine in ethnic subgroups. In: NCDEU. Boca Raton, FL, USA. 1999. [CSZG: 7042]
- Tran PV, Zhang F, Hwu HG, Liehmak F. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Taiwan and Hong Kong. In: American Psychiatric Association Annual Meeting; 1999 May 15-20; Washington DC; USA. 1999. [CSZG: 4049] [CSG NO. 4118]
- Zhang F, Tran PV, Taylor C, Hwu GH, Chen YS, Chang WH, et al. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Taiwan and Hong Kong. In: World Psychiatric Association. Hamburg, Germany. 1999. [CSZG: 18834]
HGFH (Korea) 1998 {unpublished data only}
- HGFH Korea. Data on file. Data supplied to the Cochrane Schizophrenia Group 1999.
Hu 2014i {published data only}
- 胡立红. 氟哌啶醇与奥氮平治疗精神分裂症疗效和安全性. 中国卫生标准管理 2014;-(17):90-1. [Google Scholar]
Ishigooka 2001 {published data only}5738
- Inada T, Beasley CM, Yoko T, Walker D. Extrapyramidal symptom profiles assessed with the Drug-Induced Extrapyramidal Symptom Scale: comparison with Western scales in the clinical double-blind studies of schizophrenic patients treated with either olanzapine or haoperidol. International Clinical Psychopharmacology 2003;18:39-48. [CSZG: 9109] [DOI] [PubMed] [Google Scholar]
- Inada T, Miura S. Favorable eps profiles of olanzapine measured by the diepss: predictive validity of this scale to differentiate the eps profiles of atypical antipsychotic drugs from conventional antipsychotic drugs in the clinical trial. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):S147. [CSZG: 4748] [Google Scholar]
- Inada T, Yagi G, Miura S. Extrapyramidal symptom profiles in Japanese patients with schizophrenia treated with olanzapine or haloperidol. Schizophrenia Research 2002;57(2-3):227-38. [CSZG: 8571] [DOI] [PubMed] [Google Scholar]
- Ishigooka J, Hirotsu C, Kurihara M, Inada T, Miura S. Olanzapine versus haloperidol in the treatment of patients with chronic schizophrenia: results of the Japan multi-center double-blind olanzapine trial. Psychiatry and Clinical Neurosciences 2001;55(4):403-14. [CSZG: 4470] [DOI] [PubMed] [Google Scholar]
Jiang 2009b {published data only}
- 蒋合萍, 罗毅平. Olanzapine and haloperidol in the treatment of schizophrenia comparative study of excited agitation [Google Translate] [奥氮平与氟哌啶醇治疗精神分裂症兴奋激越症状的对照研究 []. Sichuan Mental Health [四川精神卫生] 2009;22(1):43-4. [Google Scholar]
Jones 1998 (P022) {published and unpublished data}3314
- Canadian Cognition and Outcome Study Group. Neuropsychological change in early phase schizophrenia over twelve months of treatment with olanzapine, risperidone or haloperidol. Schizophrenia Research 1998;29:132-3. [DOI] [PubMed] [Google Scholar]
- David SR, Purdon S, Jones BD, Stip E, Labelle A, Breier AF, et al. Olanzapine versus risperidone versus haloperidol in early illness schizophrenia. Education improves outcomes in MDD. In: 152nd Annual Meeting of the American Psychiatric Association; 1999 May 15-20; Washington, USA. 1999. [CSZG: 3502] [MEDLINE: ]
- Jones B, Tollefson G. Olanzapine versus risperidone and haloperidol in the treatment of schizophrenia. Schizophrenia Research 1998;29:150-1. [CSZG: 7215] [Google Scholar]
- Jones B. Olanzapine versus risperidone and haloperidol in the treatment of schizophrenia. In: 151st Annual Meeting of American Psychiatric Association; May 30-June 4; Toronto; ON, Canada. 1998. [CSZG: 3408]
- Jones B. Treatment of cognitive deficits with antipsychotic drugs. Neurobiology of Aging (Abstracts of 6th International Conference on Alzheimer's Disease and Related Disorders; 1998 Jul 18-23; Amsterdam, the Netherlands) 1998;4S:S152-3. [CSZG: 8662] [Google Scholar]
- Purdon SE, Jones B, Labelle A, Addington D, Tollefson G. A multicentre comparison of olanzapine, risperidone, and haloperidol on working memory, new learning, and delayed recall of verbal and nonverbal materials in early-phase schizophrenia over a 12-month prospective double-blind clinical trial. In: Schizophrenia Research (Abstracts of The 7th International Congress on Schizophrenia Research; 1999 Apr 17-21; Santa Fe, USA). 1999:150. [CSZG: 5699] [MEDLINE: ]
- Purdon SE, Jones BD, Stip E, Labelle A, Addington D, David SR, et al. Neuropsychological change in early phase schizophrenia during 12 months of treatment with olanzapine, risperidone, or haloperidol. The Canadian Collaborative Group for research in schizophrenia.. Archives of General Psychiatry 2000;57(3):249-58. [CSZG: 5220] [CSG NO. 4548] [DOI] [PubMed] [Google Scholar]
- Purdon SE, Jones BDW, Stip E, Labelle A, Addington D, Breier A, et al and the Canadian Collaborative Group for Research on Cognition in Schizophrenia. Olanzapine versus haloperidol versus risperidone in early illness schizophrenia. Unpublished typescript 2001. [CSZG: 7556]
- Purdon SE, Jones BDW, Stip E, Labelle A, Addington Dm Breier A, Tollefson GD. Olanzapine versus haloperidol versus risperidone in early illness schizophrenia. Unpublished data on file 2001. [CSZG: 7556] [MEDLINE: ]
- Purdon SE, Woodward N, Lindborg SR, Stip E. Procedural learning in schizophrenia after 6 months of double-blind treatment with olanzapine, risperidone, and haloperidol. Psychopharmacology 2003;169(3-4):390-7. [CSZG: 10061] [PMID 12827347] [DOI] [PubMed] [Google Scholar]
- Sharma T. Atypical antipsychotics and cognition in schizophrenia. Archives of General Psychiatry 2002;59(6):571-2. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Woodward ND, Purdon SE, David SR, Stip E. Procedural learning over six months double blind treatment with haloperidol, risperidone or olanzapine. Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada) 2001;1-2 Suppl:125. [CSZG: 6087] [MEDLINE: ] [Google Scholar]
Kahn (EUFEST) 2005 {published and unpublished data}68736636
- Boter H, Peuskens J, Libiger J, Fleischhacker WW, Davidson M, Galderisi S, Eufest Study Group. Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission: an open randomized clinical trial (EUFEST). Schizophrenia Research 2009;115(2-3):97-103. [DOI: 10.1016/j.schres.2009.09.019] [DOI] [PubMed] [Google Scholar]
- Davidson M, Galderisi S, Weiser M, Werbeloff N, Fleischhacker WW, Keefe RS, et al. Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). American Journal of Psychiatry 2009;166(6):675-82. [DOI: 10.1176/appi.ajp.2008.08060806] [DOI] [PubMed] [Google Scholar]
- Fleischhacker WW, Keet IP, Kahn RS, EUFEST Steering Committee. The European First Episode Schizophrenia Trial (EUFEST): rationale and design of the trial. Schizophrenia Research 2005;78(2-3):147-56. [DOI: 10.1016/j.schres.2005.06.004] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371(9618):1085-97. [DOI: 10.1016/S0140-6736(08)60486-9] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Malik P, Kemmler G, Hummer M, Riecher-Roessler A, Kahn RS, Fleischhacker WW, EUFEST Study Group. Sexual dysfunction in first-episode schizophrenia patients: results from European First Episode Schizophrenia Trial. Journal of Clinical Psychopharmacology 2011;31(3):274-80. [DOI: 10.1097/JCP.0b013e3182199bcc] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Volavka J, Czobor P, Derks EM, Bitter I, Libiger J, Kahn RS, et al. Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). Journal of Clinical Psychiatry 2011;72(7):955-61. [DOI: 10.4088/JCP.10m06529] [PMID: ] [DOI] [PubMed] [Google Scholar]
Kinon 2004 {published data only}
- Kinon BJ, Ahl J, Rotelli MD, McMullen E. Efficacy of accelerated dose titration of olanzapine with adjunctive lorazepam to treat acute agitation in schizophrenia. American Journal of Emergency Medicine 2004;22(3):181-6. [DOI: 10.1016/j.ajem.2004.02.021] [DOI] [PubMed] [Google Scholar]
Krakowski 2006 {published data only}
- Krakowski M, Czobor P, Citrome L. Weight gain, metabolic parameters, and the impact of race in aggressive inpatients randomized to double-blind clozapine, olanzapine or haloperidol. Schizophrenia Research 2009;110(1-3):95-102. [DOI: 10.1016/j.schres.2009.02.006] [DOI] [PubMed] [Google Scholar]
- Krakowski M, Czobor P. A prospective longitudinal study of cholesterol and aggression in patients randomized to clozapine, olanzapine and haloperidol. International Clinical Psychopharmacology 2011;26:e135-6. [DOI: 10.1097/01.yic.0000405864.74645.87] [DOI] [PubMed] [Google Scholar]
- Krakowski M, Czobor P. Cholesterol and cognition in schizophrenia: a double-blind study of patients randomized to clozapine, olanzapine and haloperidol. Schizophrenia Research 2011;130(1-3):27-33. [DOI: 10.1016/j.schres.2011.04.005] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Krakowski MI, Czobor P, Citrome L, Bark N, Cooper TB, et al. Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Archives of General Psychiatry 2006;63(6):622-9. [DOI: 10.1001/archpsyc.63.6.622] [DOI] [PubMed] [Google Scholar]
- Krakowski MI, Czobor P. A prospective longitudinal study of cholesterol and aggression in patients randomized to clozapine, olanzapine, and haloperidol.. Journal of Clinical Psychopharmacology 2010;30(2):198-200. [DOI: 10.1097/JCP.0b013e3181d47b5e] [DOI] [PubMed] [Google Scholar]
- Krakowski MI, Czobor P. Clozapine and olanzapine in violent schizophrenics. CRISP database (https://www-commons. cit. nih. gov/crisp/index. html) (accessed 19 February 2001).
- Krakowski MI, Czobor P. Depression and impulsivity as pathways to violence: implications for antiaggressive treatment.. Schizophrenia Bulletin 2013;40(4):886-94. [DOI: 10.1093/schbul/sbt117] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krakowski MI, Czobor P. Executive function predicts response to antiaggression treatment in schizophrenia: a randomized controlled trial. Journal of Clinical Psychiatry 2012;73(1):74-80. [DOI: 10.4088/JCP.11m07238] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Krakowski MI, Czobor P. Neurocognitive impairment limits the response to treatment of aggression with antipsychotic agents. Schizophrenia Bulletin 2011;37:311-2. [Google Scholar]
Lahti 2007 {published data only}
- Bolding MS, White DM, Hadley JA, Weiler M, Holcomb HH, Lahti AC. Antipsychotic drugs alter functional connectivity between the medial frontal cortex, hippocampus, and nucleus accumbens as measured by H215O PET. Frontiers in Psychiatry 2012;3:105. [DOI: 10.3389/fpsyt.2012.00105] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lahti AC, Holcomb HH, Tamminga CA, Weiler MA. Limbic rcbf patterns predict treatment response in schizophrenia. Schizophrenia Bulletin 2007;33(2):474. [Google Scholar]
- Lahti AC, Weiler MA, Holcomb HH, Tamminga CA, Cropsey KL. Modulation of limbic circuitry predicts treatment response to antipsychotic medication: a functional imaging study in schizophrenia. Neuropsychopharmacology 2009;34(13):2675-90. [DOI: 10.1038/npp.2009.94] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Li 2005f {published data only}
- Li C, Zhu S, Ling Z. A controlled study of olanzapine and haloperidol in the treatment of the acute phase of schizophrenia. Shanghai Archives of Psychiatry [上海精神医学] [上海精神醫學] 2005;17(5):275-7. [Google Scholar]
Lieberman (HGDH) 2003 {published data only}7019
- Breier A, Keefe RS, Young CA, Purdon SE, Gold JM, Davis KL. A one-year double-blind comparison of the neurocognitive efficacy of olanzapine, risperidone, and haloperidol in patients with schizophrenia. Schizophrenia Research 2003;60:274-5. [CSZG: 9685] [EMBASE 2003496187] [DOI] [PubMed] [Google Scholar]
- Breier AF, Zipursky RB, Perkins DO, Addington JM, Tohen MF, David SR, et al. A trial of olanzapine versus pbo in the prodrome: protocol and baseline sample. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002. [CSZG: 8951] [Lilly study possible stands alone not published]
- Centorrino F, Hamer RM, Tohen M, Lieberman JA. Drug attitudes and treatment adherence in a clinical trial comparing haloperidol and olanzapine in first episode schizophrenia. Schizophrenia Research 2003;60:277. [CSZG: 9691] [EMBASE: 2003241517] [Google Scholar]
- Green A, Tohen M, Strakowski SM, Lieberman JA, Glick D, Clarke SW. Comorbid substance use disorder and first episode schizophrenia: acute effects of olanzapine versus haloperidol. Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada) 2001;1-2 Suppl:230. [CSZG: 6021] [MEDLINE: ] [Google Scholar]
- Green A, Tohen MF, Hamer RM, Strakowski SM, Lieberman JA, Glick ICWS, GDH Research Group. First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophrenia Research 2004;66(2-3):125-35. [CSZG: 10111] [PMID 15061244] [DOI] [PubMed] [Google Scholar]
- Kahn RS, Lieberman JA, Charles C, Sharma T, Zipursky RB, Gur R, et al. Antipsychotic treatment effects on progression of brain pathomorphology in first episode schizophrenia. Journal of the European College of Neuropsychopharmacology 2003;13(4):S336. [CSZG: 9877] [P.2.131] [Google Scholar]
- Keefe R, McEvoy J, Vaughn A. Source monitoring improvement in patients with schizophrenia. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:196. [CSZG: 8080] [Google Scholar]
- Keefe R, Seidman LJ, Christensen B, Hamer RM, Yurgelun-Todd D, Lewine R, et al. Neurocognitive effects of olanzapine and low-dose haloperidol: a two-year treatment study in first episode psychosis. In: Schizophrenia Research. Vol. 60. 2003:289-90. [CSZG: 9707] [EMBASE: 2003241517]
- Keefe RS, Seiden LJ, Christensen B, Yurgelun-Todd DA, Lewine RR, Sitskoorn M, et al. Treatment of neurocognitive deficits with olanzapine or low-dose haloperidol in first episode psychosis. In: 39th Annual Meeting of the American College of Neuropsychopharmacology; 2000; Dec 10-14; San Juan; Puerto Rico. 2000. [CSZG: 7595]
- Keefe RS, Seidman LJ, Hamer RM, Todd DY, Christensen B, Sitskoorn MM, et al. Neurocognition after two years olanzapine or low-dose haldol in fe psychosis. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9789] [[NR576]]
- Keefe RS, Seidman LJ, Hamer RM, Todd DY, Christensen B, Sitskoorn MM, et al. Neurocognition after two years olanzapine or low-dose haldol in fe psychosis. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9789] [[NR576]]
- Lieberman J, Charles HC, Sharma T, Zipursky R, Kahn R, Gur R, et al. Antipsychotic treatment effects on progression of brain pathomorphology in first episode schizophrenia. Schizophrenia Research 2003;60:293. [CSZG: 9717] [EMBASE: 2003241517] [Google Scholar]
- Lieberman J, Sanger T, Tohen M, First Episode Collaborative Study Group. Olanzapine and haloperidol treatment of first epiode schizophrenia and schizoaffective disorder: 12 week outcome of a two year randomized double blind trial. In: 2nd International Conference on Early Psychosis; 2000 Mar 31 - Apr 2, New York, USA. 2000. [CSZG: 10139] [PsycINFO 2004-13151-011]
- Lieberman J, Tohen M, McEvoy J, Sanger T, Keefe R, Charles C, et al. Olanzapine versus haldoperidol in the treatment of first episode phychosis. In: 39th Annual Meeting of the American College of Neuropsychopharmacology; 2000; Dec 10-14; San Juan; Puerto Rico. 2000. [CSZG: 7603]
- Lieberman JA, Charles C, Sharma T, Zipursky RB, Hamer RM, Tollefson GD. Effect of olanzapine versus haloperidol on brain pathomorphology in first-episode psychosis. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9796] [[NR740]]
- Lieberman JA, Schneider LS, McEroy J, Pariot P, Stroup S, Adiao J, et al. Effectiveness trials of antipsychotic drugs. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002. [CSZG: 8994]
- Lieberman JA, Schneider LS, McEroy J, Pariot P, Stroup S, Adiao J, et al. Effectiveness trials of antipsychotic drugs. In: Annual Meeting of the American Psychiatric Association; 2001 May 5-10; LA, USA. Marathon Multimedia, 2001. [CSZG: 8013] [MEDLINE: ]
- Lieberman JA, Stroup TS. Schizophrenia, VI: Treatments. American Journal of Psychiatry 2003;160(10):1748. [CSZG: 9998] [PMID 14514482] [DOI] [PubMed] [Google Scholar]
- Lieberman JA, Tollefson G, Tohen M, Green AI, Gur RE, Kahn R, HGDH Study Group. Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. American Journal of Psychiatry 2003;160(8):1396-404. [CSZG: 9833] [MEDLINE: ] [PMID 12900300] [DOI] [PubMed] [Google Scholar]
- Lieberman JA. Research gaps and current research initiatives to improve the treatment of schizophrenia. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9795] [[SYMPOSIUM]No. 28]
- McEvoy J, Lieberman JA, Perkins D, Hamer RM, Sharma T, Zipursky R, et al. Long-term efficacy and safety of atypical and conventional antipsychotic drugs in first episode schizophrenia. In: Schizophrenia Research. Vol. 60. 2003:313. [CSZG: 9721] [EMBASE: 2003241517]
- McEvoy JP, Lieberman JA, Perkins DO, Hamer RM, Sharma T, Zipursky RB. Long-term olanzapine treatment versus haloperidol in first-episode psychosis. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9802] [[NR207]]
- Sharma T, Kumari V, Hughes C, Soni W, Mehrotra R, Binneman B. Cognitive effects of clozapine and olanzapine in patients with chronic schizophrenia. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:195. [CSZG: 8107] [Google Scholar]
- Sharma T, Lieberman JA, McEvoy JP, Perkins DO, Hamer RM, Zipursky RB, et al. Long-term efficacy and safety of atypical and conventional antipsychotic drugs in first episode schizophrenia. Journal of the European College of Neuropsychopharmacology 2003;13(4):S134. [CSZG: 9879] [S.14.05] [Google Scholar]
- Sharma T. The acute and long-term efficacy of olanzapine in first-episode psychotic disorders: a randomised double-blind comparison with haloperidol. National Research Register 2000. [CSZG: 5574]
- Stroup TS, McEvoy JP, Swartz MS, Byerly MJ, Glick ID, Canive JM, et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophrenia Bulletin 2003;29(1):15-31. [CSZG: 9824] [EMBASE 2003292851] [DOI] [PubMed] [Google Scholar]
- Zipursky R, Gu H, Green AI, Centorrina F, Glick I, Perkins DO, et al. Clinical correlates of weight gain in first episode psychosis patients treated with olanzapine. Schizophrenia Research 2003;60:372. [CSZG: 9756] [EMBASE: 2003241517] [Google Scholar]
- Zipursky RB, Hongbin G, Green AI, Centorrina F, Glick ID, Lieberman JA. Clinical correlates of weight gain in first-episode patients on olanzapine. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9817] [[NR563]]
Lilly (HGGN) 2000 {published data only}
- Breier A, Young C, Purdon SE, Gold JM, Davis, KL, Keefe RSE. A one year double-blind comparision of the neurocognitive efficacy of olanzapine, risperidone and haloperidol in patients with schizophrenia. In: Schizophrenia Research March 29 - April 2003; Colorado Springs, CO. 2003.
- Keefe RS, Young CA, Rock SL, Purdon SE, Gold JM, Breier A, HGGN Study Group. One-year double-blind study of the neurocognitive efficacy of olanzapine, risperidone, and haloperidol in schizophrenia. Schizophrenia Research 2006;81(1):1-15. [DOI: 10.1016/j.schres.2005.07.038] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Lipkovich IA, Deberdt W, Csernansky JG, Sabbe B, Keefe RS, Kollack-Walker S. Relationships among neurocognition, symptoms and functioning in patients with schizophrenia: a path-analytic approach for associations at baseline and following 24 weeks of antipsychotic drug therapy. BMC Psychiatry 2009;9(1):44. [DOI: 10.1186/1471-244X-9-44] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liu-Seifert H, Osuntokun OO, Godfrey JL, Feldman PD. Patient perspectives on antipsychotic treatments and their association with clinical outcomes. Patient Preference and Adherence 2010;4:369-77. [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lysaker PH. Olanzapine and risperidone may improve neurocognition more than haloperidol in people with schizophrenia who continue treatment for 52 weeks. Evidence-Based Mental Health 2006;9(3):71. [DOI: 10.1136/ebmh.9.3.71] [DOI] [PubMed] [Google Scholar]
Lilly (S029) 2007 {published data only}
- Eli Lilly. Efficacy study of switching stabilized schizophrenic patients from conventional to atypical antipsychotic treatment. Unpublished report 2007;NA:1-26. [NCT00191555] [Google Scholar]
Lilly 2006a {published data only}
- Adrianzén C, Sánchez M, Córdova J, Castillo I. Olanzapina versus haloperidol: efectividad en la funcionalidad y estado de salud en una muestra de pacientes venezolanos con esquizofrenia. ERTE 2008;9:254-60. [http://www.polemos.com.ar/docs/vertex/vertex81.pdf#page=15] [PubMed] [Google Scholar]
- Eli Lilly. Olanzapine for schizophrenia: a cost benefit study. STUDY F1D-GW-S034 2006.
Lin 2008 {published data only}
- 林福荣. Comparative efficacy of olanzapine and haloperidol treatment episode psychosis patients [奥氮平与氟哌啶醇治疗首发精神病患者的疗效对比研究]. 中外健康文摘 [医药月刊] 2008;5(4):269-70.
Lindenmayer 2007 {published data only}
- Lindenmayer J, Iskander A, Abad T, Parker B, Lerman M, Khan A. A randomized, double-blind study of olanzapine vs haloperidol in the treatment of primary negative symptoms in schizophrenia. Schizophrenia Bulletin 2005;31(2):493-4. [Google Scholar]
- Lindenmayer JP, Khan A, Iskander A, Abad MT, Parker B. A randomized controlled trial of olanzapine versus haloperidol in the treatment of primary negative symptoms and neurocognitive deficits in schizophrenia. Journal of Clinical Psychiatry 2007;68(3):368-79. [PMID: PMID: 17388705] [DOI] [PubMed] [Google Scholar]
Liu 2010l {published data only}
- 刘国斌. Effect of olanzapine and haloperidol in the treatment of Schizophrenia [Google Translate] [奥氮平与氟哌啶醇治疗精神分裂症的对照研究]. Medical Journal of Chinese People's Health [中国民康医学] 2010;22(14):1782, 1835.
Liu 2011i {published data only}
- 刘晓军. Controlled study of olanzapine and haloperidol in schizophrenia cognitive function [奥氮平与氟哌啶醇对精神分裂症认知功能影响的对照研究]. Journal of Medical Forum [医药论坛杂志] 2011;32(13):126-8.
Liu 2012ao {published data only}
- 柳贵明, 叶渊, 张跃坤. Senile controlled study of olanzapine and haloperidol in schizophrenia treatment [Google Translate] [奥氮平与氟哌啶醇治疗老年期精神分裂症对照研究]. Medical Journal of Chinese People's Health [中国民康医学] 2012;-(04):396-7. [Google Scholar]
Luo 2012d {published data only}
- 罗思光. 奥氮平与氟哌啶醇治疗首发精神病患者的疗效对比研究. 健康必读（中旬刊） 2012;11(6):35. [Google Scholar]
Ma 2005d {published data only}
- 马兆峰, 陈希, 庄晓华, 张立亮. The efficacy and quality of life of patients with schizophrenia, olanzapine [奥氮平对精神分裂症患者疗效及生活质量的影响]. Chinese Journal of Behavioral Medical Science [中国行为医学科学] 2005;14(8):723-4. [Google Scholar]
Malyarov 1999 {published data only}5262
- Malyarov S, Dzub G. Comparative assessment of the positive and negative symptom dynamics in schizophrenic patients treated with atypical antipsychotics or haloperidol. In: Journal of the European College of Neuropsychopharmacology. 1999:S296. [CSZG: 5971] [MEDLINE: ]
Mousavi 2013 {published data only}
- Mousavi SG, Rostami H, Sharbafchi MR, Boroujeni AS, Mahaki B, et al. Onset of action of atypical and typical antipsychotics in the treatment of acute psychosis. Journal of Research in Pharmacy Practice 2013;2(4):138-44. [DOI: 10.4103/2279-042X.128142] [PMID: 24991622] [DOI] [PMC free article] [PubMed] [Google Scholar]
Nag 2013 {published data only}
- Bhardwaj R, Nag P, Srivastava B, Gaur S, Kaul V. Depressive symptomatology: comparative evaluation of typical versus atypical antipsychotics in schizophrenic patients using MADRS scale. Indian Journal of Applied Research 2016;6(12):47-50. [http://wwjournals.com/index.php/ijar/article/viewFile/1114/1108] [Google Scholar]
Namjoshi 2002 {published and unpublished data}
- Namjoshi M, Young C, Huang L, Edgell ET, Breier A. Conical and quality-of-life outcomes associated with olanzapine, risperidone, and haloperidol treatment in patients with schizophrenia: results from a US random study. International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum; 2002 Jun 23-27; Montreal, Canada) 2002;Suppl 1:S127. [Google Scholar]
- Namjoshi M, Young CA, Huang L, Edgell E, Breier A. Cost-effectiveness of olanzapine compared to risperidone and haloperidol in the treatment of patients with schizophrenia: results from a U.S. randomized controlled trial. In: Schizophrenia Research International Congress on Schizophrenia Research, March 29-April 2, 2003, Colorado Springs, CO. 2003. [EMBASE 2003496187]
- Namjoshi M, Young CA, Huang L, Edgell E, Breier A. Cost-effectiveness of olanzapine compared to risperidone and haloperidol in the treatment of patients with schizophrenia: results from a U.S. randomized controlled trial. Schizophrenia Research 2003;60:296. [N0146099645] [Google Scholar]
- Namjoshi M, Young CM, Huang L, Edgell ET, Breier A. Hospitalization rates associated with olanzapine, risperidone, and haloperidol treatment in patients with schizophrenia: Results from a U.S. randomized controlled trial. European Neuropsychopharmacology 2002;(Suppl 3):S315.
Pan 2005 {published data only}
- Pan N, Yang X, Mei Q. Large dose of olanzapine in the ictus treatment of agitated symptoms of schizophrenia. Journal of Clinical Psychosomatic Diseases [临床心身疾病杂志] 2005;11(2):113-5. [Google Scholar]
Parabiaghi (GiSAS) 2010 {published and unpublished data}
- Parabiaghi A, D'Avanzo B, Tettamanti M, Barbato A, GiSAS Study Group. The GiSAS study: Rationale and design of a pragmatic randomized controlled trial on aripiprazole, olanzapine and haloperidol in the long-term treatment of schizophrenia. Contemporary Clinical Trials 2011;32(5):675-84. [DOI: 10.1016/j.cct.2011.04.008] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Parabiaghi A, Tettamanti M, D'Avanzo B, Barbato A, GISAS Study Group, Aguglia E, et al. Metabolic syndrome and drug discontinuation in schizophrenia: a randomized trial comparing aripiprazole olanzapine and haloperidol. Acta Psychiatrica Scandinavica 2016;133(1):63-75. [DOI: 10.1111/acps.12468] [PMID: ] [DOI] [PubMed] [Google Scholar]
- Parabiaghi A. Aripiprazole, Olanzapine and Haloperidol in the Long-Term Treatment of Schizophrenia: The Rationale and Development of the GiSAS Pragmatic Randomized Controlled Trial, a Consideration and Empirical Study of Factors Associated With Recruitment (the GiSAS Survey) and the Concept of Endpoints Using a Secondary Analysis of Existing Data and a Preliminary Analysis of GiSAS Trial Data [Doctoral dissertation]. The Open University, 2012. [Google Scholar]
Qi 2013b {published data only}
- 齐俊茹. Olanzapine analysis of the effect of treatment of mental illness [Google Translate] [奥氮平治疗精神病的效果分析]. 中外医学研究 2013;NA(16):139. [Google Scholar]
Qin 2006a {published data only}
- Qin Y. A comparative trial of olanzapine versus haloperidol in the treatment of schizophrenia [再普乐与氟哌啶醇治疗精神分裂症的比较研究]. Hebei Medicine [河北医学] 2006;12(10):1011-3. [Google Scholar]
Raposo 2011 {published data only}
- Raposo NRB, Ferreira AS, Gattaz WF. Body mass index increase, serum leptin, adiponectin, neuropeptide Y and lipid levels during treatment with olanzapine and haloperidol. Pharmacopsychiatry 2011;44(5):169-72. [DOI: 10.1055/s-0031-1280793]] [DOI] [PubMed] [Google Scholar]
Rosenheck (HGFI) 2003 {published data only}7169
- Davis L, Sheikh J, Rosenheck R, Frecska E, Douyon R, Evans D, et al. To determine if olanzapine is more cost effective than haloperidol for the treatment of schizophrenia/The clinical and economic impact of olanzapine in the treatment of schizophrenia. National Institutes of Health (http://www.clinicaltrials.gov/) accessed 16 February 2001. [CSZG: 5460]
- Glazer WM. Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial. JAMA 2004;291(9):1064-5. [CSZG: 10079] [PsycINFO 2004-11623-005] [DOI] [PubMed] [Google Scholar]
- Rosenheck R, Perlick D, Bingham S, Liu-Mares W, Collins J, Warren S, et al. Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial. JAMA 2003;290(20):2693-702. [CSZG: 9954] [DOI] [PubMed] [Google Scholar]
Saddichha 2007 {published data only}
- Saddichha S, Akhtar S. Antipsychotic use associated with metabolic & weight changes in schizophrenia. International Clinical Psychopharmacology 2011;26:e134-5. [https://journals.lww.com/intclinpsychopharm/Citation/2011/09001/Antipsychotic_use_associated_with_metabolic__.249.aspx] [Google Scholar]
- Saddichha S, Akhtar S. Hypertension, diabetes and cardiometabolic changes associated with antipsychotic use in schizophrenia. International Clinical Psychopharmacology 2011;26:e143. [https://journals.lww.com/intclinpsychopharm/Citation/2011/09001/Hypertension,_diabetes_and_cardiometabolic_changes.265.aspx] [Google Scholar]
- Saddichha S, Ameen S, Akhtar S. Predictors of antipsychotic-induced weight gain in first-episode psychosis: conclusions from a randomized, double-blind, controlled prospective study of olanzapine, risperidone, and haloperidol. Journal of Clinical Psychopharmacology 2008;28(1):27-31. [DOI: 10.1097/jcp.0b013e3181602fe6] [DOI] [PubMed] [Google Scholar]
- Saddichha S, Manjunatha N, Akhtar S. Obesity, diabetes and hypertension associated with antipsychotic use in drug naive schizophrenia. - 2010;-:-. [DOI] [PubMed] [Google Scholar]
- Saddichha S, Manjunatha N, Ameen S, Akhtar S. Diabetes and schizophrenia–effect of disease or drug? Results from a randomized, double‐blind, controlled prospective study in first‐episode schizophrenia. Acta Psychiatrica Scandinavica 2008;117(5):342-7. [DOI: 10.1111/j.1600-0447.2008.01158.x] [DOI] [PubMed] [Google Scholar]
- Saddichha S, Manjunatha N, Ameen S, Akhtar S. Effect of olanzapine, risperidone, and haloperidol treatment on weight and body mass index in first-episode schizophrenia patients in India: a randomized, double-blind, controlled, prospective study. Journal of Clinical Psychiatry 2007;68(11):1793-8. [PMID: PMID: 18052574] [DOI] [PubMed] [Google Scholar]
- Saddichha S, Manjunatha N, Ameen S, Akhtar S. Erratum to “Metabolic syndrome in first episode schizophrenia—A randomized double-blind controlled, short-term prospective study”[Schizophrenia Research 101 (2008) 266272]. Schizophrenia Research 2008;104(1-3):307-8. [DOI: 10.1016/j.schres.2008.05.023] [DOI] [PubMed] [Google Scholar]
- Saddichha S, Manjunatha N, Ameen S, Akhtar S. Metabolic syndrome in first episode schizophrenia—a randomized double-blind controlled, short-term prospective study. Schizophrenia Research 2008;101(1-3):266-72. [DOI: 10.1016/j.schres.2008.01.004] [PMID: ] [DOI] [PubMed] [Google Scholar]
San 2012 {published data only}
- Arranz B, Safont G, Corripio I, Ramirez N, Dueñas RM, Perez V, et al. Substance use in patients with first-episode psychosis: is gender relevant? Journal of Dual Diagnosis 2015;11(3-4):153-60. [DOI: 10.1080/15504263.2015.1113761] [PMID: ] [DOI] [PubMed] [Google Scholar]
- San L, Arranz B, Perez V, Safont G, Corripio I, Ramirez N, et al. One-year, randomized, open trial comparing olanzapine, quetiapine, risperidone and ziprasidone effectiveness in antipsychotic-naive patients with a first-episode psychosis. Psychiatry Research 2012;200(2-3):693-701. [DOI: 10.1016/j.psychres.2012.07.005] [PMID: PMID: 22954905] [DOI] [PubMed] [Google Scholar]
Sergi 2007 {published data only}
- Sergi MJ, Green MF, Widmark C, Reist C, Erhart S, Braff DL, et al. Social cognition and neurocognition: effects of risperidone, olanzapine, and haloperidol. American Journal of Psychiatry 2007;164(10):1585-92. [DOI: 10.1176/appi.ajp.2007.06091515] [PMID: ] [DOI] [PubMed] [Google Scholar]
Song 2009c {published data only}
- 宋燕, 孙燕妮, 伍毅, 宋兵福, 丁华, 郑琰婷. A control study on olanzapine versus haloperidol in the treatment of female schizophrenic [奥氮平与氟哌啶醇治疗女性精神分裂症]. Sichuan Mental Health [四川精神卫生] 2009;22(1):26-9. [Google Scholar]
Taraskina 2017 {published data only}
- Taraskina AE, Nasyrova RF, Zabotina AM, Sosin DN, Sosina КА, Ershov EE, et al. Potential diagnostic markers of olanzapine efficiency for acute psychosis: a focus on peripheral biogenic amines. BMC Psychiatry 2017;17(1):394. [10.1186/s12888-017-1562-1] [PMID: PMID: 29221470] [DOI] [PMC free article] [PubMed] [Google Scholar]
Tollefson (HGAJ) 1997 {published and unpublished data}14625
- Alan B, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment resistant schizophrenia. In: 11th World Congress of Psychiatry; 1999 Aug 6-11; Hamburg, Germany. 1999:144. [CSZG: 4633] [DOI] [PubMed]
- Almond S, O'Donnell O. Cost analysis of the treatment of schizophrenia in the UK: a comparison of olanzapine and haloperidol. Pharmacoeconomics 1998;13(5 Pt 2):575-88. [CSZG: 18839] [DOI] [PubMed] [Google Scholar]
- Andersen S, Cohen L, Goldstein J, Tohen M, Tollefson G. Sex and neuroendocrine differences in response to treatment with olanzapine: a preliminary analysis. Schizophrenia Research 1998;29(1-2):186-7. [CSZG: 7071] [Google Scholar]
- Andersen SW, Tollefson GD, Sanger T. Depressive signs and symptoms in schizophrenia:a prospective blinded trial of olanzapine and haloperidol. In: APA Annual Meeting; May 15-20; Washington DC; USA. 1999. [CSZG: 3446] [CSG NO. 4125] [DOI] [PubMed]
- Baker R W, Julier B, Stauffer V. Manic-like symptoms in schizophrenic patients treated with olanzapine, haloperidol and placebo. In: 7th World Congress of Biological Psychiatry; 2001 Jul 1-6; Berlin, Germany. 2001. [CSZG: 7566]
- Basson B, Kinon BJ, Gilmore JA, Taylor CC, Tollefson GD, Czekalla J. Factors influencing weight change in patients with schizophrenia treated with olanzapine verus haloperidol or risperidone. Journal of Psychopharmacology 2000;14(3 Suppl):A60. [MEDLINE: ] [9519] [PMID 22476629]22476629 [Google Scholar]
- Beasley C, Tran P, Beuzen JN, Tamura R, Dellva MA, Bailey J, et al. Olanzapine versus haloperidol: long-term results of the multi-center international trial. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne; Australia. 1996. [CSZG: 1115]
- Beasley CM Jr, Tollefson GD, Tran PV. Safety of olanzapine. Journal of Clinical Psychiatry 1997;58(Suppl 10):13-7. [PubMed] [Google Scholar]
- Beasley CM, Sayler ME, Kiesler GM, Potvin JH, Sanger TM, Tollefson GD. The influence of pharmacotherapy on self-directed and externally-directed aggression in schizophrenia. Schizophrenia Research 1998;29(1-2):28. [CSZG: 9191] [Google Scholar]
- Beasley CM, Tollefson GD, Dellva MA, Tamura R, Glazer WM, Morgenstern H. The differential risk of tardive dyskinesia with olanzapine. In: 151st Annual Meeting of American Psychiatric Association; May 30 - June 4; Toronto; ON, Canada. 1998. [CSZG: 6965]
- Beasley CM. Safety of olanzapine. Journal of Clinical Psychiatry 1997;15(2):19-21. [CSZG: 9984] [MEDLINE: ] [EMBASE 2003516387] [Google Scholar]
- Beasley CM. Safety of olanzapine. Journal of Clinical Psychiatry Monograph 1997;15(2):19-21. [CSZG: 9984] [PubMed] [Google Scholar]
- Brecher M. Risperidone versus olanzapine in the treatment of patients with schizophrenia or schizoaffective disorder. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow; Scotland, UK. 1998. [CSZG: 3137]
- Breier A, Berg PH. The psychosis of schizophrenia: prevalence, response to atypical antipsychotics, prediction of outcome. Biological Psychiatry 1999;46(3):361-4. [CSZG: 4888] [CSG NO. 4342] [DOI] [PubMed] [Google Scholar]
- Breier A, Hamilton SH. Comparative efficacy of olanzapine and haloperidol with treatment-resistant schizophrenia. Biological Psychiatry 1999;45(4):403-11. [CSZG: 4898] [DOI] [PubMed] [Google Scholar]
- Breier AF, Hamilton SH. Comparative efficacy of olanzapine and haloperidol for patients with treatment-resistant schizophrenia. In: APA Annual Meeting, May 15-20, 1999, Washington, DC. 1999. [CSZG: 3139] [DOI] [PubMed]
- Burns PR, Reams SG, Sanger TM, Beasley CM Jr. Olanzapine in the treatment of elderly patients with schizophrenia and related psychotic disorders. In: 9th Biennial Winter Workshop on Schizophrenia, February 7-13, 1998-Davos, Switzerland. 1998:ABSTRACT REF:PT07052. [CSZG: 1582] [CSG NO. 3963]
- Burns PR, Reams SG, Sanger TM, Beasley CMJr. Olanzapine in the treatment of elderly patients with schizophrenia and related psychotic disorders. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK. July 12-16, 1998. [CSZG: 1582]
- Cohen LS, Goldstein JM, Lee H, Tohen M, Andersen S, Tollefson GD. Sex and neuroendocrine differences following treatment with typical and atypical antipsychotics. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
- Conley RR, Brecher M, The Risperidone/Olanzapine Study Group. Riasperidone versus olanzapine in patients with schizophrenia or schizoaffective disorders. In: European College of Neurpsychopharmacology Meeting; October 31-November 4; Paris; France. 1998. [CSZG: 6977]
- Crawford AM, Gomez JC, Beasley CM, Tollefson GD. Olanzapine versus haloperidol: analysis of schizophrenic patients from the multi-center international trial. Journal of the European College of Neuropsychopharmacology 1997;7:2015. [CSZG: 9196] [DOI] [PubMed] [Google Scholar]
- Crawford AMK, Gomez JC, Beasley CM Jr, Tollefson GD. Olanzapine versus haloperidol: analysis of schizophrenic patients from the multi-center international trial. Journal of the European College of Neuropsychopharmacology 1997;7:P.2.015. [CSZG: 9196] [EMBASE 2002184411; CN-00443250.] [Google Scholar]
- David S, Crawford AM, Breier A. Prolactin levels in olanzapine versus typical and atypical antipsychotics. European Neuropsychopharmacology 1998;8(Suppl 2):S229. [CSZG: 12175] [Google Scholar]
- David S, Crawford AM, Breier A. Prolactin levels in olanzapine versus typical and atypical antipsychotics. Schizophrenia Research 1998;29(1-2):153. [Google Scholar]
- Dellva M, Satterlee W, Tran P, Beasley C, Greaney M, Tollefson G. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in acute treatment. In: 9th Congress of the European College of Neuropsychopharmacology, Amsterdam, The Netherlands. 1996. [CSZG: 3184] [CSG NO. 3906]
- Dellva MA, Beasley CM, Kuntz AJ, Tamura RN, Glazer WM, Morgenstern H, et al. What is the differential risk of tardive dyskinesia with the novel antipsychotic olanzapine? In: 11th Annual Meeting of the American Association for Geriatric Psychiatry; San Diego; California. 1998. [CSZG: 1399] [CSG NO. 2922]
- Dellva MA, Beasley CM, Tamura RN, Tollefson GD. What is the differential risk of tardive dyskinesia with the novel antipsychotic olanzapine? In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow; Scotland, UK. 1998. [CSZG: 18842]
- Dellva MA, Tran P, Tollefson GD, Wentley AL, Beasley CM Jr. Standard olanzapine versus placebo and ineffective-dose olanzapine in the maintenance treatment of schizophrenia. Psychiatric Services 1997;48:1571-7. [CSZG: 3185] [DOI] [PubMed] [Google Scholar]
- Edgell ET, Hamilton SH, Revicki DA, Genduso LA, Tollefson GD. Costs of olanzapine treatment compared with haloperidol for schizophrenia: results from a randomized clinical trial. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow; Scotland, UK. 1998. [CSZG: 3199]
- Gilmore J, Kinon BJ, Basson BR, Tollefson GD. Effect of long term olanzapine treatment on weight change in schizophrenia. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):S155. [CSZG: 4688] [Google Scholar]
- Gilmore J, Kinon BJ, Basson BR, Tollefson GD. Effect of long term olanzapine treatment on weight change in schizophrenia. Journal of the European College of Neuropsychopharmacology 2000;10(Suppl 3):S305. [CSZG: 4687] [Google Scholar]
- Gilmore J, McGuire G, Kennedy JS, Shaw SC, Kaiser CJ, Sutton V, et al. Acute double-blind comparison of olanzapine and haloperidol in schizophrenia patients age >= 60. American Journal of Geriatric Psychiatry 2002;10(2):100. [Google Scholar]
- Gilmore JA, Kinon BJ, Zhao Z, Barber B. Improvement in quality of life and depressive symptoms in schizophrenic patients is associated with robust acute treatment response of olanzapine versus haloperidol. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:177. [CSZG: 8071] [Google Scholar]
- Gilmore JA, Kinon BJ, Zhao Z, Barber B. Rigorous criteria for treatment response differentiated efficacy of olanzapine versus haloperidol in patients with schizophrenia. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:177. [CSZG: 8072] [Google Scholar]
- Glazer WM, Johnstone BM. Pharmacoeconomic evaluation of antipsychotic therapy for schizophrenia. Journal of Clinical Psychiatry 1997;58(Suppl 10):50-4. [CSZG: 1263] [PubMed] [Google Scholar]
- Goldstein JM, Cohen LS, Horton NJ, Lee H, Andersen S, Tohen M, et al. Sex differences in clinical response to olanzapine compared with haloperidol. Psychiatry Research 2002;110(1):27-37. [CSZG: 9213] [MEDLINE: ] [CENTRAL CN-00389114] [DOI] [PubMed] [Google Scholar]
- Gomez JC, Crawford AM. Superior efficacy of olanzapine over haloperidol: analysis of patients with schizophrenia from a multicenter international trial. Journal of Clinical Psychiatry 2001;62(Suppl 2):6-11. [CSZG: 6273] [MEDLINE: ] [PubMed] [Google Scholar]
- Grainger D, Hamilton SH, Genduso LA, Revicki DA. Medical resource use and work and social outcomes for olanzapine compared with haloperidol in the treatment of schizophrenia. In: 21st Congress of Collegium Internationale Neuro-psychopharmacologicum; Glasgow; Scotland, UK. 1998. [CSZG: 3325] [CSG NO. 3607,ABSTRACT REF:PT07058]
- Gregor K, Hamilton S, Edgell E. Functional outcomes in schizophrenia: a European comparison of olanzapine and haloperidol. In: 11th World Congress of Psychiatry; 1999 Aug 6-11; Hamburg, Germany. 1999:152. [CSZG: 4727]
- Gregor KJ, Allicar MP, Lilliu H, Bouhassira M, Le Pen C. An economic comparison of olanzapine versus haloperidol in the treatment of schizophrenia in France. Schizophrenia Research 2000;41(Number 1 - Special Issue):189-90. [CSZG: 5011] [Google Scholar]
- Gregor KJ, Allicar MP, Lilliu H, Olivier V, Le Pen C, Gavart S. An economic comparison of olanzapine versus haloperidol in the treatment of schizophrenia in France. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):S161. [CSZG: 4728] [Google Scholar]
- Gregor KJ, Hamilton SH, Edgell ET. Functional outcomes in schizophrenia: a European comparison of olanzapine and haloperidol. Journal of the European College of Neuropsychopharmacology 1999;9(Suppl 1):S11. [CSZG: 4729] [Google Scholar]
- Gregor KJ, Hamilton SH, Edgell ET. Functional outcomes in schizophrenia: a European comparison of olanzapine and haloperidol. Journal of the European College of Neuropsychopharmacology 1999;9(Suppl 1):S11. [CSZG: 4729] [Google Scholar]
- Gregor KJ, Hamilton SH, Edgell ET. Functional outcomes in schizophrenia: a European comparison of olanzapine and haloperidol. Journal of the European College of Neuropsychopharmacology 1999;9:S289. [CSZG: 5963] [MEDLINE: ] [Google Scholar]
- Gregor KJ, Hamilton SH, Edgell ET. Functional outcomes in schizophrenia: a European comparison of olanzapine and haloperidol. Schizophrenia Research (10th Biennial Winter Workshop on Schizophrenia; 2000 Feb 5-11; Davos, Switzerland) 2000;1:189. [CSZG: 8658] [Google Scholar]
- Hamilton S, Breier A, David S. Comparative efficacy of olanzapine and haloperidol for patients with treatment resistant schizophrenia. In: 11th Congress of The European College of Neuropsychopharmacology; 1998 Oct 31- Nov 4; Paris, France. 1998. [CSZG: 4732]
- Hamilton S, Revicki D, Genduso LA, Tollefson GD. Cost of olanzapine treatment compared with haloperidol for schizophrenia: results from a randomized clinical trial. In: 151st Annual Meeting of the American Psychiatric Association; May 30-June 4; Toronto; ON, Canada. 1998. [CSZG: 3715]
- Hamilton SH, Breier A, David S. Comparative efficacy of olanzapine and patients with treatment-resistant schizophrenia. European Neuropsychopharmacology 1998;8(Suppl 2):S228. [Google Scholar]
- Hamilton SH, Edgell ET, Revicki DA, Breier A. Functional outcomes in schizophrenia: a comparison of olanzapine and haloperidol in a European sample. International Clinical Psychopharmacology 2000;15(5):245-55. [CSZG: 5764] [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Hamilton SH, Edgell ET, Revicki LA, Genduso LA, Tollefson G. Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia: results from a randomized clinical trial. European Neuropsychopharmacology 1998;8(Suppl 2):S236. [CSZG: 4733] [DOI] [PubMed] [Google Scholar]
- Hamilton SH, Genduso LA, Haley JC, Revicki DA. Medical resource use and socioeconomics in the treatment of schizophrenia: olanzapine compared with haloperidol. In: 10th European College of Neuropsychopharmacology Congress; Sep 13-17; Vienna; Austria. 1997. [CSZG: 3912]
- Hamilton SH, Genduso LA, Revicki DA. Medical resource use and work and social outcomes for olanzapine compared with haloperidol in the treatment of schizophrenia and other psychotic disorders. Schizophrenia Research 1998;29(1-2):148-9. [CSZG: 3716] [Google Scholar]
- Hamilton SH, Revicki DA, Edgell ET, Genduso LA, Tollefson G. Clinical and economic outcomes of olanzapine compared with haloperidol for schizophrenia - results from a randomised clinical trial. Pharmacoeconomics 1999;15(5):469-80. [CSZG: 5040] [DOI] [PubMed] [Google Scholar]
- Hamilton SH, Revicki DA, Genduso LA, Tollefson GD. Costs of olanzapine treatment compared with haloperidol for schizophrenia: results from a randomized clinical trial. Schizophrenia Research 1998;29(1-2):149. [CSZG: 3718] [DOI] [PubMed] [Google Scholar]
- Jaton LA, Kinon BJ, Rotelli MD, Kaiser C, Kollack-Walker S. Differential rate of weight gain present among patients treated with olanzapine. Schizophrenia Research 2003;60:S357. [CSZG: 18991] [MEDLINE: ] [EMBASE 2003516387] [Google Scholar]
- Javor K, Kinon BJ, Gilmore J. Continued improvement in quality of life despite weight change during olanzapine treatment. Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada) 2001;1-2 Suppl:233. [CSZG: 6026] [MEDLINE: ] [Google Scholar]
- Johnstone BM, Obenchain RL, Croghan TW, Tunis SL, Kniesner TJ. To evaluate the cost-effectiveness of olanzapine compared to haloperidol for schizophrenia. In: 151st Annual Meeting of American Psychiatric Association; May 30-June 4; Toronto; ON, Canada. 1998. [CSZG: 3405]
- Johnstone BM, Obenchain RL, Edgell ET, Croghan TW, Tunis SL, Kniesner TJ. Intent-to-treat analysis of repeated measures data from a randomized clinical trial comparing the cost and effectiveness of treatment for schizophrenia with olanzapine or haloperidol. European Neuropsychopharmacology 1998;8(Suppl 2):S235. [Google Scholar]
- Kennedy JS, Jeste D, Kaiser CJ, Golsham S, Maguire GA, Tollefson G, et al. Olanzapine vs haloperidol in geriatric schizophrenia: analysis of data from a double-blind controlled trial. International Journal of Geriatric Psychiatry 2003;18:1013-20. [CSZG: 9955] [MEDLINE: ] [PsycINFO 2003-10341-008; EMBASE 2003491563] [DOI] [PubMed] [Google Scholar]
- Kinon B, Basson B, Tollefson GD. Gender specific prolactin olanzapine versus haloperidol in schizophrenia. In: American Psychiatric Association, Toronto, Canada MAy 30- June 4. 1998. [CSZG: 1950]
- Kinon BJ, Basson B, Szymanski K, Tollefson GD. Predictors of weight gain during olanzapine treatment. European Neuropsychopharmacology 1998;8(Suppl 2):S220. [Google Scholar]
- Kinon BJ, Basson BR, Gilmore JA, Tollefson GD. Long-term olanzapine treatment: weight change and weight-related health factors in schizophrenia. Journal of Clinical Psychiatry 2001;62(2):92-100. [CSZG: 8291] [PubMed] [Google Scholar]
- Kinon BJ, Basson BR, Tollefson GD. Effect of long-term olanzapine treatment on weight change in schizophrenia. Schizophrenia Research 2000;41(Number 1 - Special Issue):195-6. [CSZG: 18843] [CSG NO. 4511] [Google Scholar]
- Kinon BJ, Basson MS, Tollefson GD. Gender-specific prolactin response to treatment with olanzapine vs. haloperidol in schizophrenia. In: Poster presented at the 9th Biennial European Winter Workshop on Schizophrenia; 1998 February 7-13, Davos, Switzerland. 1998. [CSG NO. 3325]
- Kinon BJ, Gilmore JA, Gottschalk LA. Continued improvement in quality of life despite weight change during olanzapine treatment. In: 39th Annual Meeting of the American College of Neuropsychopharmacology; 2000; Dec 10-14; San Juan; Puerto Rico. 2000. [CSZG: 7596]
- Kinon BJ, Milton DR, Hill AL. Effective resolution of acute presentation of behavioral agitation and positive psychotic symptoms in schizophrenia with olanzapine. International Journal of Neuropsychopharmacology 2000;3(Suppl 1):S154. [CSZG: 4817] [PubMed] [Google Scholar]
- Kinon BJ, Roychowdhury SM, Milton DR, Hill AL. Effective resolution with olanzapine of acute presentation of behavioral agitation and positive psychotic symptoms in schizophrenia. Journal of Clinical Psychiatry 2001;62(Suppl 2):17-21. [CSZG: 5898] [PubMed] [Google Scholar]
- Kuntz AJ, Sanger TM, Beasley CM. Olanzapine in the treatment of elderly patients with schizophrenia and related psychotic disorders. In: 11th Annual Meeting of the American Association for Geriatric Psychiatry, San Diego, California. 1998. [CSZG: 1582] [CSG NO. 2920]
- Lane LM, Burns PR, Reamse SC, Sanger TM, Beasley CM Jr. Olanzapine in the treatment of elderly patients with schizophrenia and related psychotic disorders. European Neuropsychopharmacology 1998;8(Suppl 2):S225. [Google Scholar]
- Le Pen C, Lilliu H, Allicar M P, Olivier V, Gregor KJ. An economic comparison of olanzapine versus haloperidol in the treatment of schizophrenia in France. Encephale 1999;25(4):281-6. [CSZG: 5124] [CSG NO. 4412] [PubMed] [Google Scholar]
- Lu Y, Sanger T, Beasley C, Tran P, Tollefson, G. Olanzapine in the treatment of schizoaffective disorder. In: 9th Congress of the European College of Neuropsychopharmacology; Amsterdam; The Netherlands. 1996. [CSZG: 1754] [CSG NO. 2807]
- Mallinckrodt C, David S, Burns P, Breier A. Long-term efficacy and safety of olanzapine in patients with inadequate initial response to haloperidol or olanzapine. European Neuropsychopharmacology 1998;8(Suppl 2):S228. [CSZG: 18844] [Google Scholar]
- Mallinckrodt CH, David SR, Burns PR, Breier A. Long-term efficiacy and safety of olanzapine in patients with inadequate initial response to haloperidol or olanzapine. In: Schizophrenia Research (7th International Congress on Schizophrenia Research, 1999 Apr 17-21, Santa Fe, New Mexico, USA). 1999:288. [CSZG: 8667]
- Martin C, Genduso L, Revicki D, Hamilton S, Tran P, Beasley C. Impact of olanzapine on patient quality of life in schizophrenia. In: Xth World Congress of Psychiatry; August 23-28; Madrid; Spain. 1996. [CSZG: 3914]
- Martin C. Impact of olanzapine on quality of life in schizophrenia. In: 8th Congress of the Association of European Psychiatrists; Jul 7-12; London; England, UK. 1996. [CSZG: 3913]
- Meehan KM, David SR, Taylor CC, Sutton VK. Change in extrapyramidal symptoms with olanzapine in comparison with other antipspychotic agents. Schizophrenia Research 2000;41(1):192. [CSZG: 5151] [Google Scholar]
- Naber D. Evidence of efficacy of neuroleptics in effective versus negative symptoms. In: 10th European College of Neuropsychopharmacology Congress; Sep 13-17; Vienna; Austria. 1997. [CSZG: 2122]
- Patel B, Kurtz DL, Callaghan JT, Beasley CM Jr, Bergstrom RF. Effect of smoking and gender on population pharmacokinetics of olanzapine. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 2238]
- Pilowsky LS, Busatto GF, Taylor M, Costa DC, Sharma T, Sigmundsson T, et al. Dopamine D2 receptor occupancy in vivo by the novel atypical antipsychotic olanzapine - a 123I IBZM single photon emission tomography (SPET) study. Psychopharmocology 1996;124:148-53. [CSZG: 18845] [DOI] [PubMed] [Google Scholar]
- Reams SG, Sanger TM, Beasley CM Jr. Olanzapine in the treatment of elderly patients with schizophrenia and related psychotic disorders. Schizophrenia Research 1998;29(1-2):151-2. [CSZG: 2401] [Google Scholar]
- Revicki D, Genduso LA, Hamilton SL, Martin C, Reblando J, Tran PV. Quality of life outcomes for olanzapine and haloperidol treatment for schizophrenia and related psychotic disorders. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 3915]
- Revicki D, Haley J, Hamilton S. Quality of life outcomes for olanzapine and haloperidol treatment for schizophrenia and other psychotic disorders: results of an international randomized clinical trial. Quality of Life Research 1997;6:708. [CSZG: 5212] [CSG NO. 4596] [DOI] [PubMed] [Google Scholar]
- Revicki DA. Quality of life and re-integration of chronically ill patients. In: 9th Congress of the Association of European Psychiatrists; Copenhagen. 1998:Abstract number:Lilly-SAT1-5. [CSZG: 5860] [CSG NO. 3806]
- Revicki LA, Genduso LA, Hamilton SH, Beasley CM Jr. Olanzapine versus haloperidol in the treatment of schizophrenia, schizoaffective and schizophreniform disorders. Quality of life outcomes of a randomized clinical trial. Quality of Life Research 1999;8:417-26. [CSZG: 5213] [DOI] [PubMed] [Google Scholar]
- Sanger T, Lieberman J, Tohen M, Grundy S, Beasley C Jr, Tollefson G. Olanzapine versus haloperidol treatment in first-episode psychosis. European Neuropsychopharmacology 1998;8(Suppl 2):S228-9. [DOI] [PubMed] [Google Scholar]
- Sanger T, Lieberman JA, Tohen M, Tollefson GD. Olanzapine versus haloperidol in the treatment of first episode psychosis. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow; Scotland, UK. 1998. [CSZG: 3759]
- Sanger T, Lieberman JA, Tohen M, Tollefson GD. Olanzapine versus haloperidol in the treatment of psychosis. In: 151st Annual Meeting of the American Psychiatric Association; May 30-June 4; Toronto; ON, Canada. 1998. [CSZG: 3760]
- Sanger T, Tollefson GD, Lieberman JA, Tohen M. Olanzapine versus haloperidol in the treatment of first-episode psychosis. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 3762]
- Sanger TM, Lieberman JA, Tohen M, Starr Grungy PH, Beasley C-Jr, Tollefson GD. Olanzapine versus haloperidol treatment in first-episode psychosis. American Journal of Psychiatry 1999;156:79-87. [CSZG: 3763] [DOI] [PubMed] [Google Scholar]
- Sanger TM, Lieberman JA, Tohen M, Tollefson GD. Olanzapine versus haloperidol treatment of first-episode psychosis. Schizophrenia Research 1998;29(1-2):151. [CSZG: 3764] [DOI] [PubMed] [Google Scholar]
- Satterlee W, Beaasley C, Sanger T, Tran P, Tollefson G. Olanzapine, a new "atypical" antipsychotic. Schizophrenia Research 1995;15(1,2):163. [CSZG: 3657] [CSG NO. 4032] [Google Scholar]
- Satterlee WG, Beasley CM, Tran PV, Tamura RN, Krueger JA, Tollefson GD. Olanzapine versus haloperidol - results of a large multi-center international trial. In: American Psychiatric Association, 149th Annual Meeting; May 4-9. 1996. [CSZG: 3916]
- Satterlee WG, Beasley CM, Tran PV, Tamura RN, Krueger JA, Tollefson GD. Olanzapine versus haloperidol in a large international trial. In: Xth World Congress of Psychiatry; August 23-28; Madrid; Spain. 1996. [CSZG: 3917]
- Street JS, Tamura R, Sanger T, Tollefson G. Long-term treatment-emergent dyskinetic symptoms in patients treated with olanzapine and haloperidol. Psychopharmacology Bulletin 1996;32(3):522. [Google Scholar]
- Tamura RN, Beasley CM, Dellva MA, Glazer WM, Morgenstern H, Tollefson GD. What is the differential risk of tardive dyskinesia with the novel antipsychotic olanzapine? Schizophrenia Research 1998;29(1-2):176. [CSZG: 2808] [Google Scholar]
- Tohen M, Sanger T, Tollefson GD, McElroy SL. Olanzapine versus haloperidol in the treatment of schizoaffective bipolar patients. In: American Psychiatric Association, 150th Annual Meeting. San Diego, CA, USA. 1997. [CSZG: 3783]
- Tohen M, Sanger T, Tollefson GD, McElroy SL. Olanzapine versus haloperidol in the treatment of schizoaffective bipolar patients. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 3783]
- Tohen M, Sanger T, Tollefson GD. Gender differences in the response of olanzapine versus haloperidol in the treatment of first-episode psychosis. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 3782]
- Tohen MF, Zhang F, Sanger TM, Gannon KS, Tollefson GD. Olanzapine versus haloperidol in schizoaffective bipolar disorder: a repeated-measures analysis. In: APA Annual Meeting, May 15-20, Washington, DC. 1999. [CSZG: 3690] [CSG NO. 4113]
- Tollefson G, Beasley C, Tran P, Dellva MA, Krueger J, Tamura R. Olanzapine versus haloperidol: acute results of the multicenter international trial. Psychopharmacology Bulletin 1996;32(3):401. [CSZG: 7389] [Google Scholar]
- Tollefson G, Beasley C, Tran P, Sanger T. Olanzapine: an exciting atypical antipsychotic: the clinical experience. In: 8th European College of Neuropsychopharmacology Congress; Sep 30-Oct 4; Venice; Italy. 1995. [CSZG: 3784]
- Tollefson GD, Beasley CM Jr, Tamura RN, Tran PV, Potvin JH. Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. American Journal of Psychiatry 1997;154(9):1248-54. [CSZG: 5284] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Beasley CM, Tran PV, Street JS, Krueger JA, Tamura RN, et al. Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders: results of an international collaborative trial. American Journal of Psychiatry 1997;154:457-65. [CSZG: 3918] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Beasley CM, Tran PV, Tamura RN, Sanger TM, Wood A, et al. Olanzapine versus haloperidol: results of the multi-center international trial. Schizophrenia Research 1996;18(2-3):131. [CSZG: 3691] [Google Scholar]
- Tollefson GD, Lu Y, Sanger TM, Beasley CM, Tran PV. Olanzapine in the treatment of schizoaffective disorder. Schizophrenia Research (Special Issue) - The VIth International Congress on Schizophrenia Research, Colorado Springs, CO, USA; April 12-16, 1997 1997;24:192. [CSZG: 3921] [Google Scholar]
- Tollefson GD, Lu Y, Sanger TM, Beasley CM, Tran PV. Olanzapine in the treatment of schizoaffective disorder. Schizophrenia Research 1997;24(1-2):192-3. [CSZG: 3921] [Google Scholar]
- Tollefson GD, Lu Y. A blinded trial on the course and relationship of depressive symptoms in schizophrenia. In: American Psychiatric Association, 150th Annual Meeting; San Diego; CA, USA. 1997. [CSZG: 4033]
- Tollefson GD, Lu Y. Comorbid mood disturbance in schizophrenia. In: 9th European College of Neuropsychopharmacology Congress; Sep 21-25; Amsterdam; The Netherlands. 1996. [CSZG: 3920]
- Tollefson GD, Lu Y. Comorbid mood disturbance in schizophrenia. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne; Australia. 1996. [CSZG: 3919]
- Tollefson GD, Lu Y. Comorbid mood disturbance in schizophrenia. Schizophrenia Research (Special Issue) - The VIth International Congress on Schizophrenia Research, Colorado Springs, CO, USA; April 12-16, 1997 1997;24:192. [CSZG: 9377] [PubMed] [Google Scholar]
- Tollefson GD, Lu Y. Comorbid mood disturbance in schizophrenia. Schizophrenia Research 1997;24:191. [CSZG: 9377] [Google Scholar]
- Tollefson GD, Sanger TD, Lieberman JA. Olanzapine versus haloperidol in the treatment of first episode psychosis. Biological Psychiatry 1997;41:73S. [CSZG: 9533] [MEDLINE: ] [PMID 22476629]22476629 [Google Scholar]
- Tollefson GD, Sanger TM, Andersen SW. Depressive signs and symptoms in schizophrenia: a prospective blinded trial of olanzapine and haloperidol. European Neuropsychopharmacology 1998;8(Suppl 2):225. [CSZG: 18838] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Sanger TM, Andersen SW. Depressive signs and symptoms in schizophrenia: a prospective blinded trial of olanzapine and haloperidol. European Neuropsychopharmacology 1998;Suppl 2:225. [CSZG: 18838] [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Sanger TM, Andersen SW. Depressive signs and symptoms in schizophrenia:a prospective blinded trial of olanzapine and haloperidol. In: 11th Congress of the European College of Neuropsychopharmacology; Paris; France. 1998. [CSZG: 4034] [CSG NO. 3368] [DOI] [PubMed]
- Tollefson GD, Sanger TM, Leiberman JA. Olanzapine versus haloperidol in the treatment of first episode psychosis. Schizophrenia Research (Special Issue) - The VIth International Congress on Schizophrenia Research, Colorado Springs, CO, USA; April 12-16, 1997 1997;24:193. [CSZG: 3922] [Google Scholar]
- Tollefson GD, Sanger TM, Lieberman JA. Olanzapine versus haloperidol in the treatment of first-epsiode psychosis. Schizophrenia Research 1997;24:193. [CSZG: 3922] [Google Scholar]
- Tollefson GD, Sanger TM, Lu Y, Thieme ME. Depressive signs and symptoms in schizophrenia: a prospective blinded trial of olanzapine and haloperidol. Archives of General Psychiatry 1998;55(3):250-8. [CSZG: 4035] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Sanger TM. Anxious-depressive symptoms in schizophrenia:a new treatment target for pharmacotherapy? Schizophrenia Research 1999;35 Suppl:S13-21. [CSZG: 5298] [CSG NO. 4574] [DOI] [PubMed] [Google Scholar]
- Tollefson GD, Tran PV, Hamilton S, Kuntz A. Olanzapine versus risperidone in the treatment of psychosis. Preliminary report. Biological Psychiatry 1997;41:20S. [CSZG: 9384] [N0146103028] [Google Scholar]
- Tollefson GD. A blinded trial on the course and relationship of depressive symptoms in schizophrenia. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum; July 12-16; Glasgow; Scotland, UK. 1998. [CSZG: 4029]
- Tollefson GD. Olanzapine: a novel antipsychotic with a broad spectrum profile. Neuropsychopharmacology 1994;10(3S):S189. [Google Scholar]
- Tollefson GD. Treatment consideration for comorbid mood disorders in schizophrenic patients. In: Sixth World Congress of Biological Psychiatry; June 22-27; Nice; France. 1997. [CSZG: 4030]
- Tran P, Beasley C, Street J, Tamura R, Dellva MA, Graffeo K, et al. Olanzapine versus haloperidol: acute results of the multi-center international trial. In: XXth Collegium Internationale Neuro-psychopharmacologicum; June 23-27; Melbourne; Australia. 1996. [CSZG: 3923]
- Tran P, Dellva M, Tamura R, Krueger J, Beasley C, Tollefson G. Olanzapine versus haloperidol: results of the international trial. In: 9th Congress of the European College of Neuropsychopharmacology; Amsterdam; The Netherlands. 1996. [CSZG: 4036] [CSG NO. 3730]
- Tran P, Lu Y, Sanger T, Beasley C, Tollefson G. Olanzapine in the treatment of schizoaffective disorder. In: 21st Congress of the Collegium Internationale Neuro-psychopharmacologicum; 1998 Jul 12-16; Glasgow, Scotland. 1998. [CSZG: 4039] [MEDLINE: ]
- Tran P, Lu Y, Sanger T, Beasley C, Tollefson G. Olanzapine in the treatment of schizoaffective disorder. Psychopharmacology Bulletin 1996;32(3):527. [CSZG: 9386] [N0146103028] [Google Scholar]
- Tran P, Lu Y, Sanger T, Beasley C, Tollefson G. Olanzapine in the treatment of schizoaffective disorder. Psychopharmacology Bulletin 1996;32(3):527. [CSZG: 9386] [Google Scholar]
- Tran P, Lu Y, Sanger T, Beasley C, Tollefson G. Olanzapine in the treatment of schizoaffective disorder. Schizophrenia Research 1998;29(1-2):151. [CSZG: 4038] [Google Scholar]
- Tran P, Sanger TM, Satterlee W, Beasley CJ, Tamura RN, Tollefson GD. Olanzapine vs haloperidol - results of a large multi-centre international trial. In: Schizophrenia 1996: Breaking down the Barriers, 4th International Conference; October 6-9; Vancouver; BC, Canada. 1996. [CSZG: 3924]
- Tran PV, Dellva MA, Beasley CM Jr, Satterlee WG, Cousins LM, Tollefson GD. Clinical experience with long-term continuation treatment with olanzapine. In: 149th Annual Meeting of the American Psychiatric Association; 1996 May 4-9; New York, USA. 1996. [CSZG: 4040] [MEDLINE: ]
- Tran PV, Dellva MA, Tollefson GD, Beasley CM Jr, Potvin JH, Kiesler GM. Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia. Journal of Clinical Psychiatry 1997;58:205-11. [CSZG: 5308] [DOI] [PubMed] [Google Scholar]
- Tran PV, Dellva MA, Tollefson GD, Wentley AL, Beasley C Jr. Oral olanzapine versus oral haloperidol in the maintenance treatment of schizophrenia and related psychoses. British Journal of Psychiatry 1998;172:499-505. [CSZG: 18350] [DOI] [PubMed] [Google Scholar]
- Tran PV, Tollefson GD, Creanga D, Zhang F, Wang J, Vangala S, et al. Clinical experience with olanzapine in patients of African, Asian, and Hispanic descent. In: World Psychiatric Association; Hamburg; Germany. 1999. [CSZG: 7053]
- Tran PV, Tollefson GD, Sanger TM, et al. Olanzapine versus haloperidol in the treatment of schizoaffective disorder: acute and long-term therapy. British Journal of Psychiatry 1999;174:15-22. [CSZG: 4048] [DOI] [PubMed] [Google Scholar]
- Tunis SL, Croghan TW, Heilman DK. Validity of SF36 for severely mentally ill patients. In: 151st Annual Meeting of American Psychiatric Association; May 30-June 4; Toronto; ON, Canada. 1998. [CSZG: 7043]
- Tunis SL, Croghan TW, Heilman DK, Johnston BM, Obenchain RL. Reliability, validity, application of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in schizophrenic patients treated with olanzapine versus haloperidol. Medical Care 1999;37(7):678-91. [CSZG: 5291] [CSG NO. 4586] [DOI] [PubMed] [Google Scholar]
- Tunis SL, Johnstone BM, Gibson PJ, Loosbrock DL, Dulisse BK. Changes in perceived health and functioning as a cost-effectiveness measure for olanzapine versus haloperidol treatment of schizophrenia. Journal of Clinical Psychiatry 1999;60 Suppl 19:38-45. [CSZG: 5296] [CSG NO. 4244] [PubMed] [Google Scholar]
- Williamson D, Beasley C, Tran P, Tamura N, Sanger T, Tollefson G. Olanzapine versus haloperidol: results of the multi-center international trial. In: 8th Congress of the Association of European Psychiatrists; Jul 7-12; London; England, UK. 1996. [CSZG: 3925]
- Wright P, Tollefson GD, Beasley CM, Tamura RN, Tran PV, Potvin JII. A blinded, controlled, long-term study of the comparative incidence of treatement-emergent tardive dyskinesia with olanzapine or haloperidol. Schizophrenia Research 1998;29(1-2):206. [CSZG: 9192] [EMBASE 2002184411; CN-00443250.] [DOI] [PubMed] [Google Scholar]
- Wright P, Tollefson GD, Beasley CM, Tamura RN, Tran PV, Potvin JII. A blinded, controlled, long-term study of the comparative incidence of treatment-resistant tardive dyskinesia with olanzapine or haloperidol. Schizophrenia Research 1998;29(1-2):206. [CSZG: 9192] [Google Scholar]
- Zhang F, Tohen M, Gannon KS, Breier A. Olanzapine versus haloperidol: assessment of cognitive function in patients with schizoaffective disorder, bipolar type. In: Journal of the European College of Neuropsychopharmacology. 1999:S247. [CSZG: 5981] [MEDLINE: ]
- Zhang F, Tohen M, Sanger T, Gannon KS, Tollefson GD, Breier A. Olanzapine versus haloperidol in schizoaffective disorder, bipolar type: a~repeated measures analysis. Journal of the European College of Neuropsychopharmacology 1999;9:S246. [CSZG: 5982] [MEDLINE: ] [Google Scholar]
Vedam 2022 {published data only}
- Vedam VA, Ghanta MK, Kantipudi SJ, David DC, Vijayalakshmi M, Nuthalapati P. Homocysteine levels and clinical outcomes in schizophrenia—a pilot randomized controlled trial. Journal of Pharmacology and Pharmacotherapeutics 2022;13(3):284-92. [DOI: 10.1177/0976500X2211286] [DOI] [Google Scholar]
Walther 2014 {published data only}
- Walther S, Moggi F, Horn H, Moskvitin K, Abderhalden C, Maier N, et al. Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine. Journal of Clinical Psychopharmacology 2014;34(1):124-8. [DOI: 10.1097/JCP.0000000000000050] [DOI] [PubMed] [Google Scholar]
Wang 2012k {published data only}
- 汪艳, 蔡丽伟, 张红星, 杜波, 金超, 阎浩, et al. Randomized controlled study of haloperidol and olanzapine in the treatment of schizophrenia efficacy and safety [Google Translate] [氟哌啶醇与奥氮平治疗精神分裂症疗效和安全性的随机对照研究]. Chinese Journal of Nervous and Mental Diseases [Zhongguo Shen Jing Jing Shen Ji Bing Za Zhi; 中国神经精神疾病杂志] 2012;-(04):217-21. [Google Scholar]
Wang 2013az {published data only}
- 王茜, 王洪明. Olanzapine and haloperidol controlled study of patients with refractory schizophrenia affect the quality of life of the [Google Translate] [奥氮平与氟哌啶醇对难治性精神分裂症病人生活质量影响的对照研究]. 中国卫生产业 2013;-(13):26-7. [Google Scholar]
Xianzhen 2004 {published data only}
- Zheng X, Jiang F. A double blind comparing study between the effects of haloperidol and olanzapine on the quality of life of the patients with schizophrenia [奧氮平與氟哌啶醇對精神分裂癥病人生活質量影響的雙盲對照研究]. Journal of Jining Medical College 2004;27(3):20-2. [Google Scholar]
Xu 2014n {published data only}
- 许素娥. 奥氮平与氟哌啶醇对精神分裂症患者生活质量影响的对照研究. 中外健康文摘 2014;-(18):107-8. [Google Scholar]
Zhang 2005g {published data only}
- Zhang M-L, Yuan G-Z, Yao J-J, Chu X, Zhang Y-B, Zhou D-X, et al. Changes in the serum levels of prolactin and growth hormone in patients with schizophrenic after different drug administration [不同藥物治療精神分裂癥患者血清催乳素與生長激素水平的變化]. Chinese Journal of Clinical Rehabilitation 2005;9(32):76-7. [Google Scholar]
Zhang 2010ad {published data only}
- 张树龙. Olanzapine control study of first episode schizophrenia [Google Translate] [奥氮平治疗首发精神分裂症对照研究 []. China Contemporary Medicine [当代医学] 2010;16(12):141-2. [Google Scholar]
Zhang 2010ae {published data only}
- 张海燕. Tablets of olanzapine treatment of schizophrenia and the effect of haloperidol compared SBR [Google Translate] [奥氮平片与氟哌丁苯治疗精神分裂症疗效比较 []. Chinese Journal of Modern Drug Application [中国现代药物应用] 2010;4(8):133. [Google Scholar]
Zhang 2013m {published data only}
- 张懿. Olanzapine and haloperidol in the treatment of schizophrenia comparison of efficacy [Google Translate] [奥氮平与氟哌啶醇治疗精神分裂症疗效比较]. Medical Journal of Chinese People's Health [中国民康医学] 2013;-(16):47+67. [Google Scholar]
Zhang 2016al {published data only}
- 张建, 常余善, 蒋正伟. 氟哌啶醇与奥氮平治疗精神分裂症的临床疗效对比研究. 临床合理用药杂志 2016;9(21):11-3. [Google Scholar]
Zheng 2003b {published data only}
- Zheng R. Olanzapine treatment of positive symptoms of schizophrenia and ammonia piperidinol control study [奥氮平与氨哌啶醇治疗精神分裂症阳性症状的对照研究]. Acta Academiae Medicinae Suzhou [苏州医学院学报] 2003;23(2):218-9.
Zhu 2014f {published data only}
- 朱虹, 贾竑晓, 何瑞荣, 卜力, 张燕敏, 许英. 奥氮平对精神分裂症患者认知功能和生活质量改善作用及疗效. China Journal of Health Psychology [中国健康心理学杂志] 2014;22(10):1451-3. [Google Scholar]
Zubair 2020 {published data only}
- Zubair UB, Ali SA, Taj R, Batool SM. Comparison of effectiveness of antipsychotics in schizophrenia: second-generation versus the first-generation. Journal of Ayub Medical College Abbottabad 2020;32(1):24-7. [PMID: PMID: 32468749] [PubMed] [Google Scholar]
References to studies excluded from this review
Addington 1998 {published data only}
- Addington DE, Addington JM. Costs of novel antipsychotics in clinical practice. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Allan 1998 {published data only}
- Allan ER, Sison CE, Alpert M, Connolly B, Crichton J. The relationship between negative symptoms of schizophrenia with extrapyramidal side effects with haloperidol and olanzapine. Psychopharmacology Bulletin 1998;34(1):71. [PubMed] [Google Scholar]
Allison 1998 {published data only}
- Allison DB, Mentor JL, Heo M, Weiden PJ, Chandler LP, Cappelleri J. Weight gain associated with conventional and newer antipsychotics: a meta-analysis. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
- Allison DB, Mentor JL, Heo M, Weiden PJ, Chandler LP, Cappelleri J. Weight gain associated with conventional and newer antipsychotics: a meta-analysis. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK; July 12-16, 1998. 1998. [American J of Psychiatry 1999 vol 156, p1686-96]
Alvarez 2005 {published data only}
- Alvarez M, Gonzalez-Blanch C, Perez-Iglesias R, Perez-Pardal, T, Martinez-Garcia O, Crespo-Facorro B, et al. Early intervention in antipsychotic-induced weight gain in first episode psychosis. International Congress on Schizophrenia Research 2005;31(2):518. [Google Scholar]
- Alvarez-Jimenez M, Gonzalez-Blanch C, Vazquez-Barquero JL, Perez-Iglesias R, Martínez-García O, Perez-Pardal T, et al. Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: a randomized controlled trial.. Journal of Clinical Psychiatry 2006;67(8):1253-60. [DOI: 10.4088/jcp.v67n0812] [DOI] [PubMed] [Google Scholar]
- Álvarez-Jiménez M, Martínez-García O, Pérez-Iglesias R, Ramírez ML, Vázquez-Barquero JL, Crespo-Facorro B. Prevention of antipsychotic-induced weight gain with early behavioural intervention in first-episode psychosis: 2-year results of a randomized controlled trial. Schizophrenia Research 2010;116(1):16-9. [DOI: 10.1016/j.schres.2009.10.012] [DOI] [PubMed] [Google Scholar]
Apicella 2001 {published data only}
- Apicella A. National Alliance for Research on Schizophrenia and Depression. www.mhsource.com/narsad/bd/studyops.html 2001.
Apiquian 2003 {published data only}
- Apiquian R, Fresan A, Errera K, Ulloa RE, Loyzaga C, De LaFuente-Sandoval C, et al. Minimum effective doses of haloperidol for the treatment of first psychotic episode: a comparative study with risperidone and olanzapine. International Journal of Neuropsychopharmacology 2003;6(4):403-8. [EMBASE: 2004054013] [DOI] [PubMed] [Google Scholar]
Aquila 2000 (HGEC) {published data only}
- Aquila R, Weiden PJ, Kinon BJ, Milton DR, Zygmunt A, Swindle RW, et al. Effectiveness of olanzapine upon psychiatric and vocational rehabilitation outcomes. In: 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13-18; Chicago, USA. 2000.
Arango 2001 {published data only}
- Arango C, Summerfelt A, Buchanan RW. Olanzapine effects on auditory sensory gating in schizophrenia. American Journal of Psychiatry 2003;160(11):2066-8. [PMID 14594761] [DOI] [PubMed] [Google Scholar]
- Arango C, Summerfelt AT, Buchanan RW. Lack of P50 changes in a randomized double blind study of olanzapine and haloperidol. Schizophrenia Research 2001;49(1-2 Suppl):197. [MEDLINE: ] [Google Scholar]
Arous 2016 {published data only}
- Arous A, Chebbi W, Mrizak J, Ammar HB, El Hechmi Z. Effects of atypical and conventional antipsychotics on cognition in schizophrenia. European Neuropsychopharmacology 2016;2(26):S347-8. [Google Scholar]
Awad 2002b {published data only}
- Awad AG, Vourganti L, Dugar A. Patient attitude after switch to ziprasidone from other antipsychotics. European Psychiatry (11th Association of European Psychiatrists Congress, 2002 4-8th May, Stockholm, Sweden) 2002;17(Suppl 1):102s. [probably Pfizzer study] [Google Scholar]
Baker 2003 {published data only}
- Baker R, Kinon BJ, Liu H, Richey A, Hill AL, Bergstrom RF, et al. Effectiveness of rapid initial dose escalation of oral olanzapine for acute agitation. Schizophrenia Research 2003;60:272. [EMBASE 2003496187] [Google Scholar]
- Baker RW, Kinon BJ, Maguire GA, Liu H, Hill AL. Effectiveness of rapid initial dose escalation of up to forty milligrams per day of oral olanzapine in acute agitation. Journal of Clinical Psychopharmacology 2003;23(4):342-8. [PMID 12920409] [DOI] [PubMed] [Google Scholar]
Baldacara 2011 {published data only}
- Baldaçara L, Sanches M, Cordeiro DC, Jackowski AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Brazilian Journal of Psychiatry 2011;33(1):30-9. [DOI: 10.1590/S1516-44462011000100008] [DOI] [PubMed] [Google Scholar]
Barak 2005 {published data only}
- Barak Y, Swartz M, Plopsky I. Assessing cardiovascular risks of olanzapine treatment: a 6-month study versus haloperidol in schizophrenia patients. International Clinical Psychopharmacology 2005;20(6):315-7. [PMID: ] [DOI] [PubMed] [Google Scholar]
Bayar 2005 {published data only}
- Bayar R, Kocabasoglu N, Yargic I, Sevim ME, Corapcioglu A, Benbir G. A multi-centered study evaluating the effects of haloperidol and olanzapine on depressive symptoms in schizophrenic patients.. European Neuropsychopharmacology 2005;15:S474. [Google Scholar]
Beasley 1996c {published data only}
- Beasley C, Tollefson G, Wood G, Tran P, Satterlee W, Beuzen J. Safety overview of olanzapine. In: Xth World Congress of Psychiatry. Madrid, Spain; August 23-28, 1996. 1996.
Beasley 2003 (HGGI) {published data only}
- Beasley CM, Hamilton SH, Dossenbach M. Relapse prevention with olanzapine. Schizophrenia Research 2000;41(1):196-7. [CSG NO. 4512] [Google Scholar]
- Beasley CM, Sutton VK, Hamilton SH, Walker DJ, Dossenbach M, Taylor CC, et al. A double-blind, randomized, placebo-controlled trial of olanzapine in the prevention of psychotic relapse. Journal of Clinical Psychopharmacology 2003;23(6):582-94. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Beasley Jr C, Hamilton S, Dossenbach M. Relapse prevention with olanzapine. Journal of the European College of Neuropsychopharmacology 2000;10(Suppl 3):S304. [Google Scholar]
Beuzen 1996 (HGCE) {published data only}
- Beuzen JN. Olanzapine - cognitive and motor effects in healthy elderly. In: Xth World Congress of Psychiatry. Madrid, Spain; August 23-28, 1996. 1996.
- Taylor N, Beuzen JN, Wesnes K, Wood A. The effect of olanzapine on cognition and psychomotor function in healthy elderly volunteers. Schizophrenia Research 1996;18(2-3):VC2. [DOI] [PubMed] [Google Scholar]
Birkett 1994 {published data only}
- Birkett P. State of the Art - Winter Workshop on Schizophrenia, Les Diablerets, Switzerland, January 1994. Journal of Psychopharmacology 1995;9(2):157-60. [DOI] [PubMed] [Google Scholar]
Bourin 2007 {published data only}
- Barbato LM, Newcomer JW, Heisterberg J. Efficacy and metabolic profile of bifeprunox in patients with schizophrenia. Schizophrenia Bulletin 2007;33(2):419. [Google Scholar]
- Bourin M, Debelle M, Heisterberg J, Josiassen MK, Ostergaard JB, Sands E. 304–Efficacy of bifeprunox in patients in the post-acute, maintenance phase of schizophrenia: Findings from a 6-month study. Schizophrenia Research 2008;98:158. [DOI: 10.1016/j.schres.2007.12.371] [DOI] [Google Scholar]
- Bourin M, Debelle M, Heisterberg J, Krog Josiassen M, Buch Ostergaard J, Sands EA, et al. Long-term efficacy and safety of bifeprunox in stable patients with schizophrenia: findings from a 6-month study. Journal of the European College of Neuropsychopharmacology 2007;17(4):S454. [Google Scholar]
- Ostergard JB, Barbato LM, Yeung PP. Bifeprunox is safe and effective in preventing deterioration in patients with stable schizophrenia: results from a 6-month, placebo-controlled study. Schizophrenia Bulletin 2007;33(2):422-3. [Google Scholar]
- Shapira NA, Newcomer JW, Barbato LM, Heisterberg J, Yeung P. Metabolic effects of bifeprunox in patients with schizophrenia. Schizophrenia Bulletin 2007;33(2):459. [Google Scholar]
Britto 2002 {published data only}
- Britto D. Ziprasidone quality of life study in the treatment of chronic schizophrenia. National Research Register 2002;1. [N0083099522]
Buchsbaum 2004 {published data only}
- Buchsbaum MS, Haznedar MM, Aronowitz J, Brickman AM, Newmark RE, Bloom, et al. FDG-PET in never-previously medicated psychotic adolescents treated with olanzapine or haloperidol. Schizophrenia Research 2007;94(1-3):293-305. [DOI: 10.1016/j.schres.2007.04.027] [DOI] [PubMed] [Google Scholar]
- Buchsbaum MS, Haznedar MM, Aronowitz J, Brickman AM, Newmark RE, Canfield E, et al. White matter volume and anisotropy in never medicated psychotic adolescents treated with olanzapine and haloperidol. Journal of the European College of Neuropsychopharmacology 2004;17(4):S426. [Google Scholar]
- Buchsbaum MS, Haznedar MM, Hazlett E. Antipsychotic response prediction with FDG-PET in schizophrenia. World Psychiatry 2004;3:S1:148. [Google Scholar]
Burgoyne 1996 {published data only}
- Burgoyne K, Ananth J, Gadasally R, Smith M. Maintenance treatment with olanzapine for schizophrenic patients. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK; July 12-16, 1998. 1998.
- Burgoyne K, Ananth J, Smith M, Swartz JR, Gadasally R, Arns P. Olanzapine versus haloperidol: the results of a double-blind study on acute psychotic patients. In: XXth Collegium Internationale Neuro-psychopharmacologicum. Melbourne, Australia; June 23-27, 1996. 1996.
Castilla 2002 {published data only}
- Castilla R. Early medication intervention in the treatment of psychosis in children. In: International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum; 2002 Jun 23-27; Montreal, Canada). 2002:S51.
Chetvertnykh 2008 {published data only}
- Chetvertnykh I, Soulimov GY, Mosolov SN. Longterm efficacy and safety of atypical antipsychotics and haloperidol in neuroleptic naive psychotic patients. International Journal of Neuropsychopharmacology 2008;11:139. [Google Scholar]
Clouth 1999 {published data only}
- Clouth J. Pharmacoeconomic evaluation of the treatment of schizophrenia in Germany: a comparison of olanzapine and haloperidol. In: APA Annual Meeting, May 15-20, 1999, Washington, DC. 1999. [CSG NO. 4109]
Corya 2002 (HGGA) {published data only}
- Corya S, Dubé S, Andersen SW, Sanger TM, Clemow D, Tohen M, et al. Olanzapine-fluoxetine combination for psychotic major depression. In: International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum; 2002 Jun 23-27; Montreal, Canada). 2002:S144. [lilly data]
Cutler 2002 {published data only}
- Cutler NR, Simpson G, Weiden PJ, Romanoa SJ. Effects of oral ziprasidone on weight and serum lipids in patients with schizophrenia. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:160. [Google Scholar]
Dalheim 1997 {published data only}
- Dalheim LJ, Weiden PJ, Aquila R, Standard J, Emanuel M, Zygmunt A. Olanzapine crossover in stable outpatients. In: American Psychiatric Association, 150th Annual Meeting, San Diego, CA, USA. 1997.
Daskalakis 2003 {published data only}
- Daskalakis ZJ, Christensen BK, Chen R, Fitzgerald PB, Zipursky RB, Kapur S. The effects of antipsychotics on cortical inhibition using transcranial magnetic stimulation. Schizophrenia Research 2003;1(60):249. [DOI: 10.1016/S0920-9964(03)81269-0] [DOI] [PubMed] [Google Scholar]
Davis 1998 {published data only}
- Davis JM, Janicak PG, Sharma RP, Manav R. Comparisons of the effects of the newer atypical antipsychotics in the treatment of schizophrenia: a meta-analysis. In: 151st Annual Meeting of American Psychiatric Association. May 30-June 4, Toronto, ON, Canada. 1998. [now published - independent data not lilly]
- Davis JM, Sharma RP, Manav R. Comparisons of the effects of the newer atypical antipsychotics in the treatment of schizophrenia: a meta-analysis. In: 151st Annual Meeting of American Psychiatric Association. May 30-June 4, Toronto, ON, Canada. 1998.
Devanand 1998 {published data only}
- Devanand DP, Michaels K, Sackeim HA, Marder K, Mayeux RP. Antipsychotics in the treatment of dementia complicated by psychosis. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada. May 30-June 4, 1998.
- Devanand DP. Classic neuroleptics in dementia. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Docherty 2002 {published data only}
- Docherty JP, Napolitano J, Mahmoud RA, Martinez RA, Lasser RA, Pandina GJ, et al. Anticholinergic effect of atypical antipsychotics in elderly patients. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
- Tune L, Mulsant B, Gharabawi G. Anticholinergic effect of atypical antipsychotics in elderly patients. European Neuropsychopharmacology 2002;12(Suppl 3):S314. [Google Scholar]
Dolnak 2000 {published data only}
- Dolnak DR, Hyman Rapaport M, Caligiuri M, Lohr J, Golshan S. A prospective, randomized, double-blind study contrasting motor dysfunction, negative symptoms and functioning in schizophrenic patients treated with olanzapine and risperidone.. In: 40th Annual Meeting of the New Clinical Drug Evaluation Unit (NCDEU); 2000 May 30 - Jun 2; Boca Raton, Florida, USA. 2000:133.
- Dolnak DR, Minn K, Wieneke M, Watson, Espinoza S. Olanzapine versus haloperidol in the treatment of schizophrenia. In: American Psychiatric Association, 149th Annual Meeting; May 4-9, 1996. 1996.
- Dolnak DR, Rapaport MH, Michael C, Shahrokh G. Motor dysfunction in schizophrenia. In: 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13-18; Chicago, USA. 2000.
- Dolnak DR, Rapaport MH, Michael C, Shahrokh G. Motor dysfunction in schizophrenia. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
- Dolnak R, Rapaport MH. A prospective, randomized, doubleblind study examining functioning in schizophrenic patients treated with olanzapine and risperidone. In: Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada). 2001:225-6. [MEDLINE: ]
Dossenbach 1997 {published data only}
- Dossenbach M, Friedel P, Folnegovic V, Jackovljevic M, Hutujac L, Uglesic B, et al. Olanzapine vs. fluphenazine - 6 weeks treatment of acute schizophrenia. In: 10th European Colleague of Neuropsychopharmacology Congress 1997 September 13-17 Vienna. 1997.
Erinfolami 2009 {published data only}
- Erinfolami A, Ola B, Olagunju A. Impact of atypical and conventional antipsychotics on the quality of life of patients with schizophrenia: a preliminary report from Lagos teaching hospitals. unknown source 2009;-:125. [Google Scholar]
Esel 2001 {published and unpublished data}5709
- Esel E, Basturk M, Saffet Gonul A, Kula M, Tayfun Turan M, Yabanoglu I, et al. Effects of olanzapine and haloperidol on serum prolactin levels in male schizophrenic patients. Psychoneuroendocrinology 2001;26(6):641-7. [CSZG: 7677] [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Fallahi 2011 {published data only}IRCT138706051100N1
- Fallahi B, Beiki D. Evaluation of therapeutic efficacy of treatment with olanzapine and halopridol on regional cerebral blood flow measured by SPECT in patients with schizophrenia, correlating with the response to treatment. Study protocol 2011;NA:0-3. [Google Scholar]
Finzen 2002 {published data only}
- Finzen A. Changing neuroleptics: from new to conventional - and vice versa [Neuroleptikawechsel: von atypischen zu konventionellen und zuruck - und - umgekehrt]. Psychiatrische Praxis 2002;29(8):445-6. [Google Scholar]
Fleming 1999 {published data only}
- Fleming K, Potkin SG, Alva G, Carreon D. Dissociation of improvement in neurocognition and negative symptomatology with olanzapine and clozapine conference abstract. In: Schizophrenia Research (Abstracts of The 7th International Congress on Schizophrenia Research; 1999 Apr 17-21; Santa Fe, USA). 1999:279.
Freeman 2009 {published data only}
- Freeman DJ, DiPaula BA, Love RC. Intramuscular haloperidol versus intramuscular olanzapine for treatment of acute agitation: a cost‐minimization study. Pharmacotherapy: the Journal of Human Pharmacology and Drug Therapy 2009;29(8):930-6. [DOI: 10.1592/phco.29.8.930] [PMID: ] [DOI] [PubMed] [Google Scholar]
Gallinat 2001 {published data only}
- Gallinat J, Riedel M, Juckel G, Sokullu S, Frodl T, Moukhtieva R, et al. P300 and symptom improvement in schizophrenia. Psychopharmacology 2001;158(1):55-65. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Goldman 2004 {published data only}
- Goldman MB, Hussain N. Absence of effect of olanzapine on primary polydipsia: results of a double-blind, randomized study. Journal of Clinical Psychopharmacology 2004;24(6):678-80. [DOI: 10.1097/01.jcp.0000145337.07676.2f] [DOI] [PubMed] [Google Scholar]
Gothelf 2003 {published data only}
- Gothelf D, Apter A, Reidman J, Brand-Gothelf A, Bloch Y, Gal GKL, et al. Olanzapine, risperidone and haloperidol in the treatment of adolescent patients with schizophrenia. Journal of Neural Transmission 2003;110(5):545-60. [MEDLINE: ] [PMID 12721815] [DOI] [PubMed] [Google Scholar]
Grecu 2006 {published data only}
- Gabos Grecu I, Gabos Grecu M, Pop M. Clinical effectiveness of atypical vs typical antipsychotics in treatment of schizophrenic patients. unknown 2006;-:-. [Google Scholar]
Harrigan 2004 {published data only}
- Chiu CC, Chang WH, Huang MC, Chiu YW, Lane HY. Regular-dose risperidone on QTc intervals. Journal of Clinical Psychopharmacology 2005;25(4):391-3. [DOI: 10.1097/01.jcp.0000170032.78060.cd] [DOI] [PubMed] [Google Scholar]
- Harrigan EP, Miceli JJ, Anziano R, Watsky E, Reeves KR, Cutler NR, et al. A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition. Journal of Clinical Psychopharmacology 2004;24(1):62-9. [DOI: 10.1097/01.jcp.0000104913.75206.62] [PMID: ] [DOI] [PubMed] [Google Scholar]
Hazlett 2009 {published data only}
- Hazlett E. Predicting best treatment response in schizophrenia with striatal function. NA 2009;-:-. [Google Scholar]
- Haznedar MM. Prediction of antipsychotic response with diffusion tensor imaging. unknown -;-:-. [Google Scholar]
Hrdlicka 2001 {published data only}
- Hrdlicka M, Rosillon D, Duchesne I. Czech results of the RODOS study: comparison of risperidone and olanzapine from the point of view of efficacy, tolerability and treatment costs [Ceske vysledky studie RODOS: Porovnani risperidonu a olanzapinu z hlediska ucinnosti, snasenlivosti a nakladu lecby]. Ceska A Slovenska Psychiatrie 2001;97(7):343-9. [should be 3 publications Janssen data] [Google Scholar]
Hsu 2010 {published data only}
- Hsu WY, Huang SS, Lee BS, Chiu NY. Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan. Journal of Clinical Psychopharmacology 2010;30(3):230-4. [DOI: 10.1097/JCP.0b013e3181db8715] [PMID: ] [DOI] [PubMed] [Google Scholar]
Irwin 2003 {published data only}
- Irwin J, Moses SN, Edgar JC, Torres F, Thoma RJ, Hanlon FM, et al. Olanzapine and risperidone in schizophrenia: a randomized double-blind crossover study. In: Schizophrenia Research. Vol. 60. 2003:286. [EMBASE: 2003241517]
Jarboe 2001 {published data only}
- Jarboe KS, Lewine RR. Haloperidol versus olanzapine induced weight gain and clinical relevance, a double-blind and open label comparison. Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada) 2001;1-2 Suppl:232. [MEDLINE: ] [Google Scholar]
Javitt 2001 {published data only}
- Javitt DC, Silipo G, Cienfuegos A, Shelley AM, Bark N, Park M, et al. Adjunctive high-dose glycine in the treatment of schizophrenia. International Journal of Neuropsychopharmacology 2001;4(4):385-91. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Jerrell 2002 {published data only}
- Jerrell JM. Cost-effectiveness of risperidone, olanzapine, and conventional antipsychotic medications. Schizophrenia Bulletin 2002;28(4):589-605. [EMBASE 2003196530] [DOI] [PubMed] [Google Scholar]
Kalali 2000 {published data only}
- Kalali A, Lasser R, Campbell B, Cucchiaro J, El-Bizri H, Guven A, et al. The management of cultural differences and the importance of safety monitoring in global studies: the realize clinical program. In: 39th Annual Meeting of the American College of Neuropsychopharmacology; 2000; Dec 10-14; San Juan; Puerto Rico. 2000.
Kasthurip 2012 {published data only}
- Kasthurip. A comparative study of efficacy and safety of olanzapine versus haloperidol in schizophrenia in a tertiary care hospital.. Indian Journal of Psychiatry 2012;54:S51. [Google Scholar]
Kinon (HGFW) {published data only}
- Kinon BJ, Basson B, Wang J, Malcolm SK, Stauffer VL. Rapid reduction in hyperprolactinemia upon switching treatment to olanzapine from conventional antipsychotic drugs or risperidone. In: 40th Annual Meeting of the New Clinical Drug Evaluation Unit (NCDEU); 2000 May 30 - Jun 2; Boca Raton, Florida. 2000. [N0146103028]
- Kinon BJ, Basson B, Wang J, Malcolm SK. Rapid reduction in hyperprolactinemia upon switching treatment to olanzapine from conventional antipsychotic drugs or risperidone. Schizophrenia Research 2000;41(1):194-5. [CSG NO. 4510] [Google Scholar]
- Kinon BJ, Basson BR, Malcolm SK, Breier A. Strategies for switching from conventional antipsychotic drugs and risperidone to olanzapine. In: World Congress of Psychiatry (WPA). Hamburg, Germany; August 8-11, 1999. 1999.
- Kinon BJ, Basson BR, Malcolm SK, Tollefson GD. Strategies for switching from conventional antipsychotic drugs and risperidone to olanzapine. In: 2nd Annual Meeting of the College of Psychiatric and Neurologic Pharmacists. Lake Tahoe, NV, USA; March 25-28, 1999. 1999.
- Kinon BJ, Basson BR, Malcolm SK, Tollefson GD. Strategies for switching from conventional antipsychotic drugs and risperidone to olanzapine. In: American College of Neuropsychopharmacology (ACNP). Las Carabas, Puerto Rico; December 14-18, 1998. 1998.
- Kinon BJ, Basson BR, Malcolm SK, Tollefson GD. Strategies for switching from conventional antipsychotic drugs and risperidone to olanzapine. In: American Psychiatric Association (APA). Washington, DC, USA; May 15-20, 1999. 1999.
- Kinon BJ, Basson BR, Malcolm SK, Tollefson GD. Strategies for switching from conventional antipsychotic drugs and risperidone to olanzapine. In: Biennial Meeting, International Congress on Schizophrenia Research (ICSR). Santa Fe, NM, USA; April 17-21, 1999. 1999.
- Kinon BJ, Basson BR, Wang J, Malcolm SK, Stauffer VL. Rapid reduction in hyperprolactinemia upon switching treatment to olanzapine from conventional antipsychotic drugs or risperidone. In: International Society of Psychoneuroendocrinology (ISPNE). Orlando, FL, 1999; July 30-August 3, 1999. 1999.
Kinon 2003 {published data only}
- Ahl J. Olanzapine reduces neuroleptic-induced hyperprolactinemia in schizophrenia. Schizophrenia Research 2003;60:350. [EMBASE: 2003241517] [Google Scholar]
- Kinon BJ, Liu H, Ahl J, Baker RW. Longitudinal effects of olanzapine on fasting serum lipids: a randomized, prospective, four- month study. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR553]]
- Kinon BJ, Liu H, Ahl J. Sexual dysfunction associated with neuroleptic-induced hyperprolactinemia improves with reduction in prolactin levels. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR552]] [DOI] [PubMed]
- Kinon BJ, Milton DR, Hill AL, Williamson DJ. Effective resolution of acute presentation of behavioral agitation and positive psychotic symptoms in schizophrenia with olanzapine. Journal of Psychopharmacology 2000;14(3):A60. [N0146103028] [Google Scholar]
Knegtering 2000 {published data only}
- Knegtering R, Boks M, Wiersma D, Blijd C, Bruggeman R, Oer RBV. Sexual dysfunctions in patients on antipsychotics. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
- Knegtering R, Boks M, Wiersma D, Blijd C, Bruggeman R, Oer RB. Sexual dysfunctions in patients on antipsychotics. In: 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13-18; Chicago, USA. 2000.
- Knegtering R, Castelein S, Bous H, Van Der Linde J, Bruggeman R, Kluiter H, et al. A randomized open-label study of the impact of quetiapine versus risperidone on sexual functioning. Journal of Clinical Psychopharmacology 2004;24(1):56-61. [EMBASE: 2004050225] [DOI] [PubMed] [Google Scholar]
Kolff 2000 {published data only}
- Kolff M, Coenen A, Dis H, Duigemans P. Differential effects of antipsychotic drugs on clinical symptoms and cognitive functions in the treatment of schizophrenia. Journal of the European College of Neuropsychopharmacology 2000;Suppl 2:S59. [Google Scholar]
Kong 2009 {published data only}
- Kong BG, Shim JC, Lee SK. Comparison of the effects of intramuscular antipsychotics injection in the treatment of acute agitation in psychosis. unknown -;-:S525. [Google Scholar]
Krakowski 2021 {published data only}
- Krakowski M, Tural U, Czobor P. The importance of conduct disorder in the treatment of violence in schizophrenia: efficacy of clozapine compared with olanzapine and haloperidol. American Journal of Psychiatry 2021;178(3):266-74. [DOI: 10.1176/appi.ajp.2020.20010052] [DOI] [PubMed] [Google Scholar]
Kucerova 2002 {published data only}
- Kucerova H. Olanzapine and improvement of tardive dyskinesia. European Psychiatry 2002;17(7):421-4. [DOI] [PubMed] [Google Scholar]
Lahti 1999a {published data only}
- Lahti AC, Holcomb HH, Weiler MA, Parwani A, Michaelidis T, Medoff DR, et al. Changes rcbf after acute challenge with haloperidol and olanzapine in patients with schizophrenia. In: Schizophrenia Research (Abstracts of The 7th International Congress on Schizophrenia Research; 1999 Apr 17-21; Santa Fe, USA). 1999:224. [MEDLINE: ]
- Lahti AC, Weiler MA, Holcomb HH, Lee SM, Tamminga CA. Time course of RCBF changes with haloperidol and olanzapine over a six week treatment. Schizophrenia Research 2003;-:-. [Google Scholar]
Lilly (HGBM) 1999 {unpublished data only}
- Eli Lilly. Open-label clinical trial on antipsychotic efficacy and safety of olanzapine in schizophrenic patients with positive or negative symptomatology. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGCL) 1999 {unpublished data only}
- Eli Lilly. Efficacy and safety of olanzapine in the treatment of schizophrenic, schizophreniform and schizoaffective patients in Saudi Arabia. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGCV) 1999 {unpublished data only}
- Eli Lilly. Olanzapine in schizophrenic patients intolerant of, or resistant to, clozapine. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGDU) 1999 {unpublished data only}
- Eli Lilly. Safety and efficacy of olanzapine in patients with severe haloperidol side effects in Romania. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGDZ) 1999 {unpublished data only}
- Eli Lilly. Efficacy and safety of olanzapine in the treatment of schizophrenic and schizoaffective patients in Russia. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGEP) 1999 {unpublished data only}
- Eli Lilly. Open-label olanzapine. Data supplied to the Cochrane Schizophrenia Group 1999.
Lilly (HGFM) 1999 {unpublished data only}
- Eli Lilly. Efficacy and safety of olanzapine in the treatment of schizophrenic patients in China. In: Data supplied to the Cochrane Schizophrenia Group. 1999.
Lilly (HGHB) 2005 {published data only}
- Battaglia J, David SR, Alaka K, Meehan K, Wright P. Calming versus sedative effects of IM olanzapine in agitated patients. Schizophrenia Research 2002;53(3):182-3. [DOI] [PubMed] [Google Scholar]
- Battaglia J, Houston JP, Ahl J, Meyers AL, Kaiser CJ. A post hoc analysis of transitioning to oral treatment with olanzapine or haloperidol after 24-hour intramuscular treatment in acutely agitated adult patients with schizophrenia. Clinical Therapeutics 2005;27(10):1612-8. [DOI] [PubMed] [Google Scholar]
- Battaglia J, Lindborg SR, Alaka K, Meehan K, Wright P. Calming versus sedative effects of intramuscular olanzapine in agitated patients. American Journal of Emergency Medicine 2003;21(3):192-8. [DOI] [PubMed] [Google Scholar]
- David SR, Battaglia J, Alaka KL, Meehan K, Wright P. Calming versus sedative effects of IM olanzapine in agitated patients. European Psychiatry 2002;17:104-5. [Google Scholar]
- David SR, Beasley CM, Alaka K. QTc intervals during treatment with IM olanzapine in acutely agitated patients. Biological Psychiatry 2002;51(8):78S. [Google Scholar]
- George M. A double-blind randomised comparison of the efficacy and safety of short acting intramuscular olanzapine, short acting intramuscular haloperidol and intramuscular placebo inpatients with schizophrenia. unknown source 2000;-:-. [Google Scholar]
- Kapur S, Arenovich T, Agid O, Zipursky R, Lindborg S, Jones B. Evidence for onset of antipsychotic effects within the first 24 hours of treatment. American Journal of Psychiatry 2005;162(5):939-46. [DOI] [PubMed] [Google Scholar]
- Lindborg SR, Beasley Jr CM, Alaka K, Taylor CC. Effects of intramuscular olanzapine vs. haloperidol and placebo on QTc intervals in acutely agitated patients. Psychiatry Research 2003;119(1-2):113-23. [DOI] [PubMed] [Google Scholar]
- Wright P, Lindborg SR, Birkett M, Meehan K, Jones B, Alaka K, et al. Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment.. Canadian Journal of Psychiatry 2003;48(11):716-21. [DOI] [PubMed] [Google Scholar]
- Wright P, Meehan K, Birkett M, Lindborg SR, Taylor CC, Morris P, et al. A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy. Clinical Therapeutics 2003;25(5):1420-8. [DOI] [PubMed] [Google Scholar]
Lilly (HGHV) 2005 {published data only}
- Breier A, Meehan K, Birkett M, David S, Ferchland I, Sutton V, et al. A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia. Archives of General Psychiatry 2002;59(5):441-8. [DOI] [PubMed] [Google Scholar]
- Breier A, Wright P, Birkett M, David S, Brook S, Meehan K. A double-blind dose response study comparing intramuscular (IM) olanzapine, haloperidol, and placebo in acutely agitated schizophrenic patients. Biological Psychiatry 2001;49(8):21S. [Google Scholar]
- Breier A, Wright P, Birkett M, Meehan K, David SR, Brook S. Intramuscular olanzapine: dose-related improvement in acutely agitated patients with schizophrenia. Proceedings of the 154th Annual Meeting of the American Psychiatric Association 2001;5:77. [Google Scholar]
- Smith RC. 10 mg intramuscular olanzapine reduces acute agitation in schizophrenia more effectively than lower doses. Evidence-Based Mental Health 2003;6(1):-. [PubMed] [Google Scholar]
- Wright P, Birkett MA, Meehan K, David SR, Brook S, Breier A. A double-blind dose response study comparing intramuscular olanzapine, haloperidol and placebo in acutely agitated schizophrenic patients. Schizophrenia Research 2001;49(1-2):250-1. [Google Scholar]
Lilly (TW‐S025) 2006 {published data only}
- Chan HY, Ree SC, Su LW, Chen JJ, Chou SY, Chen CK, et al. A double-blind, randomized comparison study of efficacy and safety of intramuscular olanzapine and intramuscular haloperidol in patients with schizophrenia and acute agitated behavior. Journal of Clinical Psychopharmacology 2006;34(3):355-8. [DOI] [PubMed] [Google Scholar]
- Lilly. Clinical Study Summary: F1D-TW-S025. Unpublished data 2006;NA:1-22. [Google Scholar]
Lima 2003 (HGHS) {published and unpublished data}6937
- Lima MS, Mari JJ, Costa AMN, Alexandrini N, Filho SR, Oliverira IR, et al. Quality of life of patients with schizophrenia: a randomised, naturalistic, controlled trial comparing olanzapine with typical antipsychotics in Brazil. Eli Lilly and Company.
- Lima MS, Jesus Mari J, Costa AMN, Alexandrini N, Filho SR, Oliveira IR, et al. Quality of life of patients with schizophrenia: a randomized, naturalistic, controlled trial comparing olanzapine with typical antipsychotics in Brazil. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9416] [N0146103028]
- Mari JD, Lima MS, Costa AN, Alexandrini N, Filho SR, Oliveira IR. A nine month naturalistic randomized controlled trial comparing olanzapine and conventional antipsychotics for schizophrenia and related disorders. Schizophrenia Research 2003;60:294. [CSZG: 9720] [EMBASE: 2003241517] [Google Scholar]
- Mari JdJ, Lima MS, Costa AMN, Alexandrini N, Filho SR, Oliveira IR. Olanzapine versus conventional antipsychotics: long-term risk of tardive dyskinesia. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [CSZG: 9800] [[NR254]]
Lindenmayer 1998 {published data only}
- Lindenmayer JP. Beyond symptoms: optimizing real-world outcomes. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Lindenmayer 2001 {published data only}
- Lindenmayer JP, Smith RC, Singh A, Parker B, Chou E, Kotsaftis A. Hyperglycemia in patients with schizophrenia who are treated with olanzapine. Journal of Clinical Psychopharmacology 2001;21(3):351-3. [DOI] [PubMed] [Google Scholar]
Loza 2001 {published data only}
- Loza B, Kucharska-Pietura K, Debowska G. Atypical versus typical antipsychotic treatment prognosis in first-episode paranoid schizophrenia based on wcst and dichotic listening scores. In: European Neuropsychopharmacology (Abstracts of the 14th Congress of the European College of Neuropsychopharmacology; 2001 Oct 13-17; Istanbul, Turkey). 2001:285.
- Loza B. Atypical antipsychotic treatment prognosis in first-episode paranoid schizophrenia based on syllabic and language-related dichotic listening scores. European Neuropsychopharmacology 2002;Suppl 3:S298. [Google Scholar]
Lu 2022 {published data only}
- Lu Z, Zhang Y, Yan H, Su Y, Guo L, Liao Y, et al. ATAD3B and SKIL polymorphisms associated with antipsychotic-induced QTc interval change in patients with schizophrenia: a genome-wide association study. Translational Psychiatry 2022;12(1):56. [DOI: 10.1038/s41398-022-01825-0] [DOI] [PMC free article] [PubMed] [Google Scholar]
Mahmoud 1999 {published data only}
- Mahmoud RA, Engelhart LM, Janagap C, Awad G. Assessment of symptoms affecting quality of life and patient satisfaction with antipsychotic drugs:new insights for a trial of risperidone/olanzapine. In: APA Annual Meeting, May 15-20, 1999, Washington, DC. 1999. [CSG NO. 4121]
- Mahmoud RA, Engelhart LM, Janagap C, Dogherty J. Symptoms commonly attributed to prolactin:a new assessment tool and findings from a trial of risperidone versus olanzapine. In: APA Annual Meeting, May 15-20, 1999, Washington, DC. 1999. [CSG NO. 4122]
Marder 1998 {published data only}
- Marder SR. Newer antipsychotics: side-effect profiles. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada. May 30-June 4, 1998.
Maurer 2002 {published data only}
- Czekalla J, Volz HP, Maurer I, Smesny S, Sauer H, Dittmann RW, et al. Olanzapine versus haloperidol: a randomized, double-blind cross over study with P-31-nuclear magnetic resonance spectroscopy (MRS) and regional cerebral blood flow measurements (fMRI) of the dorsolateral prefrontal cortex (DLPFC) in schizophrenics. Schizophrenia Research 2002;53(3):180. [Google Scholar]
- Maurer I, Volz HP, Czekalla J, Holstein W, Streck S, Winnefel K. Reduction of arachidonic acid levels by haloperidol treatment in patients with schizophrenia. Schizophrenia Research 2002;53(3):209. [Google Scholar]
Mauri 2002 {published data only}
- Mauri MC, Steinhilber CPC, Laini V, Pavone F, Barale F. Olanzapine and quetiapine in the treatment of acute schizophrenia: a descriptive analysis. International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum; 2002 Jun 23-27; Montreal, Canada) 2002;Suppl 1:S119. [Google Scholar]
McCue 2006 {published data only}
- McCue RE, Waheed R, Urcuyo L, Orendain G, Joseph MD, Charles R, et al. Comparative effectiveness of second-generation antipsychotics and haloperidol in acute schizophrenia. British Journal of Psychiatry 2006;189(5):433-40. [10.1192/bjp.bp.105.019307] [DOI] [PubMed] [Google Scholar]
- Taylor D. Haloperidol, olanzapine and risperidone reduce treatment failure compared to aripiprazole, quetiapine and ziprasidone in acute schizophrenia. Evidence-Based Mental Health 2007;10(3):76. [http://ebmh.bmj.com/cgi/content/full/10/3/76] [DOI] [PubMed] [Google Scholar]
McElroy 1998 {published data only}
- McElroy SL. Atypical antipsychotics in women with bipolar and other psychiatric disorders. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
McGurk 1998 {published data only}
- McGurk SR, Meltzer HY. The affects of atypical antipsychotic drugs on cognitive functioning in schizophrenia. Schizophrenia Research 1998;29(1-2):160. [Google Scholar]
- McGurk SR. The effects of atypical antipsychotic drugs on cognitive function in schizophrenia. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Meltzer 2003 {published data only}
- Meltzer HY, Sumiyoshi T, Carpenter WT, Gold JM. Atypical antipsychotic drugs improve cognition in schizophrenia. Biological Psychiatry 2003;51(3):265-8. [DOI] [PubMed] [Google Scholar]
Mintzer 1998 {published data only}
- Mintzer JE. Efficacy and safety of atypical neuroleptics in dementia. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Mitchell 2003 {published data only}
- Mitchell M, Earley W, Bari MA, Riesenberg RA, Marquez E, Kurtz D, et al. A preliminary study of the pharmacokinetics and tolerability of higher dose oral olanzapine (20, 30, or 40mg/day) in stable patients with serious mental disorders. Journal of the European College of Neuropsychopharmacology 2003;13(4):S315. [P.2.081] [Google Scholar]
Mosolov 1998 {published data only}
- Mosolov SN. Biological treatment of mental disorders in Russia. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Mulqueen 2000 {published data only}
- Mulqueen AW, Wudarsky M, Nicolson RJ, Gochman P, Hamburger S, Lenane M, et al. Weight gain in pediatric patients on typical and atypical antipsychotics. In: 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13-18; Chicago, USA. 2000.
- Mulqueen AW, Wudarsky M, Nicolson RJ, Gochman P, Hamburger S, Lenane M, et al. Weight gain in pediatric patients on typical and atypical antipsychotics. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
Naber 1997 {published data only}
- Naber D. Evidence of efficacy of neuroleptics in effective versus negative symptoms. In: 10th European College of Neuropsychopharmacology Congress. Vienna, Austria; September 13-17, 1997. 1997.
Narendran 2003 {published data only}
- Narendran R, Young CM, Pristach CA, Pato MT, Valenti AM, Fass AR. Efficacy of clozapine in the treatment of atypical antipsychotic refractory schizophrenia: A pilot study. Journal of Clinical Psychopharmacology 2003;23(1):103-4. [DOI] [PubMed] [Google Scholar]
NCT00419653 {published data only}
- Schlöss R. Modulation of regional brain activation in schizophrenic patients by pharmacological therapy. Study protocol 2007;NA:1-3. [Google Scholar]
Oliemeulen 2000 {published data only}
- Oliemeulen EAP, Jogems-Kosterman BJM, Hoof JJM. Is olanzapine a substitute for clozapine? In: Schizophrenia Research (Abstracts of The 7th International Congress on Schizophrenia Research; 1999 Apr 17-21; Santa Fe, USA). 1999:146-7. [MEDLINE: ]
- Oliemeulen EAP, Hoof JJM, Jogem-Kosterman BJM, Hulsttijn W, Tuynman-Qua HG. Is olanzapine a substitute for clozapine? The effects on psychomotor performance. Schizophrenia Research 2000;41(1):187. [CSG NO. 4502] [Google Scholar]
Ortega‐Solo (HGBS) {published data only}
- Nicolini H, Cruz C, Camarena B, Ortega H. 5HT2A and DRD4 molecular genotypes in a clinical trial of olanzapine versus risperidone in schizophrenic patients. European College of Neuropsychopharmacology, congress, Vienna, Austria, September 13-17 1997.
- Ortega-Solo HA, Apiquian R, Ullca RE, Loyzaga C, Mendiazabal A, Brunner E. Olanzapine versus risperidone a double blind trial in Mexican patients. In: Regional meeting of the Collegium Internationale Neuro-Psychopharmacologicum and the Collegio Mexicano de Neuropsicofarmacologia. Acapulco, Mexico; August 21-23, 1997. 1997.
Ortho‐McNeil 2010 {published data only}
- A twelve month, prospective, randomized, active controlled, open label, flexible dose study of paliperidone palmitate compared with oral antipsychotic treatment in adults with schizophrenia who have been recently discharged from an inpatient psychiatric hospital. Study protocol 2010.
Paquet 2001 {published data only}
- Paquet F, Soucy J, Stip E, Elie A, Cheneval E, Bedard M. Comparaison between olanzapine and haloperidol on the procedural learning and on the striatal D2 receptor occupancy in schizophrenia. Schizophrenia Research 2001;49(1-2):117-8. [DOI] [PubMed] [Google Scholar]
Parellada 1999 {published data only}
- Parellada E, Lomena F, Catafau A, Font M, Gomez JC, Salamero M, Bernardo M. Olanzapine versus haloperidol d2 occupancy:a single photon emission tomography study. In: APA Annual Meeting, May 15-20, 1999, Washington, DC. 1999. [CSG NO. 3999]
Patel 2022 {published data only}
- Patel R, Griffiths K, Martinez-Gutierrez A, Garcia-Marin L. Antipsychotic treatment patterns in patients with schizophrenia: A real-world data analysis of electronic health records. Journal of Managed Care: Specialty Pharmacy Supplement Poster Abstracts 2022;28(10-a):54-5.
Perez 2003 {published data only}
- Perez R, Gonzalez-Blanch C, Sierra-Biddle D, Marti I, Vazquez-Barquero JL, Crespo-Facorro B. Efficacy and safety of olanzapine, risperidone and haloperidol in acute treatment of patients with first episode psychosis. Schizophrenia Research 2003;1(60):298-9. [Google Scholar]
Perro 1999 {published data only}
- Lambert M, Moritz S, Karow A, Krausz M, Naber D. Quality of life in the treatment of schizophrenia- a randomised, open label comparison trial of amisulpride, olanzapine, quetiapine, risperidone and zotepine. In: Schizophrenia Research (Abstract of the 11th Biannual Winter Workshop on Schizophrenia). 2002.
- Perro C LMMSKMatAA. Depressive symptoms under atypical neuroleptic treatment in schizophrenia. Acta Psychiatrica Scandinavica (Abstracts of 13th International Symposium for the Psychological Treatment of Schizophrenia and Other Psychoses (ISPS); 2000 Jun 5-9; Stavanger, Norway) 2000;Suppl 404:62-3. [PubMed] [Google Scholar]
- Perro C, Lambert M, Moritz S, Krausz M, Naber D. A comparison of clinical outcome of four atypical neuroleptics in the treatment of schizophrenia. Pharmacopsychiatry (Abstracts of 21st Symposium of the Arbeitsgemeinschaft Neuropsychopharmakologie Und Pharmakopsychiatrie (AGNP); 1999 Oct 6-9; Nuremberg, Germany) 1999;5:201. [Google Scholar]
- Perro C, Naber D, Lambert M, Moritz S, Krause M. A prospective clinical comparative-study of four atypical antipsychotic agents in the treatment of schizophrenia. In: 11th World Congress of Psychiatry; 1999 Aug 6-11; Hamburg, Germany. 1999:13.
Pivac 2002 {published data only}
- Pivac N, Muck-Seler D, Jakovljevic M, Sagud M, Mihaljevic-Peles A, Junaci S. The effects of olanzapine or fluphenazine on peripheral biochemical markers in schizophrenic patients. International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the Collegium Internationale Neuro-Psychopharmacologicum; 2002 Jun 23-27; Montreal, Canada) 2002;Suppl 1:S184. [Google Scholar]
Rasmussen 2016 {published data only}
- Rasmussen SA, Rosebush PI, Anglin RE, Mazurek MF, et al. The predictive value of early treatment response in antipsychotic-naive patients with first-episode psychosis: Haloperidol versus olanzapine. Psychiatry Research 2016;241:72-7. [DOI: 10.1016/j.psychres.2016.04.097] [DOI] [PubMed] [Google Scholar]
Ratakonda 1998 {published data only}
- Ratakonda S, Miller CE, Gorman JM, Sharif ZA. Efficacy of a 12 week trial of olanzapine in treatment refractory schizophrenia or schizoaffective disorder. Schizophrenia Research 1998;29(1,2):150. [CSG NO. 4079] [Google Scholar]
Reus 1997 {published data only}
- Kerwin R. Olanzapine. Lancet 1997;350:594. [DOI] [PubMed] [Google Scholar]
- Reus VI. Olanzapine: a novel atypical neuroleptic agent. Lancet 1997;349:1264-5. [DOI] [PubMed] [Google Scholar]
Rosebush 2000 {published data only}
- Rosebush P, Mazurek M. Olanzapine versus haloperidol in randomized trials of the first-episode patients with schizophrenia. Stanley Foundation Research Awards - 2000 ResearchAward Recipients (http://www.stanleyresearch.org/) 2000 (accessed February 2001).
Sacchetti 2003 {published data only}
- Sacchetti E, Valsecchi P, Regini C, Galluzzo A, Cacciani P, Agrimi E, et al. Comparison of quetiapine, olanzapine and risperidone in patients with schizophrenia: interim results of a randomised, rater-blinded study. In: 16th European College of Neuropsychopharmacology (ECNP), 2003 Sep 20-24, Prague, Czech Republic. 2003. [EMBASE: 2003409683]
- Sacchetti E, Valsecchi P, Regini C, Galluzzo A, Cacciani P, Agrimi E, et al. Comparison of quetiapine, olanzapine and risperidone in patients with schizophrenia: interim results of a randomised, rater-blinded study. Journal of the European College of Neuropsychopharmacology 2003;13(4):S350. [P.2.162] [Google Scholar]
Sacristan (HGGS) {published data only}
- Sacristan JA. Doses of olanzapine, risperidone, and haloperidol in clinical practice: results of a prospective pharmaco-epidemiological study (efeso). Schizophrenia Research (Abstracts of the 10th Biennial Winter Workshop on Schizophrenia; 2000 Feb 5-11; Davos, Switzerland) 2000;1:188-9. [Google Scholar]
Sangar 1998 (HGEH) {published data only}
- Sanger T M, Tohen M, Tollefson GD, McElroy SL, Greaney MG, Toma V. Olanzapine vs placebo in the treatment of acute mania. Schizophrenia Research (9th Biennial Winter Workshop on Schizophrenia, 1998 Feb 7-13, Davos, Switzerland) 1998;1,2:152. [Google Scholar]
- Sanger T, Tohen M, Tollefson GD, Jacobs T. Olanzapine versus placebo in rapid-cycling bipolar disorder. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK; July 12-16, 1998. 1998.
- Sanger TM, Tohen M, Vieta E, Dunner DL, Bowden CL, Calabrese JR, et al. Olanzapine in the acute treatment of bipolar I disorder with a history of rapid cycling. Journal of Affective Disorders 2003;73(1-2):155-61. [DOI] [PubMed] [Google Scholar]
- Toben M, Zarate C Jr, Sanger IM. A placebo-controlled trial of olanzapine in psychotic or non-psychotic acute mania. Schizophrenia Research 1998;29(1,2):204. [MEDLINE: ] [Google Scholar]
- Tohen M, Jacobs T, Gannon KS, Sanger TM, Greaney M, Toma V, et al. Olanzapine: acute and long term efficacy in bipolar I patients. Schizophrenia Research 2000;41(1):192. [MEDLINE: ] [Google Scholar]
- Tohen M, Sanger T, McElroy S, Tollefson GD, Chengappa KN, Roy MD, et al. Olanzapine versus placebo in the treatment of acute mania. American Journal of Psychiatry 1999;156(5):702-9. [DOI] [PubMed] [Google Scholar]
- Tohen M, Sanger T, Tollefson GD, McElroy SL, Greaney MG, Toma V. Experience using olanzapine in the treatment of acute bipolar mania. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
- Tohen M, Sanger T, Tollefson GD, McElroy SL, Greaney MG, Toma V. Experience using olanzapine in the treatment of acute bipolar mania. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK; July 12-16, 1998. 1998.
Sayers 2005 {published data only}
- Sayers SL, Campbell EC, Kondrich J, Mann SC, Cornish J, O'Brien C, et al. Cocaine abuse in schizophrenic patients treated with olanzapine versus haloperidol. Journal of Nervous and Mental Disease 2005;193(6):379-86. [DOI: 10.1097/01.nmd.0000165089.14736.bf] [PMID: ] [DOI] [PubMed] [Google Scholar]
Sharma 2003 {published data only}
- Sharma M. Efficacy and safety of olanzapine versus haloperidol in schizophrenic patients in India. http://www.kgmcindia.edu/departments/psychiatry/psychiatry_fac_res.htm 2003. [MEDLINE: ]
Sheitman 1997 {published data only}
- Sheitman BB, Lindgren JC, Early J, Sved M. High dose olanzapine for treatment-refractory schizophrenia. American Journal of Psychiatry 1997;154(11):1626. [DOI] [PubMed] [Google Scholar]
Sheitman 2000 {published data only}
- Sheitman B. Olanzapine versus risperidone for people with schizophrenia hospitalized after a relapse. Stanley Foundation Research Awards - 2000 Research Award Recipients (http://www.stanleyresearch.org/) 2000 (accessed February 2001).
Sikich 2004 {published data only}
- Sikich L, Hamer RM, Bashford RA, Sheitman BB, Lieberman JA. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Neuropsychopharmacology 2004;29(1):133-45. [EMBASE: 2004025276; 14583740 PMID] [DOI] [PubMed] [Google Scholar]
- Sikich L, Williamson K, Malekpour A, Bashford RA, Hooper S, Sheitman B, et al. Interim results of a randomized controlled trial of haloperidol, risperidone, and olanzapine in psychotic youth. In: 38th Annual Meeting of the American College of Neuropsychopharmacology; 1999 Dec 12-16; Acapulco, Mexico. 1999.
Smarek 2003 {published data only}
- Sramek JJ, Cutler NR, Shiovitz T. The effect of antipsychotics on plasma lipids. Journal of Clinical Psychopharmacology 2003;23(6):679-80. [DOI: 10.1097/01.jcp.0000096252.95165.a1] [DOI] [PubMed] [Google Scholar]
Smelson 2003 {published data only}
- Smelson DA, Ziedonis DM, Williams JA, Losonczy MF, Williams J, Kaune M. A double-blind trial of olanzapine reduces cue-elicited cocaine craving and relapses. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR692]]
Smith 1998 {published data only}
- Smith RC, Nigam S, Stern A, Infante M, Mehta R. Olanzapine in chronic nonresponding schizophrenia: effects on psychopathology and neurocognitive function. In: 21st Congress of Collegium Internationale Neuro-psychopharmacologicum, Glasgow, Scotland, UK. 1998. [CSG NO. 3628]
Smith 2001 {published data only}
- Smith RC, Infante M, Singh A, Garlapati V, Ali A. Response of chronic nonresponding schizophrenic patients to olanzapine: clinical and neurocognitive effects. Department Psychiatry, NYU Medical School & Manhattan Psychiatric Center 2001;unknown:-. [Google Scholar]
- Smith RC, Infante M, Singh A, Khandat A. The effects of olanzapine on neurocognitive functioning in medication-refractory schizophrenia. International Journal of Neuropsychopharmacology 2001;4(3):239-50. [DOI: ] [DOI] [PubMed] [Google Scholar]
- Smith RC, Lindenmayer J-P, Khandat A, Infante M, Singh A. Olanzapine affects neurocognitive function in medication-refractory schizophrenia. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
- Smith RC, Lindenmayer J-P, Khandat A, Infante M, Singh A. Olanzapine affects neurocognitive function in medication-refractory schizophrenia. In: Annual Meeting of the American Psychiatric Association; 2001 May 5-10; LA, USA. Marathon Multimedia, 2001. [MEDLINE: ]
Soutullo 1998 {published data only}
- Soutullo CA, Sorter MT, Foster KD, McElroy SL, Keck PE. Olanzapine in the treatment of adolescent acute mania: preliminary report of seven cases. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Stephenson 2000 {published data only}
- Stephenson J. Delay in treating schizophrenia may narrow therapeutic window of opportunity. JAMA 2000;283(16):2091-2. [DOI] [PubMed] [Google Scholar]
Sun 2022 {published data only}
- Sun Y, Zhang Y, Lu Z, Yan H, Guo L, Liao Y, et al. Longitudinal network analysis reveals interactive change of schizophrenia symptoms during acute antipsychotic treatment. Schizophrenia Bulletin 2022;49(1):208–17. [DOI: 10.1093/schbul/sbac131] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Szafranski 1999 {published data only}
- Szafranski T, Jarema M, Olajossy M, Chrzanowski W, Araszkiewicz A, Landowski J, et al. Subjective experiences of schizophrenic patients on atypical antipsychotic olanzapine and typical antipsychotic perphenazine. In: Journal of the European College of Neuropsychopharmacology. 1999:S273. [MEDLINE: ]
Tamura 1996 (F1D‐JE) {published data only}
- Tamura RN, Tanaka Y, Satoh K, Takahashi M. Using the proportional odds model to assess the relationship between a multi-item and a global item efficacy scale in a psychiatric clinical trial. Journal of Biopharmacological Statistics 1996;6:127-37. [DOI] [PubMed] [Google Scholar]
Tang 2003 {published data only}
- Tang T, Meltzer HY. Olanzapine causes greater increases in serum lipids than risperidone. Schizophrenia Research 2003;60:367. [EMBASE: 2003241517] [Google Scholar]
Tang 2004 {published data only}
- Tang Y. A controlled study of olanzapine in treating positive symptoms of schizophrenia. Heath Psychology Journal 2004;12(5):390-1. [Google Scholar]
Tohen 2000b (HGGW) {published data only}
- Tohen M, Jacobs T, Toma V, Francis J, Zhang F, Gannon KS, et al. Is olanzapine a mood stabilizer? Schizophrenia Research 2000;41(1):193-4. [MEDLINE: ] [Google Scholar]
- Tohen M, Jacobs TG, Grundy SL, McElroy SL, Banov MC, Janicak PG, et al. Efficacy of olanzapine in acute bipolar mania: a double-blind, placebo-controlled study. Archives of General Psychiatry 2000;57(9):841-9. [DOI] [PubMed] [Google Scholar]
Tran 1998 (HGEJ) {published data only}
- Tran PV, Tohen M, Mazzoti G, Silva C, Ospina J, Gattaz WF, et al. Switching psychotic patients with symptomatic extrapyramidal symptoms from haloperidol to olanzapine: results of a multi-center, collaborative trial in Latin America. In: 151st Annual Meeting of American Psychiatric Association. Toronto, ON, Canada; May 30-June 4, 1998. 1998.
Trandafir 1998 {published data only}
- Trandafir AI, Berk M, Brook S. Olanzapine versus haloperidol in cannabis induced psychosis: a randomised double-blind trial. In: Proceedings of XXIst Collegium Internationale Neuro-psychopharmacologicum. Glasgow, Scotland, UK; July 12-16, 1998. 1998.
Tsuang 2002 {published data only}
- Tsuang J, Marder SR, Han A, Hsieh W. Olanzapine treatment for patients with schizophrenia and cocaine abuse. Journal of Clinical Psychiatry 2002;63(12):1180. [DOI] [PubMed] [Google Scholar]
Uzun 2002 {published data only}
- Uzun S, Folnegovic-Smalc V, Mimica N, Ljubin T, Makaric G, Ivezic S, et al. Ziprasidone clinical trials conducted in Croatia. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:182. [Google Scholar]
Uzun 2006 {published data only}
- Uzun S, Kozumplik O, Mimica N, Folnegović-Šmalc V. Treatment with six different antipsychotics: evaluation by scale for the assessment of negative symptoms (SANS). In: Schizophrenia Research (Abstracts of the in XIIIth Biennial Winter Workshop on Schizophrenia). 2006.
Villari 2008 {published data only}
- Villari V, Rocca P, Fonzo V, Montemagni C, Pandullo P, Bogetto F. Oral risperidone, olanzapine and quetiapine versus haloperidol in psychotic agitation. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2008;32(2):405-13. [DOI] [PubMed] [Google Scholar]
Volavka 2002 {published data only}
- Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, et al. Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder. American Journal of Psychiatry 2002;159(6):1018-28. [MEDLINE: ] [Volavka study (hostility study)] [DOI] [PubMed] [Google Scholar]
- Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman B, et al. Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol on treatment-resistant patients with schizophrenia and schizoaffective disorder. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:195. [Google Scholar]
- Bilder RM, Goldman RS, Volavka J, Czobor P, Hoptman M, Sheitman J-PLB, et al. Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol on treatment-resistant patients with schizophrenia and schizoaffective disorder. European Neuropsychopharmacology (Abstracts of the 14th Congress of the European College of Neuropsychopharmacology; 2001 Oct 13-17; Istanbul, Turkey) 2001;3:256. [Google Scholar]
- Citrome L, Volavka J, Czobor P, Sheitman B, Lindenmayer J-P, McEvoy J, et al. Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatric Services 2001;52(11):1510-4. [DOI] [PubMed] [Google Scholar]
- Citrome LL, Volavka J, Czobor P, Nolan K, Lieberman JA, Lindenmayer J-P, et al. Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR221]] [DOI] [PubMed]
- Citrome LL, Volavka J, Czobor P, Sheitman BB, Lindenmayer J-P, McEvoy JP, et al. Atypical antipsychotics and hostility in schizophrenia: a double-blind study. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002.
- Citrome LL, Volavka J, Czobor P, Sheitman BB, Lindenmayer J-P, McEvoy JP, et al. Atypical antipsychotics and hostility in schizophrenia: a double-blind study. In: Annual Meeting of the American Psychiatric Association; 2001 May 5-10; LA, USA. Marathon Multimedia, 2001. [MEDLINE: ]
- Czobor P, Volavka J, Sheitman B, Lindenmayer JP, Citrome L, McEvoy J, et al. Antipsychotic-induced weight gain and therapeutic response: a differential association.. Journal of Clinical Psychopharmacology 2002;22(3):244-51. [DOI] [PubMed] [Google Scholar]
- Lindenmayer J-P, Czobor P, Volavka J, Citrome LL, Sheitman BB, McEvoy JP, et al. Changes in glucose and cholesterol in schizophrenia treated with atypicals. In: 155th Annual Meeting of the American Psychiatric Association; 2002 May 18-23; Philadelphia, PA, USA. 2002. [full paper now published american j of psychiatry 2003 vol 160, p290-296] [DOI] [PubMed]
- Lindenmayer J-P, Czobor P, Volavka J, Citrome LL, Sheitman BB, McEvoy JP, et al. Changes in glucose and cholesterol levels in schizophrenia patients treated with typical and atypical antipsychotics. International Journal of Neuropsychopharmacology (Abstracts of the 23rd Congress of the CollegiumInternationale Neuro-Psychopharmacologicum 2002;5(1):S169. [Google Scholar]
- Lindenmayer JP, Czobor P, Volavka J, Citrome L, Sheitman B, McEvoy JP, et al. Changes in glucose and cholesterol levels in patients with schizophrenia treated with typical or atypical antipsychotics. American Journal of Psychiatry 2003;160(2):290-6. [DOI: 10.1176/appi.ajp.160.2.290] [DOI] [PubMed] [Google Scholar]
- Lindenmayer JP, Czobor P, Volavka J, Citrome L, Sheitman B, McEvoy JP, et al. Effects of atypicals on the syndromal profile in treatment-resistant schizophrenia. 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22, San Francisco, USA 2003;unknown:1. [Google Scholar]
- Lindenmayer JP, Czobor P, Volavka J, Lieberman JA, Citrome LSB, McEvoy JP, et al. Effects of atypical antipsychotics on the syndromal profile in treatment-resistant schizophrenia. Journal of Clinical Psychiatry 2004;65(4):551-6. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Lindenmayer JP, Smith RC, Singh A, Parker B, Chou E, Kotsaftis A. Hyperglycemia in patients with schizophrenia who are treated with olanzapine. Journal of Clinical Psychopharmacology 2001;21(3):351-3. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
- Lindenmayer JP, Volavka J, Lieberman JA, Citrome LL, Sheitman B, McEnvoy JP, et al. Do typicals chake the syndromal profile in treatment resistant schizophrenia? In: 155th Annual Meeting of the American Psychiatric Association, May 18-23, Philadelphia, USA. 2002.
- Mohr P, Volavka J, Lieberman JA, Czobor P, McEnvoy J, Lindenmayer J-P, et al. Clozapine, olanzapine, risperidone, and haloperidol in refractory schizophrenia.. European Psychiatry (Abstracts of 10th Congress of the Association of European Psychiatrists (AEP); 2000 Oct 28 - Nov 1; Prague, Czech Republic ) 2000;Suppl 2:284S. [Google Scholar]
- Nolan KA, Volavka J, Czobor P, Sheitman B, Lindenmayer JP, Citrome LL et al. Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder. Journal of Psychiatric Research 2005;39(1):109-15. [DOI: 10.1016/j.jpsychires.2004.04.010] [DOI] [PubMed] [Google Scholar]
- Volavka J, Czobor P, Cooper TB, Sheitman B, Lindenmayer JP, Citrome L, et al. Prolactin levels in schizophrenia and schizoaffective disorder patients treated with clozapine, olanzapine, risperidone, or haloperidol. Journal of Clinical Psychiatry 2004;65(1):57-61. [PMID 14744169] [DOI] [PubMed] [Google Scholar]
- Volavka J, Czobor P, Cooper TB, Sheitman B, Lindenmayer JP, Citrome L, et al. Prolactin levels in schizophrenia and schizoaffective disorder patients treated with clozapine, olanzapine, risperidone, or haloperidol. Journal of Clinical Psychiatry 2004;65(1):57-61. [PMID 14744169] [DOI] [PubMed] [Google Scholar]
- Volavka J, Czobor P, Nolan K, Sheitman B, Lindenmayer JP, Citrome L, et al. Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol. Journal of clinical psychopharmacology 2004;24(2):225-8. [DOI] [PubMed] [Google Scholar]
- Volavka J, Czobor P, Sheitman B, Lindenmayer J-P, Citrome L, McEvoy J, et al. Clozapine, olanzapine, risperidone, and haloperidol in refractory schizophrenia. In: 39th Annual Meeting of the American College of Neuropsychopharmacology; 2000; Dec 10-14; San Juan; Puerto Rico. 2000.
- Volavka J, Czobor P, Sheitman B, Lindenmayer JP, Citrome L, McEvoy JP, et al. Clozapine, olanzapine, risperidone, and haloperidol in the treatment of patients with chronic schizophrenia and schizoaffective disorder. American Journal of Psychiatry 2002;159:255-62. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Voruganti 2002 {published data only}
- Voruganti L, Cortese L, Owyeumi L, Kotteda V, Cernovsky Z, Zirul S, et al. Switching from conventional to novel antipsychotic drugs: Results of a prospective naturalistic study. Schizophrenia Research 2002;57(2-3):201-8. [DOI] [PubMed] [Google Scholar]
Wang 2018 {published data only}
- Wang Q, Wu HM, Yue W, Yan H, Zhang Y, Tan L, et al. Effect of damaging rare mutations in synapse-related gene sets on response to short-term antipsychotic medication in Chinese patients with schizophrenia: a randomized clinical trial. JAMA Psychiatry 2018;75(12):1261-9. [DOI: 10.1001/jamapsychiatry.2018.3039] [DOI] [PMC free article] [PubMed] [Google Scholar]
Woods 2002 (HGGF) {published data only}
- McGlashan TH, Miller TJ, Zipursky RB, Woods SW, Perkins DO, Hawkins KA, et al. Intervention in the schizophrenic prodrome: the prevention through risk identification, management, and education initiative. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[SYMPOSIUM]No. 39]
- McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller TJ, Woods SW, et al. The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design. Schizophrenia Research 2003;61(1):7-18. [MEDLINE: ] [PMID 12648731] [DOI] [PubMed] [Google Scholar]
- McGlashan TH, Zipursky RB, Perkins DO, Addington J, Woods SW, Miller TJ, et al. Olanzapine versus placebo treatment of the schizophrenia prodrome: One year results. Schizophrenia Research 2003;60:295. [EMBASE: 2003241517] [Google Scholar]
- McGlashan TH, Zipursky RB, Perkins DO, Addington JM, Woods SW, Lindborg S, et al. Olanzapine versus pbo for the schizophrenic prodrome: one-year results. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR584]]
- McGlashan TH, Zipursky RB, Perkins DO, Addington JM, Woods SW, Lindborg S, et al. Olanzapine versus pbo for the schizophrenic prodrome: one-year results. In: 156th Annual Meeting of the American Psychiatric Association; 2003 May 17-22; San Francisco, USA. 2003. [[NR584]]
- Miller TJ, Zipursky RB, Perkins D, Addington J, Woods SW, Hawkins KAHR, et al. The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the "prodromal" sample. Schizophrenia Research 2003;61(1):19-30. [MEDLINE: ] [PMID 12648732] [DOI] [PubMed] [Google Scholar]
- Woods S, Zipursky R, Perkins D, Addington J, Marquez E, Breier A, et al. Olanzapine versus placebo for prodromal symptoms. In: 3rd International Conference on Early Psychosis; 2002 Sep 26-28; Copenhagen, Denmark. 2002:43.
- Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, et al. Ransomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Society of Biological Psychiatry 2003;in press:in press. [DOI] [PubMed] [Google Scholar]
- Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, et al. Olanzapine versus placebo for prodromal symptoms. Schizophrenia Research 2003;60:306-7. [EMBASE: 2003241517] [Google Scholar]
- Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, et al. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome.[erratum appears in Biol Psychiatry. 2003 Aug 15;54(4):497]. Biological Psychiatry 2003;54(4):453-64. [PMID 12915290] [DOI] [PubMed] [Google Scholar]
- Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, et al. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome.[erratum appears in Biol Psychiatry. 2003 Aug 15;54(4):497]. Biological Psychiatry 2003;54(4):453-64. [PMID 12915290] [DOI] [PubMed] [Google Scholar]
- Woods SW, McGlashan TH. Sample size planning for prodromal intervention trials. Schizophrenia Research (Abstracts of the 11th Biennial Winter Workshop on Schizophrenia) 2002;3 Suppl 1:40. [Google Scholar]
Woodward 2001 {published data only}
- Woodward ND, Purdon SE, David SR, Stip E. Procedural learning over six months double blind treatment with haloperidol, risperidone or olanzapine. Schizophrenia Research (8th International Congress on Schizophrenia Research; 2001 Apr 28 - May 2; British Columbia, Canada) 2001;1-2 Suppl:125. [MEDLINE: ] [Google Scholar]
Wright 2003 (HGAB) {published data only}
- King KG, Wright P, Meehan K, Birkett M, David SR, Taylor CC. Transition from intramuscular to oral olanzapine. In: XIIth World Congress of Psychiatry; 2002 Aug 24-29; Yokohama, Japan. 2002. [now published lwad author wright part of (HGAB) clinical therapeutics 2003, vol 25, p420-28]
- Wright P, Lindborg SR, Birkett M, Meehan K, Jones B, Alaka K, et al. Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment. Canadian Journal of Psychiatry 2003;48:11. [EMBASE: 2003409683] [DOI] [PubMed] [Google Scholar]
- Wright P, Lindborg SR, Birkett M, Meehan K, Jones B, Alaka KF-HI, et al. Intramuscular olanzapine and intramuscular haloperidol in acute schizophrenia: antipsychotic efficacy and extrapyramidal safety during the first 24 hours of treatment. Canadian Journal of Psychiatry - Revue Canadienne de Psychiatrie 2003;48(11):716-21. [PMID 14733451] [DOI] [PubMed] [Google Scholar]
- Wright P, Meehan K, Birkett M, Lindborg SR, Taylor CC, Morris P, et al. A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy. Clinical Therapeutics 2003;25(5):1420-8. [DOI] [PubMed] [Google Scholar]
- Wright P, Meehan K, Birkett M, Lindborg SR, Taylor CC, Morris PBA. A comparison of the efficacy and safety of olanzapine versus haloperidol during transition from intramuscular to oral therapy. Clinical Therapeutics 2003;25(5):1420-8. [MEDLINE: ] [PMID 12867218] [DOI] [PubMed] [Google Scholar]
Wudarsky 1999 {published data only}
- Wudarsky M, Nicolson R, Hamburger SD, Spechler L, Gochman P, Bedwell J, et al. Elevated prolactin in pediatric patients on typical and atypical antipsychotics. Journal of Child and Adolescent Psychopharmacology 1999;9(4):239-45. [MEDLINE: ] [DOI] [PubMed] [Google Scholar]
Yagdiran 2000 {published data only}
- Yagdiran O, Krausz M. Depressive symptoms under atypical neuroleptic treatment in schizophrenia.. Der Nervenarzt (Congress of the Deutsche Gesselschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde: "Psychiatrie im Jahr 2000 - die europaische Perspektive", 2000 September 20-23, Aachen, Germany) 2000;71(Suppl 1):S135-6. [Google Scholar]
Yan 2022 {published data only}
- Yan VK, Haendler M, Lau H, Li X, Lao K, Tsui SH, et al. Cost-effectiveness of midazolam versus haloperidol versus olanzapine for the management of acute agitation in the accident and emergency department. Value in Health 2022;25(7):1099-106. [DOI: 10.1016/j.jval.2021.11.1374] [DOI] [PubMed] [Google Scholar]
Zabotina 2020 {published data only}
- Zabotina A, Grunina M, Nasyrova R, Taraskina A. Reduction of 5HTR2A protein level in peripheral blood lymphocytes during antipsychotic therapy is associated with absence of common side effects. European Neuropsychopharmacology 2020;40(Suppl. 1):S288-9. [Google Scholar]
Zhang 1999 {published and unpublished data}
- Zhang F, Tran PV, Taylor C, Hwu GH, Chen YS, Chang WH, et al. Efficacy and safety study comparing olanzapine versus haloperidol in the treatment of Chinese patients with schizophrenia in Taiwan and Hong Kong. In: World Psychiatric Association. Hamburg, Germany. 1999.
Ziherl (HGCZ) 1999 {unpublished data only}
- Ziherl S, Novak G, Kores-Plesnicar B, Kosorok M, Juch H, Dossenbach M. Efficacy and safety of olanzapine in the treatment of schizophrenic, schizophreniform and schizoaffective patients in Slovenia. In: ECNP. London, England, UK. 1999.
Additional references
Abel 2010
- Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. International Review of Psychiatry 2010;22(5):417-28. [DOI: 10.3109/09540261.2010.515205] [DOI] [PubMed] [Google Scholar]
Adams 2006
- Adams CE, Tharyan P, Coutinho ES, Stroup TS. The schizophrenia drug-treatment paradox: pharmacological treatment based on best possible evidence may be hardest to practise in high-income countries. British Journal of Psychiatry 2006;189(5):391-2. [DOI: 10.1192/bjp.bp.106.029983] [DOI] [PubMed] [Google Scholar]
Adams 2013
- Adams CE, Bergman H, Irving CB, Lawrie S. Haloperidol versus placebo for schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No: CD003082. [DOI: 10.1002/14651858.CD003082.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Addington 1993
- Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry 1993;22:39–44. [PubMed] [Google Scholar]
Alahdab 2012
- Alahdab F, Alhalabi O, Attwa G, Mousa Basha G, Adams CE. Olanzapine discontinuation for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No: CD009693. [DOI: 10.1002/14651858.CD009693] [DOI] [Google Scholar]
Alderson 2004
- Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’ Handbook 4.2.1 [updated December 2003]. In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
Altman 1996
- Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313(7066):1200. [DOI] [PMC free article] [PubMed] [Google Scholar]
AMDP‐5 1981
- Arbeltsgemelnschaft fur methodik und dokumentation inder psychiatrie (AMDP) [Association for Methodology and Documentation in Psychiatry]. Das AMDP-System: Manualzur Dokumentation Psychiatricher Befunde. Berlin, 1981. [Google Scholar]
Andreasen 1983
- Andreasen NC. Negative symptoms in schizophrenia. Archives of General Psychiatry 1982;39:784–8. [DOI] [PubMed] [Google Scholar]
Asenjo Lobos 2010
- Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, et al. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No: CD006633. [DOI: 10.1002/14651858.CD006633.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Asenjo‐Lobos 2018
- Asenjo-Lobos C, Fonseca C, Leucht S, Arancibia M, Cortés‐Jofré M. Clozapine versus olanzapine for people with schizophrenia. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No: CD013219. [DOI: 10.1002/14651858.CD013219] [DOI] [Google Scholar]
Asenjo‐Lobos 2018a
- Asenjo-Lobos C, Cortes-Jofre M, Fonseca C, Leucht S, Madrid E, Bonfill Cosp X. Clozapine versus risperidone for people with schizophrenia. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No: CD013221. [DOI: 10.1002/14651858.CD013221] [DOI] [Google Scholar]
Asmal 2013
- Asmal L, Flegar SJ, Wang J, Rummel-Kluge C, Komossa K, Leucht S. Quetiapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No: CD006625. [DOI: 10.1002/14651858.CD006625.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Bagnall 2000
- Bagnall AM, Kleijnen J, Leitner M, Lewis R. Ziprasidone for schizophrenia and severe mental illness. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No: CD001945. [DOI: 10.1002/14651858.CD001945] [DOI] [PubMed] [Google Scholar]
Barnes 1989
- Barnes TR. A rating scale for drug-induced akathisia. BritishJournal of Psychiatry 1989;154:672–6. [DOI] [PubMed] [Google Scholar]
Belgamwar 2005
- Belgamwar RB, Fenton M. Olanzapine IM or velotab for acutely disturbed/agitated people with suspected serious mental illnesses. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No: CD003729. [DOI: 10.1002/14651858.CD003729.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Bhattacharjee 2016
- Bhattacharjee J, El-Sayeh HG. Aripiprazole versus haloperidol for people with schizophrenia and schizophrenia-like psychoses. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No: CD012073. [DOI: 10.1002/14651858.CD012073] [DOI] [Google Scholar]
Blackmore 2020
- Blackmore R, Boyle JA, Fazel M, Ranasinha S, Gray KM, Fitzgerald G, et al. The prevalence of mental illness in refugees and asylum seekers: a systematic review and meta-analysis. PLOS Medicine 2020;17(9):e1003337. [DOI: 10.1371/journal.pmed.1003337] [PMID: PMID: 32956381] [DOI] [PMC free article] [PubMed] [Google Scholar]
Bland 1997
- Bland JM. Statistics notes. Trials randomised in clusters. BMJ 1997;315(7108):600. [DOI] [PMC free article] [PubMed] [Google Scholar]
Boissel 1999
- Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use [Aperçu sur la problématique des indices d'efficacité thérapeutique, 3: comparaison des indices et utilisation. Groupe d'Etude des Indices D'efficacite]. Therapie 1999;54(4):405-11. [PMID: ] [PubMed] [Google Scholar]
Bola 2011
- Bola JR, Kao D, Soydan H, Adams CE. Antipsychotic medication for early episode schizophrenia. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No: CD006374. [DOI: 10.1002/14651858.CD006374.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Bosnjak 2019
- Bosnjak Kuharic D, Kekin I, Hew J, Rojnic Kuzman M, Puljak L. Interventions for prodromal stage of psychosis. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No: CD012236. [DOI: 10.1002/14651858.CD012236.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Bymaster 1999
- Bymaster FP, Nelson DL, DeLapp NW, Falcone JF, Eckols K, Truex LL, et al. Antagonism by olanzapine of dopamine D1, serotonin2, muscarinic, histamine H1 and α1-adrenergic receptors in vitro. Schizophrenia Research 1999;37(1):107-22. [DOI: 10.1016/S0920-9964(98)00146-7] [DOI] [PubMed] [Google Scholar]
Carpenter 1984
- Heinrichs DW, Hanlon ET, Carpenter WT Jr. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 1984;10:388–96. [DOI] [PubMed] [Google Scholar]
Carpenter 1994
- Carpenter WTJ, Buchanan RW. Schizophrenia. New England Journal of Medicine 1994;330(10):681–90. [DOI: 10.1056/NEJM199403103301006] [PMID: ] [DOI] [PubMed] [Google Scholar]
Charlson 2018
- Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: findings from the global burden of disease study 2016. Schizophrenia Bulletin 2018;44(6):1195-203. [DOI: 10.1093/schbul/sby058] [DOI] [PMC free article] [PubMed] [Google Scholar]
Chisholm 2016
- Chisholm D, Burman-Roy S, Fekadu A, Kathree T, Kizza D, Luitel NP, et al. Estimating the cost of implementing district mental healthcare plans in five low-and middle-income countries: the PRIME study. British Journal of Psychiatry 2016;208(s56):s71-8. [DOI: 10.1192/bjp.bp.114.153866] [DOI] [PMC free article] [PubMed] [Google Scholar]
Chouinard 1980
- Chouinard G, Ross-Chouinard A, Annable L. Extrapyramidal symptom rating scale. Canadian Journal of Neurological Science;1980(7):233.
COSTART 1990
- Food and Drug Administration. COSTART Coding Symbols for Thesaurus of Adverse Reaction Terms. 2nd edition. Rockville MD Food and Drug Administration, 1990. [Google Scholar]
Datta 2012
- Datta SS, Kumar A, Wright SD, Russell P. Typical antipsychotics for psychosis in adolescents. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No: CD009539. [DOI: 10.1002/14651858.CD009539] [DOI] [PMC free article] [PubMed] [Google Scholar]
de Haan 2002a
- Haan L, Weisfelt M, Dingemans PMAJ, Linszen DH, Wouters L. Psychometric properties of the Subjective Well-Being Under Neuroleptics Scale (SWN) and the SubjectiveDeficit Syndrome Scale (SDSS). Psychopharmacology (Berl) 2002;162:24–8. [DOI] [PubMed] [Google Scholar]
Deeks 2000
- Deeks J. Issues in the selection for meta-analyses of binary data. In: Proceedings of the 8th International Cochrane Colloquium; 2000 Oct 25-28; Cape Town. Cape Town: The Cochrane Collaboration, 2000.
Deeks 2011
- Deeks JJ, Higgins JP, Altman DG. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
DeSilva 2006
- DeSilva P, Fenton M, Rathbone J. Zotepine for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No: CD001948. [DOI: 10.1002/14651858.CD001948.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Divine 1992
- Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7(6):623-9. [DOI] [PubMed] [Google Scholar]
Dold 2015
- Dold M, Samara MT, Li C, Tardy M, Leucht S. Haloperidol versus first-generation antipsychotics for the treatment of schizophrenia and other psychotic disorders. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No: CD009831. [DOI: 10.1002/14651858.CD009831.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Donnelly 2013
- Donnelly L, Rathbone J, Adams CE. Haloperidol dose for the acute phase of schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No: CD001951. [DOI: 10.1002/14651858.CD001951.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Donner 2002
- Donner A, Klar N. Issues in the meta-analysis of cluster randomized trials. Statistics in Medicine 2002;21(19):2971-80. [DOI] [PubMed] [Google Scholar]
Drugs 2020
- Haloperidol - usual adult dose for schizophrenia. https://www.drugs.com/dosage/haloperidol.html#Usual_Adult_Dose_for_Schizophrenia (last updated 11 February 2020).
Duggan 2005
- Duggan L, Fenton M, Rathbone J, Dardennes R, El-Dosoky A, Indran S, et al. Olanzapine for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No: CD001359. [DOI: 10.1002/14651858.CD001359.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Egger 1997
- Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34. [DOI] [PMC free article] [PubMed] [Google Scholar]
El‐Sayeh 2006
- El-Sayeh HG, Morganti C. Aripiprazole for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No: CD004578. [DOI: 10.1002/14651858.CD004578.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Elbourne 2002
- Elbourne D, Altman DG, Higgins JP, Curtina F, Worthingtond HV, Vaile A. Meta-analyses involving cross-over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140-9. [DOI] [PubMed] [Google Scholar]
Elis 2013
- Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions. Clinical Psychology Review 2013;33(8):914-28. [DOI: 10.1016/j.cpr.2013.07.001] [DOI] [PMC free article] [PubMed] [Google Scholar]
Essali 2009
- Essali A, Al-Haj Haasan N, Li C, Rathbone J. Clozapine versus typical neuroleptic medication for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No: CD000059. [DOI: 10.1002/14651858.CD000059.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Essali 2019
- Essali A, Turkmani K, Aboudamaah S, AbouDamaah A, Diaa Aldeen MR, Marwa ME, et al. Haloperidol discontinuation for people with schizophrenia. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No: CD011408. [DOI: 10.1002/14651858.CD011408.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Fenton 2007
- Fenton M, Rathbone J, Reilly J. Thioridazine for schizophrenia. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No: CD001944. [DOI: 10.1002/14651858.CD001944.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Fleischhacker 1989
- Fleischhacker WW, Bergmann KJ, Perovich R, PestreichLK, Borenstein M, Lieberman JA, et al. The Hillside Akathisia Scale: a new rating instrument for neuroleptic induced akathisia.. Psychopharmacology Bulletin 1989;25(2):222-6. [MEDLINE: ] [PubMed] [Google Scholar]
Fleischhacker 1994
- Fleischhacker WW, Meise U, Gunther V, Kurz M. Compliance with antipsychotic drug treatment: influence of side effects. Acta Psychiatrica Scandinavica. Supplementum 1994;382:11-5. [PMID: ] [PubMed] [Google Scholar]
Folstein 1975
- Folstein NF, Folstein SE, McHugh PR. Mini-Mental State:a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 1975;12:189-98. [DOI] [PubMed] [Google Scholar]
Furukawa 2006
- Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta-analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59(1):7-10. [DOI] [PubMed] [Google Scholar]
Gilbody 2016
- Gilbody S, Bagnall AM, Duggan L, Tuunainen A. Risperidone versus other atypical antipsychotic medication for schizophrenia. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No: CD002306. [DOI: 10.1002/14651858.CD002306.pub2] [DOI] [PubMed] [Google Scholar]
GRADEpro GDT [Computer program]
- GRADEpro GDT. Version accessed 6 August 2016. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015. Available at gradepro.org.
Green 2004
- Green MF, Nuechterlein KH, Gold JM, Barch DM, Cohen J, Essock S, et al. Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry 2004;56(5):301-7. [DOI: 10.1016/j.biopsych.2004.06.023] [DOI] [PubMed] [Google Scholar]
Gulliford 1999
- Gulliford MC. Components of variance and intraclass correlations for the design of community-based surveys and intervention studies: data from the Health Survey for England 1994. American Journal of Epidemiology 1999;149(9):876-83. [DOI] [PubMed] [Google Scholar]
Guy 1976
- Guy U. Early Clinical Drug Evaluation (ECDEU) Assessment Manual for Psychopharmacology. National Institute of Mental Health 1976;unknown:-. [Google Scholar]
Hamann 2003
- Hamann J, Kissling W, Leucht S, Rummel-Kluge C. New generation antipsychotics for first episode schizophrenia. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No: CD004410. [DOI: 10.1002/14651858.CD004410] [DOI] [PMC free article] [PubMed] [Google Scholar]
Hamilton 1960
- Hamilton M. A rating scale for depression. Journal of Neurology. Neurosurgery and Psychiatry 1960;23:56–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
Hamilton 1969
- Hamilton A. Diagnosis and Rating of Anxiety. BritishJournal of Psychiatry 1969;S3:76–9. [Google Scholar]
Hanafi 2017
- Hanafi I, Arafat S, Al Zayed L, Sukkar M, Albeirakdar A, Krayem D, et al. Haloperidol (route of administration) for people with schizophrenia. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No: CD012833. [DOI: 10.1002/14651858.CD012833] [DOI] [Google Scholar]
Helfer 2015
- Helfer B, Rothe PH, Leucht S, Samara MT. Switching antipsychotic for non response in schizophrenia. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No: CD011885. [DOI: 10.1002/14651858.CD011885] [DOI] [PMC free article] [PubMed] [Google Scholar]
Herath 2009
- Herath Mudiyanselage I, Alagarsamy J, Kachhap S, Jayaram MB. Olanzapine depot for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No: CD007947. [DOI: 10.1002/14651858.CD007947] [DOI] [Google Scholar]
Herath Mudiyanselage 2009
- Herath Mudiyanselage I, Alagarsamy J, Kachhap S, Jayaram MB. Olanzapine depot for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No: CD007947. [DOI: 10.1002/14651858.CD007947] [DOI] [Google Scholar]
Higgins 2003
- Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. [DOI] [PMC free article] [PubMed] [Google Scholar]
Higgins 2008
- Higgins JP, Green S. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org. [DOI: 10.1002/9780470712184] [DOI]
Higgins 2011a
- Higgins JP, Green S. Chapter 7: Selecting studies and collecting data. In: Higgins JP, Green S editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2011b
- Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al, Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. [DOI: 10.1136/bmj.d5928] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Hogan 1983
- Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Medicine 1983;13:177–83. [DOI] [PubMed] [Google Scholar]
Huf 2016
- Huf G, Alexander J, Gandhi P, Allen MH. Haloperidol plus promethazine for psychosis-induced aggression. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No: CD005146. [DOI: 10.1002/14651858.CD005146.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Huhn 2019
- Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet 2019;394(10202):939-51. [DOI: 10.1016/S0140-6736(19)31135-3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Hunter 2003
- Hunter R, Kennedy E, Song F, Gadon L, Irving CB. Risperidone versus typical antipsychotic medication for schizophrenia. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No: CD000440. [DOI: 10.1002/14651858.CD000440] [DOI] [PMC free article] [PubMed] [Google Scholar]
Huston 1996
- Huston P, Moher D. Redundancy, disaggregation, and the integrity of medical research. Lancet 1996;347(9007):1024-6. [DOI] [PubMed] [Google Scholar]
Hutton 2009
- Hutton JL. Number needed to treat and number needed to harm are not the best way to report and assess the results of randomised clinical trials. British Journal of Haematology 2009;146(1):27-30. [PMID: ] [DOI] [PubMed] [Google Scholar]
Inada 1996
- Inada M. Evaluation and Diagnosis of Drug-Enduced Extrapyramidal Symptoms: Commentary on the DIEPSS and guide to its usage. Tokyo: Seiwa Shoten, 1996. [Google Scholar]
Jaaskelainen 2013
- Jaaskelainen E, Juola P, Hirvonen N, McGrath JJ, Saha S, Isohanni M, et al. A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia bulletin 2013;39(6):1296-306. [DOI: 10.1093/schbul/sbs130] [DOI] [PMC free article] [PubMed] [Google Scholar]
Jayaram 2006
- Jayaram MB, Hosalli P, Stroup TS. Risperidone versus olanzapine for schizophrenia. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No: CD005237. [DOI: 10.1002/14651858.CD005237.pub2] [DOI] [PubMed] [Google Scholar]
Jones 2009
- Jones L, Asare JB, El Masri M, Mohanraj A, Sherief H, Van Ommeren M, et al. Severe mental disorders in complex emergencies. Lancet 2009;374(9690):654-61. [DOI: 10.1016/S0140-6736(09)61253-8] [DOI] [PubMed] [Google Scholar]
Kay 1986
- Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, NY: Multi-Health Systems, 1986. [Google Scholar]
Kennedy 2007
- Kennedy E, Kumar A, Datta SS. Antipsychotic medication for childhood-onset schizophrenia. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No: CD004027. [DOI: 10.1002/14651858.CD004027.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Khanna 2014
- Khanna P, Suo T, Komossa K, Ma H, Rummel-Kluge C, El-Sayeh HG, et al. Aripiprazole versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No: CD006569. [DOI: 10.1002/14651858.CD006569.pub5] [DOI] [PMC free article] [PubMed] [Google Scholar]
Komossa 2009
- Komossa K, Rummel-Kluge C, Hunger H, Schwarz S, Schmid F, Lewis R, et al. Sertindole versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No: CD006752. [DOI: 10.1002/14651858.CD006752.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Komossa 2009a
- Komossa K, Rummel-Kluge C, Hunger H, Schwarz S, Bhoopathi PS, Kissling W, et al. Ziprasidone versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No: CD006627. [DOI: 10.1002/14651858.CD006627.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Komossa 2010
- Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Duggan L, et al. Olanzapine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No: CD006654. [DOI: 10.1002/14651858.CD006654.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Komossa 2010a
- Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Silveira da Mota Neto JI, et al. Amisulpride versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No: CD006624. [DOI: 10.1002/14651858.CD006624.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Komossa 2011
- Komossa K, Rummel-Kluge C, Schwarz S, Schmid F, Hunger H, Kissling W, et al. Risperidone versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No: CD006626. [DOI: 10.1002/14651858.CD006626.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Kudo 1999
- Kudo S, Ishizaki T. Pharmacokinetics of haloperidol. Clinical pharmacokinetics 1999;37(6):435-56. [DOI: 10.2165/00003088-199937060-00001] [DOI] [PubMed] [Google Scholar]
Kumar 2013
- Kumar A, Datta SS, Wright SD, Furtado VA, Russell PS. Atypical antipsychotics for psychosis in adolescents. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No: CD009582. [DOI: 10.1002/14651858.CD009582.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Latifeh 2019
- Latifeh Y, Mohsen M, Mohamad S, Nassif T. Olanzapine dose for people with schizophrenia. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No: CD013266. [DOI: 10.1002/14651858.CD013266] [DOI] [Google Scholar]
Lefebvre 2019
- Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf M, et al. Searching for and selecting studies. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors(s). Cochrane Handbook for Systematic Reviews of Interventions. 2 edition. John Wiley and Sons, 2019:67-107. [DOI: 10.1002/9781119536604.ch4] [DOI] [Google Scholar]
Lehman 1983
- Lehman A. The well being of chronic mental patients:assessing their quality of life. Archives of General Psychiatry 1983;40:369–73. [DOI] [PubMed] [Google Scholar]
Leon 2006
- Leon AC, Mallinckrodt CH, Chuang-Stein C, Archibald DG, Archer GE, Chartier K. Attrition in randomized controlled clinical trials: methodological issues in psychopharmacology. Biological Psychiatry 2006;59(11):1001-5. [PMID: ] [DOI] [PubMed] [Google Scholar]
Leucht 1999
- Leucht S, Pitschel-Walz G, Abraham D, Kissling W. Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 1999;35(1):51-68. [DOI: 10.1016/S0920-9964(98)00105-4] [DOI] [PubMed] [Google Scholar]
Leucht 2005
- Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean? Schizophrenia Research 2005;79(2-3):231-8. [DOI: 10.1016/j.schres.2005.04.008] [DOI] [PubMed] [Google Scholar]
Leucht 2005a
- Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry 2005;187:366-71. [PMID: ] [DOI] [PubMed] [Google Scholar]
Leucht 2005b
- Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean? Schizophrenia Research 2005;79(2-3):231-8. [PMID: ] [DOI] [PubMed] [Google Scholar]
Leucht 2012
- Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No: CD008016. [DOI: 10.1002/14651858.CD008016.pub2] [DOI] [PubMed] [Google Scholar]
Leucht 2018
- Leucht C, Kitzmantel M, Kane J, Leucht S, Chua WLLC. Haloperidol versus chlorpromazine for schizophrenia. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No: CD004278. [DOI: 10.1002/14651858.CD004278.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Leucht 2020
- Leucht S, Crippa A, Siafis S, Patel MX, Orsini N, Davis JM. Dose-response meta-analysis of antipsychotic drugs for acute schizophrenia. American Journal of Psychiatry 2020;177(4):342-53. [DOI: 10.1176/appi.ajp.2019.19010034] [DOI] [PubMed] [Google Scholar]
Lewis 2005
- Lewis R, Bagnall AM, Leitner M. Sertindole for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No: CD001715. [DOI: 10.1002/14651858.CD001715.pub2] [DOI] [PubMed] [Google Scholar]
Li 2019
- Li Y, Du C, Jiaxiang N, Liqiang Y, Qi F. Olanzapine versus placebo for people with schizophrenia. Cochrane Database of Systematic Reviews 2019, Issue 4. Art. No: CD013310. [DOI: 10.1002/14651858.CD013310] [DOI] [Google Scholar]
Lingjaerde 1987
- Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. ActaPsychiatrica Scandinavica Supplementum 1987;76(334):100. [DOI] [PubMed] [Google Scholar]
Lopez‐Munoz 2009
- Lopez-Munoz F, Alamo C. The consolidation of neuroleptic therapy: Janssen, the discovery of haloperidol and its introduction into clinical practice. Brain research bulletin 2009;79(2):130-41. [DOI: 10.1016/j.brainresbull.2009.01.005] [DOI] [PubMed] [Google Scholar]
Lund 2018
- Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, et al. Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry 2018;5(4):357-69. [DOI: 10.1016/S2215-0366(18)30060-9] [PMID: ] [DOI] [PubMed] [Google Scholar]
Marshall 2000
- Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249-52. [DOI] [PubMed] [Google Scholar]
Marshall 2011
- Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No: CD004718. [DOI: 10.1002/14651858.CD004718.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
McGrath 2004
- McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2004;2:13. [DOI: 10.1186/1741-7015-2-13] [DOI] [PMC free article] [PubMed] [Google Scholar]
McGrath 2008
- McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews 2008;30(1):67-76. [DOI: ] [DOI] [PubMed] [Google Scholar]
Melander 2003
- Melander H, Ahlqvist-Rastad J, Meijer G, Beermann B. Evidence b (i) ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications. BMJ 2003;326(7400):1171-3. [DOI: 10.1136/bmj.326.7400.1171] [DOI] [PMC free article] [PubMed] [Google Scholar]
Miller 2010
- Miller KE, Rasmussen A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine 2010;70(1):7-16. [DOI: 10.1016/j.socscimed.2009.09.029] [DOI] [PubMed] [Google Scholar]
Montgomery 1979
- Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. British Journal of Psychiatry 1979;134:382-9. [DOI] [PubMed] [Google Scholar]
Montgomery 2004
- Montgomery JH, Byerly M, Carmody T, LiB, Miller DR, Varghese F, et al. An analysis of the effect of funding source in randomized clinical trials of second generation antipsychotics for the treatment of schizophrenia. Controlled Clinical Trials 2004;25(6):598-612. [DOI: 10.1016/j.cct.2004.09.002] [DOI] [PubMed] [Google Scholar]
Ostinelli 2017
- Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE. Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation). Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No: CD009377. [DOI: 10.1002/14651858.CD009377.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Ostuzzi 2017
- Ostuzzi G, Barbui C, Hanlon C, Chatterjee S, Eaton J, Jones L, et al. Mapping the evidence on pharmacological interventions for non-affective psychosis in humanitarian non-specialised settings: a UNHCR clinical guidance. BMC Medicine 2017;15(1):197-204. [DOI: 10.1186/s12916-017-0960-z] [DOI] [PMC free article] [PubMed] [Google Scholar]
Ostuzzi 2022a
- Ostuzzi G, Gastaldon C, Papola D, Barbui C. Calling for policy actions to increase access to long-acting antipsychotics in low-income and middle-income countries. Epidemiology and Psychiatric Sciences 2022;31:e34. [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Ostuzzi 2022b
- Ostuzzi G, Bertolini F, Tedeschi F, Vita G, Brambilla P, Del Fabro L, et al. Oral and long-acting antipsychotics for relapse prevention in schizophrenia-spectrum disorders: a network meta-analysis of 92 randomized trials including 22,645 participants. World Psychiatry 2022;21(2):295-307. [DOI: 10.1002/wps.20972] [PMID: ] [DOI] [PMC free article] [PubMed] [Google Scholar]
Overall 1962
- Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports 1962;10:799-812. [Google Scholar]
Parrott 1980
- Parrott AC, Hindmarch I. The Leeds Sleep Evaluation Questionnaire in psychopharmacological investigations - a review. Psychopharmacology 1980;71:173-9. [DOI] [PubMed] [Google Scholar]
Priebe 1999
- Priebe S, Huxley P, Knight S, Evans S. Application and results of the Manchester Short Assessment of Quality of Life (MANSA). International Journal of Social Psychiatry 1999;45:7-12. [DOI] [PubMed] [Google Scholar]
Quraishi 1999
- Quraishi SN, David A, Brasil MA, Alheira FV. Depot haloperidol decanoate for schizophrenia. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No: CD001361. [DOI: 10.1002/14651858.CD001361] [DOI] [PMC free article] [PubMed] [Google Scholar]
Ray 2017
- Ray S, Ray A, Gopi A, Hunter R. Haloperidol versus risperidone for schizophrenia. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No: CD012728. [DOI: 10.1002/14651858.CD012728] [DOI] [Google Scholar]
Review Manager 2014 [Computer program]
- Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Reynolds 2010
- Reynolds GP, Kirk SL. Metabolic side effects of antipsychotic drug treatment–pharmacological mechanisms. Pharmacology & Therapeutics 2010;125(1):169-79. [DOI: 10.1016/j.pharmthera.2009.10.010] [DOI] [PubMed] [Google Scholar]
Roberts 2021
- Roberts MT, Shokraneh F, Sun Y, Groom M, Adams CE. Classification of psychotherapy interventions for people with schizophrenia: development of the Nottingham Classification of Psychotherapies. Evidence-Based Mental Health 2021;24:62-9. [DOI: 10.1136/ebmental-2020-300151] [DOI] [PMC free article] [PubMed] [Google Scholar]
Schneider‐Thoma 2022
- Schneider-Thoma J, Chalkou K, Dörries C, Bighelli I, Ceraso A, Huhn M, et al. Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with schizophrenia: a systematic review and network meta-analysis. Lancet 2022;399:824-36. [DOI: 10.1016/S0140-6736(21)01997-8] [PMID: ] [DOI] [PubMed] [Google Scholar]
Schott 2010
- Schott G, Pachl H, Limbach U, Gundert-Remy U, Ludwig WD, Lieb K. The financing of drug trials by pharmaceutical companies and its consequences: part 1: a qualitative, systematic review of the literature on possible influences on the findings, protocols, and quality of drug trials. Deutsches Ärzteblatt International 2010;107(16):279. [DOI: 10.3238/arztebl.2010.0279] [DOI] [PMC free article] [PubMed] [Google Scholar]
Schotte 1993
- Schotte A, Janssen PF, Megens AA, Leysen JE. Occupancy of central neurotransmitter receptors by risperidone, clozapine and haloperidol, measured ex vivo by quantitative autoradiography. Brain Research 1993;631(2):191-202. [DOI: 10.1016/0006-8993(93)91535-Z] [DOI] [PubMed] [Google Scholar]
Schulz 1995
- Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. Jama 1995;273(5):408-12. [DOI] [PubMed] [Google Scholar]
Schünemann 2011
- Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In Higgins JP, Green S editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Settle 1983
- Settle EC, Ayd FJ. Haloperidol: a quarter century ofexperience. Journal of Clinical Psychiatry 1983;44:440–8. [PMID: ] [PubMed] [Google Scholar]
Shirzadi 2006
- Shirzadi AA, Ghaemi SN. Side effects of atypical antipsychotics: extrapyramidal symptoms and the metabolic syndrome. Harvard Review of Psychiatry 2006;14(3):152-64. [DOI: 10.1080/10673220600748486] [DOI] [PubMed] [Google Scholar]
Shokraneh 2017
- Shokraneh F, Adams CE. Study-based registers of randomized controlled trials: starting a systematic review with data extraction or meta-analysis. BioImpacts 2017;7(4):209-17. [DOI: 10.15171/bi.2017.25] [DOI] [PMC free article] [PubMed] [Google Scholar]
Shokraneh 2019
- Shokraneh F, Adams CE. Study-based registers reduce waste in systematic reviewing: discussion and case report. Systematic Reviews 2019;8:129. [DOI: 10.1186/s13643-019-1035-3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Shokraneh 2020
- Shokraneh F, Adams CE. Cochrane Schizophrenia Group’s study-based register of randomized controlled trials: development and content analysis. Schizophrenia Bulletin Open 2020;1:sgaa061. [DOI: 10.1093/schizbullopen/sgaa061] [DOI] [Google Scholar]
Shokraneh 2021
- Shokraneh F, Adams CE. Classification of all pharmacological interventions tested in trials relevant to people with schizophrenia: a study-based analysis. Health Information and Libraries Journal 2021;In Press:In Press. [DOI: 10.1111/hir.12366] [DOI] [PubMed] [Google Scholar]
Silveira 2002
- Silveira da Mota Neto JI, Soares BGO, Silva de Lima M. Amisulpride for schizophrenia. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No: CD001357. [DOI: 10.1002/14651858.CD001357] [DOI] [PMC free article] [PubMed] [Google Scholar]
Simpson 1970
- Simpson GM, Angus JWS. A rating scale for extrapyramidal side-effects. Acta Psychiatrica Scandinavica Supplementum 1970;212:11–9. [DOI] [PubMed] [Google Scholar]
Srisurapanont 2004
- Srisurapanont M, Maneeton B, Maneeton N, Lankappa S, Gandhi R. Quetiapine for schizophrenia. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No: CD000967. [DOI: 10.1002/14651858.CD000967.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Sterne 2011
- Sterne JA, Egger M, Moher D. Chapter 10: Addressing reporting biases. In: Higgins JP, Green S editor(s). Cochrane Handbook for Systematic Reviews of Intervention. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Subramanian 2010
- Subramanian S, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Kissling W, et al. Zotepine versus other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No: CD006628. [DOI: 10.1002/14651858.CD006628.pub3] [DOI] [PMC free article] [PubMed] [Google Scholar]
Suttajit 2013
- Suttajit S, Srisurapanont M, Xia J, Suttajit S, Maneeton B, Maneeton N. Quetiapine versus typical antipsychotic medications for schizophrenia. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No: CD007815. [DOI: 10.1002/14651858.CD007815.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Tardy 2014
- Tardy M, Huhn M, Kissling W, Engel RR, Leucht S. Haloperidol versus low-potency first-generation antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No: CD009268. [DOI: 10.1002/14651858.CD009268.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Taylor 2018
- Taylor D, Barnes, TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th edition. John Wiley & Sons, 2018. [Google Scholar]
Tong 2018
- Tong Z, Li F, Ogawa Y, Watanabe N, Furukawa TA. Quality of randomized controlled trials of new generation antidepressants and antipsychotics identified in the China National Knowledge Infrastructure (CNKI): a literature and telephone interview study. BMC Medical Research Methodology 2018;18(1):96. [DOI: 10.1186/s12874-018-0554-2] [DOI] [PMC free article] [PubMed] [Google Scholar]
Turner 2012
- Turner EH, Knoepflmacher D, Shapley L. Publication bias in antipsychotic trials: an analysis of efficacy comparing the published literature to the US Food and Drug Administration database. PLOS Medicine 2012;9(3):-. [DOI: 10.1371/journal.pmed.1001189] [DOI] [PMC free article] [PubMed] [Google Scholar]
Tuunainen 2000
- Tuunainen A, Wahlbeck K. Newer atypical antipsychotic medication versus clozapine for schizophrenia. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No: CD000966. [DOI: 10.1002/14651858.CD000966] [DOI] [PMC free article] [PubMed] [Google Scholar]
Ukoumunne 1999
- Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area-wide and organistation-based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):iii-92. [PubMed] [Google Scholar]
Ware 1992
- Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 1992;30:473-83. [PubMed] [Google Scholar]
Weston‐Green 2013
- Weston-Green K, Huang XF, Deng C, et al. Second generation antipsychotic-induced type 2 diabetes: a role for the muscarinic M3 receptor. CNS drugs 2013;27(12):1069-80. [DOI: 10.1007/s40263-013-0115-5] [DOI] [PubMed] [Google Scholar]
WHO 1996
- World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996 (No. WHOQOL-BREF). Available at https://apps.who.int/iris/handle/10665/63529 1996.
WHO 2021
- World Health Organization. Mental health atlas 2020. Available at https://apps.who.int/iris/handle/10665/345946.
WHO 2022
- World Health Organization. World mental health report: transforming mental health for all. Available at https://www.who.int/publications/i/item/9789240049338.
WHO 2023
- World Health Organization. WHO 24th Expert Committee on Selection and Use of Essential Medicines. Available at www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/24th-eml-expert-committee.
WHO 2023b
- World Health Organization. WHO model list of essential medicines. Available at https://apps.who.int/iris/handle/10665/345533 2023;23rd list:66.
Wright 2004
- Wright SD, Russell P. Interventions for psychosis in adolescents. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No: CD004965. [DOI: 10.1002/14651858.CD004965] [DOI] [Google Scholar]
Wu 2009
- Wu T, Li Y, Bian Z, Liu G, Moher D. Randomized trials published in some Chinese journals: how many are randomized? Trials 2009;10(1):46. [https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-10-46] [DOI] [PMC free article] [PubMed] [Google Scholar]
Xia 2009
- Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El-Sayeh H, et al. Loss to outcomes stakeholder survey: the LOSS study. Psychiatric Bulletin 2009;33(7):254-7. [Google Scholar]
Xiberas 2001
- Xiberas X, Martinot JL, Mallet L, Artiges E, Loc'h C, Maziere B, et al. Extrastriatal and striatal D 2 dopamine receptor blockade with haloperidol or new antipsychotic drugs in patients with schizophrenia. British Journal of Psychiatry 2001;179(6):503-8. [DOI: 10.1192/bjp.179.6.503] [DOI] [PubMed] [Google Scholar]
Yang 2017
- Yang HL, Zheng JG, Li B, Zhao S, Zheng W. Aripiprazole versus ziprasidone for schizophrenia. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No: CD012811. [DOI: 10.1002/14651858.CD012811] [DOI] [Google Scholar]
Zare 2017
- Zare M, Bazrafshan A. Chlorpromazine versus metiapine for schizophrenia. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No: CD011655. [DOI: 10.1002/14651858.CD011655.pub2] [DOI] [PMC free article] [PubMed] [Google Scholar]
References to other published versions of this review
Ibragimov 2019
- Ibragimov K, Keane G, Carreño Glaría C, Cheng J, Llosa A. Haloperidol versus olanzapine for people with schizophrenia. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No: CD013425. [DOI: 10.1002/14651858.CD013425] [DOI] [PMC free article] [PubMed] [Google Scholar]