Medical-claims databases in the design of a health-outcomes comparison of quetiapine (`Seroquel') and usual-care antipsychotic medication Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder. Atypical Antipsychotics, Neurocognitive Deficits, and Aggression in Schizophrenic Patients Influence of atypical neuroleptics on executive functioning in patients with schizophrenia: a randomized, double-blind comparison of olanzapine vs. clozapine. Clotiapine compared with chlorpromazine in chronic schizophrenia Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients. Rater-blinded, Prospective Comparison: Quetiapine Versus Clozapine for Parkinson's Disease Psychosis Clozapine reduces rehospitalization among schizophrenia patients. Benzodiazepines for psychosis-induced aggression or agitation. Use of antipsychotics and benzodiazepines in patients with psychiatric emergencies: Results of an observational trial A comparison of the effect of clozapine with typical neuroleptics on cognitive function in neuroleptic-responsive schizophrenia A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Rapid Tranquilization of Severely Agitated Patients With Schizophrenia Spectrum Disorders: A Naturalistic, Rater-Blinded, Randomized, Controlled Study With Oral Haloperidol, Risperidone, and Olanzapine Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Quetiapine and Clozapine in Parkinsonian Patients With Dopaminergic Psychosis Initial treatment of severe acute psychosis with fast orally disintegrating risperidone tablets. Acute psychotic disorders treated with 5% zuclopenthixol acetate in 'Viscoleo' ('Cisordinol-Acutard'), a global assessment of the clinical effect: an open multi-centre study.
Treating schizophrenia is expensive . Preventing rehospitalization of patients with schizophrenia provides an attractive opportunity for cost savings , especially for patients with ' revolving-door ' or multiple-episode schizophrenia . Reducing the occurrence of extrapyramidal symptoms and other adverse events associated with st and ard antipsychotic agents may increase compliance and reduce the rate of rehospitalization of patients with schizophrenia .  Quetiapine ( ' Seroquel ' , ICI 204,636 , Zeneca Pharmaceuticals ) is a new dibenzothiazepine antipsychotic agent with a low propensity for extrapyramidal symptoms . We describe here a unique methodology to compare quetiapine with usual-care medications in real-world treatment setting s. The trial objective is to determine if therapy with this new atypical antipsychotic agent can reduce the rate of rehospitalization and , therefore , treatment costs . Using two secondary medical-cl aims data bases , we defined the minimal threshold for revolving-door status as 1.0 admission per year ; this definition allows our trial to focus on the sub population of schizophrenic patients with the greatest potential for cost savings by either the new atypical antipsychotic quetiapine or usual-care therapy . We describe here the approach used in our trial CONTEXT Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community . Finding appropriate treatment of violent behaviors is of primary importance . OBJECTIVE To compare the efficacy of 2 atypical antipsychotic agents , clozapine and olanzapine , with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder . DESIGN AND SETTING R and omized , double-blind , parallel-group , 12-week trial . Physically assaultive subjects with schizophrenia or schizoaffective disorder who were in patients in state psychiatric facilities were r and omly assigned to treatment with clozapine ( n = 37 ) , olanzapine ( n = 37 ) , or haloperidol ( n = 36 ) . MAIN OUTCOME MEASURES Number and severity of physical assaults as measured by the Modified Overt Aggression Scale ( MOAS ) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score . Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale ( PANSS ) . RESULTS Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score . Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures . There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales . CONCLUSIONS Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior . This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications The purpose of this study was to compare the effects of olanzapine , clozapine , and haloperidol on neurocognitive function in schizophrenic patients who present with documented episodes of physical aggression and to determine whether change in cognitive function is related to aggression . One hundred physically aggressive schizophrenic in patients were assigned to a r and omized , double-blind , parallel-group , 12-week treatment , and received cognitive evaluations at baseline . There were 33 , 34 , and 33 subjects in the clozapine , olanzapine , and haloperidol groups , respectively . They were administered a battery of tests assessing psychomotor function , general executive function , visual and verbal memory , and visuospatial ability . A general cognitive index was derived from the above battery . The overall score on the Modified Overt Aggression Scale was used to measure the number and severity of the aggressive events . Psychiatric symptoms and side effects were also assessed . The improvement in the general cognitive index differed significantly among the 3 treatment groups , with olanzapine being superior to both haloperidol and clozapine . Further analyses revealed significantly greater improvement with olanzapine in several cognitive domains . Furthermore , improvement in the general cognitive index was significantly associated with a decrease in aggression in the olanzapine group but not in the other 2 medication groups . In violent schizophrenic patients , olanzapine treatment is associated with better cognitive functioning relative to haloperidol and clozapine . This improvement in neurocognitive function is associated with a decrease in aggressive behavior . As clozapine markedly reduced aggression , there may be different pathways for the antiaggressive effect of olanzapine and that of clozapine Accepted clinical evidence suggests superior efficacy of novel antipsychotics in the treatment of cognitive symptoms in schizophrenia . Whether this constitutes a primary drug effect or a secondary effect due to easing extrapyramidal side-effects or improving positive symptoms when converting from a first- to a second-generation neuroleptic is still open to debate . Long-term efficacy as well as differential drug effects on cognitive performance are also poorly documented . We therefore compared cognitive performance of olanzapine vs. clozapine treatment in a controlled , r and omized , double-blind trial . Fifty-four patients were assessed following a 2- to 9-day washout and again after 4 and 26 wk of neuroleptic treatment . Patients were rated on the PANSS for psychopathological changes , extrapyramidal side-effects were assessed on the Simpson-Angus Scale , and cognitive performance was assessed with the Stroop , Wisconsin Card Sorting and the Tower of London tests . Schizophrenia symptoms , extrapyramidal side-effects and cognitive performance improved significantly in the course of either drug treatment . Stroop test performance and Tower of London planning time improved significantly over 26 wk compared to baseline and 4-wk follow-up assessment while Wisconsin Card Sorting and Tower of London execution time improved significantly after 4 wk with no further improvement after 26 wk . Improved executive function was not related to improving positive symptoms and easing extrapyramidal side-effects , thus indicative of a primary treatment effect of either antipsychotic . However , Stroop reaction time improved with olanzapine while clozapine had a stronger effect on improving negative symptoms , thus suggestive of a differential drug effect OBJECTIVES Clotiapine is a classic neuroleptic with a chemical structure similar to clozapine . It was said that patients unresponsive to other neuroleptics respond to clotiapine although it causes extrapyramidal syndromes ( EPS ) like other typical neuroleptics . We conducted a study of clotiapine vs. chlorpromazine in severe chronic active psychotic hospitalized schizophrenia patients . METHODS The design was double-blind crossover of clotiapine vs chlorpromazine . No washout was necessary from previous neuroleptic treatment , and flexible overlap with the study medication was individualized for each patient . Patients were treated after reaching neuroleptic monotherapy for 3 months with clotiapine and 3 months with chlorpromazine , in r and om order . Medication was supplied in identical capsules of 100 mg chlorpromazine or 40 mg of clotiapine .  Positive and Negative Syndrome Scale ( PANSS ) and Clinical Global Impression ( CGI ) were rated every 2 weeks and Nurse 's Observation Scale for Inpatient Evaluation ( NOSIE ) every month . RESULTS Fifty-eight patients were r and omized . Forty-three patients completed at least one phase of the study , and thirty-three completed both phases . Because of the small number of hostel patients and the very high dropout rate in the hostel patients , data analysis was done separately for in patients and hostel patients . Clotiapine was significantly superior to chlorpromazine in 26 in patients completing the crossover , on the PANSS , NOSIE and CGI .  Clotiapine was also superior to chlorpromazine in an analysis of the parallel inpatient groups in the first three months before the crossover . CONCLUSION Some classic neuroleptic compounds may have superiority to chlorpromazine in a " clozapine-like " manner , despite a typical profile for EPS BACKGROUND Previous studies on the use of clozapine in neuroleptic-resistant chronic schizophrenic patients have demonstrated positive effects on tardive dyskinesia but were less conclusive about chronic akathisia and parkinsonism . The aim of the present study was to investigate the short-term ( 18 weeks ) efficacy of clozapine in neuroleptic-resistant chronic schizophrenic patients with coexisting tardive dyskinesia , chronic akathisia , and parkinsonism . METHOD Twenty chronic , neuroleptic-resistant schizophrenic patients with coexisting tardive dyskinesia , parkinsonism , and chronic akathisia were treated with clozapine . Assessment of tardive dyskinesia , parkinsonism , and chronic akathisia was made once weekly for 18 weeks with the Abnormal Involuntary Movement Scale ( AIMS ) , Simpson-Angus Rating Scale for Extrapyramidal Side Effects , and Barnes Rating Scale for Drug-Induced Akathisia ( BAS ) . RESULTS At the end of 18 weeks of clozapine treatment , improvement rates were 74 % for tardive dyskinesia , 69 % for parkinsonism , and 78 % for chronic akathisia . A statistically significant reduction in the scores on the AIMS and Simpson-Angus Scale was achieved at Week 5 and on the BAS at Week 6 ( p < .0001 ) . CONCLUSION Relatively low doses of clozapine are effective for the treatment of neuroleptic-induced extrapyramidal syndromes in neuroleptic-resistant chronic schizophrenic patients . The relief of tardive dyskinesia , parkinsonism , and chronic akathisia in this group of patients occurs more rapidly than the reduction in psychotic symptoms . Disturbing , long-term extrapyramidal syndromes in chronic schizophrenic patients should be considered an indication for clozapine treatment Objective : To compare the safety and efficacy of quetiapine versus clozapine for the treatment of psychosis in patients with Parkinson 's disease ( PD ) . Methods : Twenty-seven patients with PD and recent-onset psychosis were r and omly allocated to 2 arms of 22 weeks ' treatment with quetiapine or clozapine after 2 weeks of adjustment of antiparkinsonian medications . Assessment was done by a blinded neuropsychologist using the Clinical Global Impression of Change ( CGIC ) question naire and the Neuropsychiatric Inventory ( NPI ) . Mixed-effect models were used to compare CGIC and Neuropsychological Inventory scores over time between the 2 groups . Results : Both drugs were equally effective based on the CGIC . Clozapine had a trend over quetiapine in controlling the frequency of hallucinations ( P = 0.097 ) and a significant advantage in reducing delusions ( P = 0.011 ) . However , one patient in the clozapine arm developed leukopenia . None of the drugs worsened parkinsonism . Conclusions : Clozapine and quetiapine are effective atypical neuroleptics for the treatment of psychotic symptoms in PD . Clozapine had greater efficacy in reducing hallucinations and delusions frequency , but its use is associated with an increased risk of leukopenia A number of studies have reported reduced rehospitalization for patients on clozapine .  This article adds to that literature by mining the clozapine data base at Hillside Hospital . The sample consisted of 81 schizophrenia patients who entered Hillside on a typical neuroleptic and then had their medication changed to clozapine .  We ascertained the number of inpatient hospitalizations before starting clozapine and compared this with the number of hospitalizations after starting clozapine . We also followed an age- and gender-matched comparison group of other schizophrenia patients who entered Hillside at approximately the same time . Results indicate that the mean number of rehospitalizations while on a typical neuroleptic was 2.03 (1.93)/year , whereas it was only .56 ( .97/year after the commencement of clozapine treatment ; t(80 ) = 5.78 , p < .001 . A 95 % confidence interval for the superiority of clozapine over st and ard neuroleptic treatment as measured in rehospitalizations/year is ( 1.0 , 2.0 ) . The decrease in hospitalization rate of .4 (1.6)/year ( pre-index date minus post-index date ) for the comparison group was also statistically significant [ t(80 ) = 2.3 , p < .03 ] ; the 95 % confidence interval for this decrease over time is ( .1 , .8 ) . The pre-post change was much greater for the clozapine patients than comparison patients . A 2 x 2 repeated measures analysis of variance ( ANOVA ) contrasting the comparison group to the clozapine patients both before and after the index date indicates a significant time by group interaction ( F(1.80 ) = 22.35 , p < .001 ) , thus documenting the greater relative decrease in rehospitalization rate in the clozapine group BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation . In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome . OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms . SEARCH METHODS We search ed the Cochrane Schizophrenia Group 's register ( January 2012 ) , inspected reference lists of included and excluded studies and contacted authors of relevant studies . SELECTION CRITERIA We included all r and omised clinical trials ( RCTs ) comparing benzodiazepines alone or in combination with any antipsychotics , versus antipsychotics alone or in combination with any other antipsychotics , benzodiazepines or antihistamines , for people with acute psychotic illnesses . DATA COLLECTION AND ANALYSIS We reliably selected studies , quality assessed them and extracted data . For binary outcomes , we calculated st and ard estimates of relative risk ( RR ) and their 95 % confidence intervals ( CI ) using a fixed-effect model . For continuous outcomes , we calculated the mean difference ( MD ) between groups . If heterogeneity was identified , this was explored using a r and om-effects model . MAIN RESULTS We included 21 trials with a total of n = 1968 participants . There was no significant difference for most outcomes in the one trial that compared benzodiazepines with placebo , although there was a higher risk of no improvement in people receiving placebo in the medium term ( one to 48 hours ) ( n = 102 , 1 RCT , RR 0.62 , 95 % CI 0.40 to 0.97 , very low quality evidence ) . There was no difference in the number of participants who had not improved in the medium term when benzodiazepines were compared with antipsychotics ( n = 308 , 5 RCTs , RR 1.10 , 95 % CI 0.85 to 1.42 , low quality evidence ) ; however , people receiving benzodiazepines were less likely to experience extrapyramidal effects ( EPS ) in the medium term ( n = 536 , 8 RCTs , RR 0.15 , 95 % CI 0.06 to 0.39 , moderate quality of evidence ) . Data comparing combined benzodiazepines and antipsychotics versus benzodiazepines alone did not yield any significant results . When comparing combined benzodiazepines/antipsychotics ( all studies compared haloperidol ) with the same antipsychotics alone ( haloperidol ) , there was no difference between groups in improvement in the medium term ( n = 155 , 3 RCTs , RR 1.27 , 95 % CI 0.94 to 1.70 , very low quality evidence ) but sedation was more likely in people who received the combination therapy ( n = 172 , 3 RCTs , RR 1.75 , 95 % CI 1.14 to 2.67 , very low quality evidence ) . However , more participants receiving combined benzodiazepines and haloperidol had not improved by medium term when compared to participants receiving olanzapine ( n = 60,1 RCT , RR 25.00 , 95 % CI 1.55 to 403.99 , very low quality evidence ) or ziprasidone ( n = 60 , 1 RCT , RR 4.00 , 95 % CI 1.25 to 12.75very low quality evidence ) . When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour . AUTHORS ' CONCLUSIONS The evidence from trials for the use of benzodiazepines alone is not good . There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects . Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects . Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify . Much more high quality research is needed in this area Background Conventional antipsychotics augmented with benzodiazepines have been the st and ard acute treatment for psychiatric emergencies for more than 50 years . The inability of patients to give informed consent limits r and omised , controlled studies . This observational study on immediate therapy for aggression and impulse control in acutely agitated patients ( IMPULSE ) evaluated the short-term effectiveness and tolerability of atypical and typical antipsychotic medications ( AP ) in a non-interventional setting . Methods This was a comparative , non-r and omised , prospect i ve , open-label , observational study . Treatment over the first 5 days was classified according to whether any olanzapine , risperidone , or haloperidol was included or not . Documentations ( PANSS-excited component , CGI-aggression , CGI-suicidality , tranquilisation score ) were at baseline ( day 1 ) and days 2–6 after start of AP . Results During the short treatment-period , PANSS-EC and CGI-aggression scores improved in all cohorts . 68.7 % of patients treated with olanzapine , 72.2 % of patients treated with risperidone , and 83.3 % of patients treated with haloperidol received concomitant benzodiazepines ( haloperidol vs. non-haloperidol : p < 0.001 ) . More patients treated with olanzapine ( 73.8 % ) were fully alert according to a tranquilisation score and active at day 2 than patients treated with risperidone ( 57.1 % ) or haloperidol ( 58.0 % ) . Conclusion Current medication practice s for immediate aggression control are effective with positive results present within a few days . In this study , concomitant benzodiazepine use was significantly more frequent in patients receiving haloperidol Clozapine has been reported to improve selected aspects of cognitive function in neuroleptic-resistant schizophrenia . In this study , we report the first direct comparison of the effect of clozapine and typical neuroleptic drugs on cognitive function in neuroleptic-responsive schizophrenia . Sixty-four patients with recent onset , neuroleptic-responsive schizophrenia or schizoaffective disorder were r and omly assigned to either clozapine ( n = 35 ) or typical neuroleptics ( n = 29 ) and followed for 12 months . They were administered a comprehensive cognitive test battery at baseline and at 6 weeks , 6 months and 12 months after initiating drug treatment . Treatment with clozapine improved psychomotor speed and attention [ Digit Symbol Substitution Test ( DSST ) ] and verbal fluency [ Category Instance Generation and Controlled Word Association Test ( CWAT ) ] at 6 weeks . The improvement in these measures was maintained throughout the 12-month period . Treatment with typical neuroleptics produced no sustained improvement in any cognitive measure , except for a tendency to improve delayed recall memory ( Verbal List Learning Test ) . The improvement in the DSST and CWAT was significantly greater with clozapine treatment compared to that with typical neuroleptics . These improvements were not related to improvement in psychopathology . These results suggest that clozapine is superior to typical neuroleptics in improving specific types of cognitive function in recent onset , neuroleptic-responsive schizophrenia OBJECTIVE Data on the effectiveness of antipsychotics in the early phase of schizophrenia are limited . The authors examined the risk of rehospitalization and drug discontinuation in a nationwide cohort of 2,588 consecutive patients hospitalized for the first time with a diagnosis of schizophrenia between 2000 and 2007 in Finl and . METHOD The authors linked national data bases of hospitalization , mortality , and antipsychotic prescriptions and computed hazard ratios , adjusting for the effects of sociodemographic and clinical variables , the temporal sequence of the antipsychotics used , and the choice of the initial antipsychotic for each patient . RESULTS Of 2,588 patients , 1,507 ( 58.2 % ) collected a prescription for an antipsychotic during the first 30 days after hospital discharge , and 1,182 ( 45.7 % , 95 % confidence interval [CI]=43.7 - 47.6 ) continued their initial treatment for 30 days or longer . In a pairwise comparison between depot injections and their equivalent oral formulations , the risk of rehospitalization for patients receiving depot medications was about one-third of that for patients receiving oral medications ( adjusted hazard ratio=0.36 , 95 % CI=0.17 - 0.75 ) . Compared with oral risperidone , clozapine ( adjusted hazard ratio=0.48 , 95 % CI=0.31 - 0.76 ) and olanzapine ( adjusted hazard ratio=0.54 , 95 % CI=0.40 - 0.73 ) were each associated with a significantly lower rehospitalization risk . Use of any antipsychotic compared with no antipsychotic was associated with lower mortality ( adjusted hazard ratio=0.45 , 95 % CI=0.31 - 0.67 ) . CONCLUSIONS In Finl and , only a minority of patients adhere to their initial antipsychotic during the first 60 days after discharge from their first hospitalization for schizophrenia . Use of depot antipsychotics was associated with a significantly lower risk of rehospitalization than use of oral formulations of the same compounds . Among oral antipsychotics , clozapine and olanzapine were associated with more favorable outcomes . Use of any antipsychotic was associated with lower mortality Introduction Agitation is a major problem in acute schizophrenia . Only a few studies have tested antipsychotic agents in severely agitated patients , mainly because of legal issues . Furthermore , most studies were limited to the first 24 hours . We aim ed to investigate the efficacy of oral haloperidol , risperidone , and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over 96 hours using a prospect i ve , r and omized , rater-blinded , controlled design within a naturalistic treatment regimen . Methods In total , 43 severely agitated patients at acute care psychiatric units were enrolled . Participants were r and omly assigned to receive either daily haloperidol 15 mg , olanzapine 20 mg , or risperidone 2 to 6 mg over 5 days . Positive and Negative Syndrome Scale psychotic agitation subscale score was the primary outcome variable . A mixed-model analysis was applied . Results All drugs were effective for rapid tranquilization within 2 hours . Over 5 days , the course differed between agents ( P < 0.001 ) , but none was superior . Dropouts occurred only in the risperidone and olanzapine groups . Men responded better to treatment than did women during the initial 2 hours ( P = 0.046 ) as well as over the 5-day course ( P < 0.001 ) . No difference between drug groups was observed regarding diazepam or biperiden use . Conclusions Oral haloperidol , risperidone , and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders . Response to oral antipsychotics demonstrated a gender effect with poorer outcome in women throughout the study This study prospect ively compared the effectiveness of atypical antipsychotic medications to that of conventional neuroleptics in reducing violent behavior  among patients with schizophrenia under " usual care " conditions in the community . Participants ( n = 229 ) were adults with schizophrenia spectrum disorders receiving inpatient or outpatient services in public sector mental health systems in North Carolina . Subjects were followed for 2 years in an observational study using multiple methods of data collection at 6-month intervals to assess treatment , sociodemographic characteristics , clinical features , and violence outcomes . Treatment with atypical antipsychotic medications ( clozapine , risperidone , or olanzapine ) was found to significantly reduce the risk of violent behavior , whereas treatment with conventional neuroleptics did not have this same beneficial effect . A cumulative effect on reduced violence was attributable to consistent compliance with atypical antipsychotic medications over a 2-year period . Concurrent reductions in psychotic symptoms , substance abuse , and adverse medication side effects were found to mediate the association between adherence with atypicals and lower violence risk . Treatment with atypical antipsychotic medications should be considered as an important component of violence risk management for schizophrenia patients at risk for violent behavior Objective This study aim ed to compare the efficacy and safety of quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis in a r and omized , open-label , blinded-rater , parallel group trial . Methods Forty-five patients with Parkinson disease ( PD ) and psychosis induced by antiparkinsonian drugs were r and omly assigned to receive either quetiapine or clozapine . The duration of the trial was 12 weeks . Forty patients , 20 in each treatment group , completed the study . The final dose of quetiapine ( mean ± SD ) was 91 ± 47 mg/d and that of clozapine 26 ± 12 mg/d . The severity of psychosis was assessed using the Brief Psychiatric Rating Scale ( BPRS ) and the Clinical Global Impression Scale – Severity Subscale ( CGI-S ) . The Unified Parkinson ’s Disease Rating Scale ( UPDRS ) III was used to assess motor conditions during the study period . The Abnormal Involuntary Movement Scale ( AIMS ) was performed to evaluate dyskinesias . Results Forty patients , 20 on clozapine and 20 on quetiapine , completed the study . The psychopathologic state improved significantly ( P < 0.001 ) from baseline in both treatment groups . No differences were found between clozapine and quetiapine at any assessment time . Motor conditions remained unchanged after clozapine and quetiapine . Dyskinesias decreased significantly ( P < 0.05 ) in both groups . Side effects were mild , generally transient , and well tolerated . Conclusions Quetiapine and clozapine appear equally efficacious for treatment of dopaminergic psychosis in patients with PD INTRODUCTION Although the use of atypical antipsychotics is the st and ard of care in the maintenance treatment of psychosis , most clinicians still rely on conventional neuroleptics to treat acutely agitated psychotic patients . The objective of this study was to evaluate the effectiveness and safety of a fast orally disintegrating tablet formulation of risperidone in the initial treatment of a large sample of very acutely ill psychotic patients . METHODS In this multi-center , prospect i ve , open-label observational trial , 191 schizophrenic patients were treated upon admission to hospital with fast orally disintegrating risperidone tablets for up to seven days . Co-medication was per usual clinical practice and at physician 's discretion . Psychopathology was rated at baseline , 2 , 24 and 48 hours and 4 and 7 days after initiation of therapy . RESULTS A mean PANSS total score of 114.3+/-23.4 at baseline reflected a severely exacerbated patient population . The PANSS total score was significantly reduced to 83.6+/-26.8 ( p<0.0001 ) and the CGI from 5.6+/-0.7 to 4.5+/-1.1 ( p<0.0001 ) after 7 days . The median time to calmness was 70 min and the associated PANSS item 4 ( excitation ) dropped two hours after the first intake of the study medication from 4.3+/-1.5 to 3.1+/-1.5 ( p<0.0001 ) . A total of 172 patients ( 90.1 % ) out of 191 completed the study . The median risperidone dose was 2 mg/d at the initiation of therapy and 4 mg/d after one week . CONCLUSION Oral treatment of acutely exacerbated schizophrenic patients with fast orally disintegrating risperidone tablets , alone or in combination with benzodiazepines , was associated with a rapid onset of action and a significant and clinical ly relevant improvement of acute symptoms In an open clinical multi-centre trial carried out in five Danish psychiatric departments , patients suffering from acute psychosis including mania or exacerbation of chronic psychosis were given injections of 5 % zuclopenthixol acetate in ' Viscoleo ' . The object of the trial was to evaluate the treatment by means of a global assessment of the severity of the psychosis , the therapeutic effect and the side-effects . The results showed that the treatment was rapidly effective in reducing the severity of psychotic symptoms combined with an advantageous unspecific sedation . The side-effect profile was similar to that after other neuroleptics . Special attention should be paid , however , to a possible occurrence of acute dystonia which was observed particularly in young men with acute psychosis
REVIEW ER 'S CONCLUSIONS We found no significant evidence to support the use of clotiapine rather than other ' st and ard ' or ' non-st and ard ' treatments for the management of  acute psychotic illness .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , requires urgent pharmacological tranquillisation or sedation .
Clotiapine , a dibenzothiazepine neuroleptic , is being used for this purpose in several countries .
OBJECTIVES To estimate the effects of clotiapine when compared to other ' st and ard ' or ' non-st and ard ' treatments of acute psychotic illness in controlling disturbed behaviour and reducing psychotic symptoms .