Valproate + antipsychotics compared to antipsychotics + placebo or antipsychotics alone for schizophrenia[1]
Summary
There is limited evidence, based on a number of trials, that the augmentation of antipsychotics with valproate may be effective for overall clinical response, and also for specific symptoms, especially in terms of excitement and aggression. However, this evidence was entirely based on open RCTs. Moreover, valproate was associated with a number of adverse events among which sedation and dizziness appeared significantly more frequently than in the control groups. Further randomised studies which are blinded are necessary before any clear recommendation can be made. Ideally these would focus on people with schizophrenia and aggression, on those with treatment-resistant forms of the illness and on those with schizoaffective disorders.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Clinically significant response
Important change - as defined by the studies
Valproate + antipsychotics probably improves the outcome. Data are based on moderate quality evidence.
Valproate + antipsychotics probably slightly reduces the outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Use of additional medication for sedation at least once
Valproate + antipsychotics may improve the outcomes to do with how much hospital/community care is used, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
Clinical response - mean change score PANSS total (high = poor)
In average, people recieving valproate + antipsychotics scored 5.85 lower than people treated with antipsychotics + placebo or antipsychotics alone. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear.
Abnormal liver function/increase in alanine transaminase/gamma-glutamyl transpeptidase
Valproate + antipsychotics probably makes little or no improvement to the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Valproate + antipsychotics probably makes little or no improvement to the adverse effect or event outcome, but the difference between the two treatments is not clear. Data supporting this finding are based on moderate quality evidence.
Acupuncture added to standard dose antipsychotics versus standard dose antipsychotics for schizophrenia[1]
Summary
Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.
Measured Outcome
Findings in words
Findings in numbers
Quality of evidence
Global state
Not improved, endpoint - medium-term (various similar criteria)
Acupuncture added to standard dose antipsychotics may reduce the global state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may reduce the mental state outcome, but, at present there is only very limited data supporting this finding.
Acupuncture added to standard dose antipsychotics may improve the behaviour outcome, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
In average, people recieving acupuncture added to standard dose antipsychotics scored 16 lower than people treated with standard dose antipsychotics. There was no clear difference between the groups. The meaning of this in day-to-day care is unclear.
