Review: pimozide had effects on global operation and mental state similar to typical antipsychotic drugs for schizophrenia

Free

Loading

  1. Gregory East Gray , MD, PhD
  1. Charles R Drew University of Medicine and Science, Los Angeles, California, USA

Statistics from Altmetric.com

Sultana A, McMonagle T. Pimozide for schizophrenia or related psychoses. Cochrane Database Syst Rev 2000; 3 :latest version 26 Sep 2000.

QUESTION: Is pimozide effective for improving symptoms in patients with schizophrenia or delusional disorder?

Data sources

Studies were identified by searching electronic databases, the Cochrane Library (to April 1999), references of relevant studies, and high yield journals and past contacting authors and manufacturers of pimozide.

Study selection

Studies were selected if they were randomised controlled trials that compared pimozide with placebo, no treatment, or another drug in people with schizophrenia or delusional disorder. Exclusion criteria included schizoaffective disorder, dementing illnesses, depression, and substance abuse.

Information extraction

Reviewers assessed the quality of study methods using the criteria in the Cochrane Collaboration Handbook and the Jadad scale. Data were extracted on methods, patients, drug regimens, and outcomes.

Main results

34 studies met the selection criteria. Most of the 1278 patients (mean age approximately 43 y) had schizophrenia, and none had delusional disorder. The mean dose of pimozide (sixteen studies) was 7.5 mg/day (range 1–70 mg/d in 26 studies). Fewer patients in the pimozide group than in the placebo group had clinical relapses at half-dozen months to 1 yr (3 studies, 103 patients; table⇓). At three–12 months, fewer patients in the pimozide grouping than in the placebo grouping withdrew for any reason (table⇓). 29 studies compared pimozide with oral neuroleptic drugs; five studies involved a long acting depot preparation (fluphenazine decanoate), and no studies involved atypical antipsychotic drugs. Pimozide and oral neuroleptic drugs had like results for global country, mental state, or leaving the report early, and there were no consequent differences in adverse events, including deaths.

View this tabular array:

  • View inline

Pimozide (pim) 5 placebo for schizophrenia or related psychoses*

Conclusions

Pimozide led to results for global and mental states similar to typical neuroleptic drugs in patients with schizophrenia. No data from randomised controlled trials exist for the utilize of pimozide in delusional disorder.

Commentary

Pimozide is a high potency antipsychotic medication which has been used in many countries since the 1970s for the treatment of schizophrenia and other psychoses. In the US, it was licensed in the past decade every bit an "orphan drug" for the treatment of Tourette's syndrome.

Sultana and McMonagle have identified randomised controlled trials of pimozide for the handling of schizophrenia. Not surprisingly, pimozide was found to be more than constructive than placebo for preventing relapse and was similar to other typical antipsychotic drugs in efficacy and side event profile.

Several unanswered questions remain. It has been claimed that pimozide is more constructive than other typical antipsychotic drugs for treating negative symptoms of schizophrenia.one None of the studies included in the review specifically reported on negative symptoms as an outcome, so the review was unable to support or abnegate this merits. In improver, the efficacy of pimozide relative to the newer atypical antipsychotic drugs is unknown because no trial comparing pimozide with an singular antipsychotic drug was identified.

The safety of pimozide has been questioned after case reports of arrhythmias, prolongation of the QTc (QT corrected for eye rate) interval, and sudden expiry.2 This review plant no differences in deaths or cardiac symptoms betwixt pimozide and other antipsychotic drugs. Few useful ECG information were reported, so recommendations regarding ECG monitoring could not be derived.

Lastly, none of the clinical trials involved patients with delusional disorder. Although pimozide is ofttimes recommended as the outset line drug in the treatment of delusional disorder,3 this is based largely on case reports.4 Clinical trials comparison pimozide with other antipsychotics in the handling of delusional disorder are clearly warranted.

References

  1. ↵

    Opler LA, Feinberg SS. The office of pimozide in clinical psychiatry: a review. J Clin Psychiatry 1991;52:221–33.

  2. ↵

    Royal College of Psychiatrists' Psychopharmacology Sub-Group. The association between antipsychotic drugs and sudden death. Council Report CR 57. London: Royal College of Psychiatrists, 1997.

  3. ↵

    Csernansky JG. Delusional disorder. In: Dunner DL, editor. Current psychiatric therapy. 2nd edition. Philadelphia, PA: WB Saunders, 1997.

  4. ↵

    Munro A, Mok H. An overview of treatment in paranoia/delusional disorder. Can J Psychiatry 1995;40:616–22.

Request Permissions

If you wish to reuse any or all of this commodity delight use the link below which will take you to the Copyright Clearance Eye's RightsLink service. You will exist able to get a quick price and instant permission to reuse the content in many dissimilar means.

Copyright data:

Copyright 2000 by the Evidence-Based Mental Health