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Molindone for schizophrenia and severe mental illness

  • Review
  • Intervention

Authors


Abstract

Background

Antipsychotic therapy is the mainstay of treatment for people with schizophrenia. In recent years new or atypical antipsychotics have been introduced. These are less likely to produce movement disorders and raise serum prolactin.

Researchers have suggested that molindone should be classified as an atypical antipsychotic.

Objectives

To determine the effects of molindone compared with placebo, typical and other atypical antipsychotic drugs for schizophrenia and related psychoses.

Search methods

For the original search we searched the following databases: Biological Abstracts (1980-1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE (1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999). We also searched pharmaceutical databases on the Dialog Corporation Datastar and Dialog and the references of all identified studies for further trials. Finally, we contacted the manufacturer of molindone and the authors of any relevant trials.

For the update of this review, we searched The Cochrane Schizophrenia Group's Trials Register (August 2005).

Selection criteria

We included all randomised controlled trials that compared molindone to other treatments for schizophrenia and schizophrenia-like psychoses.

Data collection and analysis

We extracted data independently and analysed on an intention to treat basis calculating, for binary data, the fixed effect relative risk (RR), their 95% confidence intervals (CI), and the number needed to treat or harm (NNT or NNH). We excluded data if loss to follow up was greater than 50%.

Main results

We included fourteen studies. Duration ranged from very short (10 days) studies of the intramuscular preparation, to trials lasting over three months. For measures of global assessment, available data do not justify any conclusions on the comparative efficacy of molindone and placebo. When compared to other typical antipsychotics we found no evidence of a difference in effectiveness (doctors' 4 RCTs n=150, RR 1.13, CI 0.69 to 1.86; nurses 4RCTs n=146, RR 1.23, CI 0.82 to 1.86). Molindone is no more or less likely than typical drugs to cause movement disorders, but it does cause significantly more weight loss (2RCTs n=60 RR 2.78, CI 1.10 to 6.99, NNH 5 CI 2 to 77).

Authors' conclusions

The strength of the evidence relating to this compound is limited, owing to small sample size, poor study design, limited outcomes and incomplete reporting. Molindone may be an effective antipsychotic but its adverse effect profile does not differ significantly from that of typical antipsychotics (apart from the event of weight loss). Data from this review suggest, at present, there is no evidence to suggest that it may have an atypical profile.

摘要

背景

Molindone在精神分裂症及嚴重精神疾患的使用

抗精神病藥物是罹患精神分裂症患者的最主要治療,在最近幾年,新的抗精神病藥或非典型抗精神病藥開始被介紹使用。這些藥物有比較少產生動作疾病副作用及提高催乳激素血中濃度的可能。研究人員建議molindone應被歸類在非典型抗精神病藥。

目標

為決定比較molindone與安慰劑、典型抗精神病藥及其他非典型抗精神病藥用在精神分裂症及相關精神病患者的治療效果

搜尋策略

原始的搜尋,我們搜尋了下列的資料庫: Biological Abstracts (1980 – 1999), The Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's Register (January 1999), CINAHL (1982 – 1999), EMBASE (1980 – 1999), MEDLINE (1966 – 1999), LILACS (1982 – 1999), PSYNDEX (1977 – 1999), and PsycLIT (1974 – 1999)。我們也在Dialog Corporation Datastar and Dialog的藥商資料庫搜尋及所有可辨試驗的相關參考文獻。最後,我們接觸molindone的製造商及任何相關試驗的作者。為更新這篇回顧,我們在2005年8月搜查的Cochrane Schizophrenia Group's Trials Register 的試驗登記。

選擇標準

我們納入所有比較molindone及其他治療,在治療精神分裂症及類似精神分裂症精神病的隨機控制試驗。

資料收集與分析

我們獨立擷取資料,基於治療意向分析法,針對二分法資料,以固定效應計算相對風險(RR),其95%信賴區間(CI),及益需或害需治數(NNT或NNH)。我們把大於50%以上沒有後續追蹤的資料排除掉。

主要結論

我們納入了14個研究,這些試驗最短的是10天,以針劑的形式,而最長的達到3個月。從整體性的評估測量,所得的資料並不能得出molindone及安慰劑效益上差異的結論。當與其他典型抗精神病藥物比較,我們沒有發現任何證據顯示其不同效益(醫師的4個隨機臨床試驗 n = 150, RR 1.13, CI 0.69 to 1.86; 護理的4個隨機臨床試驗 n = 146, RR 1.23, CI 0.82 to 1.86)。Molindone跟典型的藥物造成運動障礙的可能性差不多,但它確實造成顯著更多的體重減少(2個隨機臨床試驗 n = 60 RR 2.78, CI 1.10 to 6.99, NNH 5 CI 2 to 77)。

作者結論

關於此合成物的證據強度因小數量的試驗個案,不佳的研究設計,有限的結果及不完整的報告所以是有限的。Molindone可能是一種有效的抗精神病藥物,但其副作用跟典型的抗精神病藥物並無顯著差異(除了體重減輕之外)。到目前從這篇回顧的資料,並沒有證據認為它可能具有非典型抗精神病藥物的特性。

翻譯人

本摘要由彰化基督教醫院許文郁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Molindone是一種老的抗精神病藥物,它具有的受器結合特性和一種新型非典型抗精神病藥物quetiapine相似。我們設法去確認molindone和安慰劑、典型抗精神病藥、非典型精神病藥比較其在治療精神分裂症及相關精神病的效果。我們納入了14個隨機控制試驗,相對於其他典型抗精神病藥物,molindone在治療效果上沒有任何差異,造成運動障礙的可能性差不多,然而它有明顯更多的體重減輕。目前還沒有證據顯示它可能有非典型的特性。

Plain language summary

Molindone for schizophrenia and severe mental illness

Molindone is an older antipsychotic drug with a receptor binding profile similar to that of quetiapine, a novel atypical antipsychotic. We sought to determine the effects of molindone compared with placebo, typical and atypical antipsychotics for treating schizophrenia and related psychoses. We included fourteen randomised controlled trials. When compared to other typical antipsychotics molindone shows no difference in effectiveness and is no more or less likely than typical drugs to cause movement disorders, it does however cause significantly more weight loss. At present there is no evidence to suggest that it may have an atypical profile.

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