People who have substance misuse problems but no mental illness can be treated via a variety of psychosocial interventions. These include motivational interviewing, or MI, that looks at people’s motivation for change; cognitive behavioural therapy, or CBT, which helps people adapt their behaviour by improving coping strategies; a supportive approach similar to that pioneered by Alcoholics Anonymous; family psycho‐education observing the signs and effects of substance misuse; and group or individual skills training. However, using these interventions for people with dual diagnosis is more complex.
The aim of this review was to assess the effects of psychosocial interventions for substance reduction in people with a serious mental illness compared to care as usual or standard care. A search for studies was carried out in July 2012; 32 studies were included in the review with a total of 3165 people. These studies used a variety of different psychosocial interventions (including CBT, MI, skills training, integrated models of care). In the main, evidence was graded as low or very low quality and no study showed any great difference between psychosocial interventions and treatment as usual. There was no compelling evidence to support any one psychosocial treatment over another. However, differences in study designs made comparisons between studies problematic. Studies also had high numbers of people leaving early, differences in outcomes measured, and differing ways in which the psychosocial interventions were delivered. More large scale, high quality and better reported studies are required to address these shortcomings. This will better address whether psychosocial interventions are effective and good for people with mental illness and substance misuse problems.
An update search for this review was carried out 28 January 2013; the review now includes 32 studies that assess the effects of pimozide for people with schizophrenia or similar mental health problems. Pimozide was compared with other antipsychotic drugs, placebo (‘dummy’ treatment) or no treatment. Results suggest that pimozide is probably just as effective as other commonly used ‘typical’ antipsychotic drugs (for outcomes such as treating mental state, relapse, leaving the study early). No studies included delusional disorders, so no information is available on this group of people. No evidence was found to support the concern that pimozide causes heart problems (although this may be result of the fact that the studies were small and short term and the participants did not receive doses above recommended limits of 20 mg/d). Pimozide may cause less sleepiness than other typical antipsychotic drugs, but it may cause more tremors and uncontrollable shaking. The claim that pimozide is useful for treating people with negative symptoms also is not supported and proven. However, the quality of evidence in the main was low or very low quality, studies were small and of short duration and were poorly reported. Large‐scale, well‐conducted and well‐reported studies are required to assess the effectiveness of pimozide in the treatment of schizophrenia and other mental health problems such as delusional disorder.
The aim of this review was to evaluate the effects of haloperidol for schizophrenia and other similar serious mental illnesses compared with ‘dummy’ or no treatment (placebo). A new search for trials was carried out in May 2012 and the review now includes 25 studies with a total of 4651 people. Review authors rated the quality of evidence reported in the trials for seven main outcomes (global state, death, discharge from hospital, relapse, leaving the study early, adverse effects and satisfaction with treatment). For global state, leaving the study early and adverse effects the reviewers rated the evidence as moderate quality, however, relapse and discharge from hospital were rated to be very low quality evidence. There were no data available for death and satisfaction with treatment.
Based on moderate quality evidence, haloperidol was found to be better than placebo in treating schizophrenia. More people given haloperidol improved in the first six weeks of treatment than those given placebo. However, a significant number of people on haloperidol suffered from side effects, including muscle stiffness, uncontrollable shaking, tremors, sleepiness and restlessness.
Authors concluded that haloperidol is a potent and effective antipsychotic for treating the symptoms of schizophrenia but has the potential to cause debilitating side effects. People with schizophrenia and psychiatrists may wish to prescribe a newer antipsychotic drug with fewer side effects.
Finally, a large proportion of other information and data in the trials were poor and badly reported, meaning that better studies are required. Many people, from both groups left the trials early. This suggests that the design and running of the trials was poor and perhaps not acceptable to people. In light of these findings, it is perhaps surprising that haloperidol is a benchmark antipsychotic in widespread use for treating schizophrenia. It is also surprising that haloperidol is widely used as a comparison for new medication. Haloperidol is an effective antipsychotic drug but has serious and debilitating side effects.
Dance therapy (also known as dance movement therapy, DMT) uses movement and dance to explore a person’s emotions in a non‐verbal way (without language or words). The therapist helps the individual to interpret their dance and movement and link them with people’s personal feelings. Dance has been used as a healing ritual since earliest human history, but the establishment of dance therapy as a profession is quite recent. Dance therapy can be used with people of all ages, races and genders. It can be effective in the treatment of people with medical, social, developmental, physical and psychological impairments. The review included one study with 45 participants. The aim was to compare dance therapy with standard care or other interventions. The one included study compared dance therapy plus routine care with routine care alone. In the main, there was no difference between those who engaged in dance therapy versus those who did not (for outcomes such as satisfaction with care, mental state, leaving the study early, quality of life). However, those who engaged in dance therapy showed significant improvement in negative symptoms.
Overall, because of the small number of participants, the findings are limited. There is little evidence to support or refute the use of dance therapy. Larger studies and trials are needed that focus on important outcomes (such as rates of relapse, quality of life, admission to hospital, leaving the study early, cost of care and satisfaction with treatment). Further research would help clarify whether dance therapy is an effective and holistic treatment for people with schizophrenia, especially in terms of helping people cope with negative symptoms that do not respond so well to antipsychotic drugs.
Publishing protocols is a crucial element of the process of producing Cochrane Reviews. PROSPERO, the international prospective register of systematic reviews in health and social care, now provides a place to register protocol information for all such reviews.
PROSPERO is web-based, free to search and open for free registration to anyone undertaking a systematic review with a health-related outcome. Launched in February 2011, PROSPERO now contains registrations of more than 2,300 reviews being undertaken in 63 different countries.
As part of a series of events to mark The Cochrane Collaboration's 20th Anniversary, a series of videos has been commissioned focusing on the ideas, achievements and people that have contributed to the Collaboration's growth since 1993.External link for more information: http://anniversary.cochrane.org Contributor's Information Contributor's name: Cochrane Web Team Email address: email@example.com
Philippines residents have extended free access to Cochrane evidence in the aftermath of Typhoon Haiyan
The Philippines, already dealing with significant casualties and damage following a magnitude 7.2 earthquake on 15 October, experienced widespread destruction and additional casualties from Typhoon Haiyan in early November.External link for more information: http://www.thecochranelibrary.com/details/collection/58... Contributor's Information Contributor's name: Nancy Owens Email address: firstname.lastname@example.org
The value of user‐held personal information for those with severe mental illnesses is not known however and research evaluating the effectiveness is rare. Some research suggests that while many people decline the offer of a user‐held record, the majority of those who carry their records report this to be useful.
Based on a search in 2011, this review includes four trials with a total of 607 people and evaluates the effects of user‐held information for people with severe mental illness. In the main, the number of relevant studies is low, with poor reporting of some outcomes. Based on moderate quality evidence, the review found that user‐held information did not decrease hospital admissions, and did not decrease compulsory admissions or encourage people with severe mental illness to attend appointments (when compared to treatment as usual). Other important outcomes, such as satisfaction with care, costs and effect on mental health, were not available due to the limited quality of the four studies. There is therefore a gap in knowledge and evidence regarding user‐held information for people with severe mental health problems. Further evidence is also required on the different types of user‐held information (for example, if it involves the mental health team and what type of information is included in the record). Large‐scale, well‐conducted and well‐reported studies are required to assess the effects of user‐held information for people with mental illness. Two important randomised studies are currently taking place. For the present, despite a gap in evidence, user‐held information is low cost and acceptable to patients, so its use is likely to grow. However, it cannot be assumed that user‐held information is of benefit to people and is cost‐effective without further large‐scale, well‐conducted and well‐reported trials.
The benefits of antipsychotic drugs, such as haloperidol, need to be weighed against their tendency for causing debilitating side effects (such as movement disorders, weight gain, lack of drive) and in some cases an increased likelihood of physical illnesses such as diabetes and heart disease. These debilitating side effects may mean that people stop taking their medication, which can lead to relapse and going into hospital. It is, therefore, important to find a tolerable and effective dose of haloperidol, which helps control the symptoms of schizophrenia but with fewer side effects.
The main aim of this review was to determine the best range of doses of haloperidol for the treatment of schizophrenia. Nineteen trials were included that compared varying doses of haloperidol. Despite over 30 years of trials, data on the effects of differing doses of haloperidol are sparse and poorly reported. This is especially so for the lower dose ranges generally used for the treatment of schizophrenia today. However, lower doses of haloperidol may be just as effective as higher doses but result in fewer side effects. This review also suggests that an important bias against haloperidol may exist in modern trials comparing new drugs with haloperidol. Results are not conclusive and are based on small, short studies of limited quality.
The authors of the review note that it would be understandable if psychiatrists were cautious about prescribing doses above 7.5 mg a day and if people with schizophrenia did not want to take higher dosages. Further research is needed to assess the tolerability and effectiveness of lower doses. Low doses of haloperidol may be just as good as higher doses, but with fewer side effects.
The Canadian Cochrane Centre (CCC) is very pleased to announce the opening of the Québec Branch of the CCC. Jeremy Grimshaw, Director of the CCC, formally announced the establishment of the Québec Branch at the Opening Ceremony of the 2013 Colloquium. The Branch will be co-directed by Dr. Paul Fortin and Dr France Légaré; Dr Légaré is a Cochrane author and has been working with the CCC as the Cochrane site representative at Université Laval for 14 years.External link for more information: http://www.ccc.cochrane.org Contributor's Information Contributor's name: Mary Ellen Schaafsma Email address: email@example.com
Many published systematic reviews restrict included studies to those published in English, and so do not make use of all available evidence. We would like to examine whether machine translation provides a reasonable enough translation for non-English language studies to be included in systematic reviews.
Cochrane methodologists from all over the world attended a successful Methods Symposium at the Université Laval, Québec City, on 24 September, immediately following the 2013 Cochrane Colloquium.External link for more information: http://methods.cochrane.org/projects-developments/metho... Contributor's Information Contributor's name: Jackie Chandler Email address: firstname.lastname@example.org
The Cochrane Collaboration is delighted to announce that the Malaysian Cochrane Network has been approved as a Branch of the Australasian Cochrane Centre. The Network will have its base at Penang Medical College but includes several sites around Malaysia, reflecting the main centres for Cochrane Review activity.
Several prizes are awarded annually to contributors to The Cochrane Collaboration. This year, the prizes were awarded at the 2013 Cochrane Colloquium in Quebec City, Canada:External link for more information: http://www.cochrane.org/about-us/awards-scholarships-fu...
23rd & 24th April 2014, Manchester
Renold Building, Manchester University, UK
Registration will be opening soon for our Annual Symposium, make sure you save the date for what will hopefully be another exciting and thought-provoking event!
The Cochrane Comparing Multiple Interventions Methods Group has put together a number of resources on their website.
These include:External link for more information: http://cmimg.cochrane.org/comparing-multiple-interventi... Contributor's Information Contributor's name: Lorne Becker Email address: email@example.com