Haloperidol versus placebo for schizophrenia

Joy CBronwen, Adams CE, Lawrie S

Summary

Haloperidol versus placebo for schizophrenia

Schizophrenia is a serious, disabling mental illness that can affect sufferers for most of their adult life; drug treatments are central to the care of people with schizophrenia. In the 1950's the introduction of chlorpromazine and haloperidol, two typical antipsychotics, revolutionised the care of people with serious mental illness. Haloperidol was hailed as a breakthrough and considered to be the most potent antipsychotic known whilst appearing to keep side effects to a minimum. Despite the introduction of a newer generation of atypical antipsychotics, and increasing concern about haloperidol's propensity to cause movement disorders, worldwide, haloperidol is still one of the most commonly prescribed drugs for psychotic disorders. It is also often used as the benchmark comparison drug against which new compounds are rated.

We sought to objectively quantify the effects of this widely used drug by systematically searching for all known randomised controlled trials comparing the use of haloperidol for people with schizophrenia to placebo. We found 21 relevant trials that randomised 1519 people.

Results did show haloperidol to be an effective antispychotic, particularly in the short term. However, adverse effect data did justify concern over the increased incidence of serious movement disorders such as acute dystonia, akathisia and parkinsonism in those receiving haloperidol.

Haloperidol is often used in developing countries where the choice of treatments is limited, and if no other drugs are available, the use of haloperidol to treat psychosis can be justified. However, where other treatments are available, both clinicians and sufferers should be aware of the adverse effects of haloperidol and consider other antipsychotics with a lesser side effect profile.