Video game addiction is associated with early stage of inhibitory control problems: An event-related potential study using cued Go/NoGo task.

Video game addiction (VGA) is associated with cognitive problems, particularly deficits in inhibitory control. The present study aimed to investigate behavioural responses and event-related potential associated with specific response inhibition using the cued Go/NoGo task to examine the effects of VGA on brain activity related to response inhibition. Twenty-five individuals addicted to video games (action video games) and 25 matched healthy controls participated in the study. The results showed that the VGA group had significantly more commission error in the NoGo trials and faster reaction time in the Go trials compared with the control group. The event-related potential analyses revealed significant reductions in amplitudes of N2 cue and N2 NoGo in the VGA group. While there was no significant difference between the N2 amplitudes of the Go and NoGo trials in the VGA group, the control group had a larger N2 amplitude in the NoGo trials. These results indicate that VGA subjects have difficulties in the early stages of response inhibition, as well as some level of impairment in proactive cognitive control.

EEG-biomarker theta/beta ratio and attentional quotients in adults who stutter: An electrophysiological and behavioral study.

INTRODUCTION: There is increasing evidence that connects developmental stuttering to attention. However, findings have represented contradiction. Therefore, this study was conducted to investigate the possible relationship between stuttering and attention in resting and undertask conditions. METHODS: In a cross-sectional study, 26 right-handed AWS (adults who stutter) and 25 matched fluent speakers were enrolled. Demographic data were collected, and the Beck anxiety inventory (BAI) was filled out for all participants. Then, QEEG was conducted, followed by IVA2. CPT test for all subjects. Finally, data were analyzed using SPSS software version 16. RESULTS: AWS indicated significantly weaker auditory focus attention in the task (p = .02) than the control group, while a similar resting-state EEG marker of attention was found between groups (p > .05). Moreover, attention was not correlated between the two conditions (p > .05). CONCLUSION: The EEG marker of attention did not necessarily designate the attentional performance of AWS under the task. Furthermore, attentional skills could be considered in the assessment and therapeutic programs of at least some groups of AWS.

Validation of the Persian version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women.

BACKGROUND: Anxiety disorder is more common in women than men. To some extent, it can be attributed to childbirth and factors related to pregnancy in women. Therefore, it is necessary for mothers to use valid and reliable scale to assess perinatal anxiety, such as the perinatal anxiety screening scale (PASS). The purpose of this study was to investigate the validity and reliability of the PASS in Persian language. METHODS: The PASS was translated into Persian (PASS-IR). Generally, 224 women antenatal and 125 postnatal answered the questions of PASS, EPDS-10, BAI and DASS-21 questionnaires. The data was collected in the health centers of Kerman by random sampling method. Finally, content validity, factor analysis, internal consistency and test-retest reliability were evaluated. RESULTS: The mean age of the participants was 32.89 years (range between 18 and 45 and SD = 6.23). More than half of the participating were at risk of severe anxiety (53.5%). Content Validity Index (CVI) and Content Validity Ratio (CVR) were 0.80 and 0.87. PASS-IR subscales include social anxiety and specific fears, general anxiety and adjustment, acute anxiety and trauma, and perfectionism and control. PASS-IR was significantly correlated with EPDS-10 (rho = 0.42), BAI (rho = 0.53), DASS-21 with three concepts of depression, anxiety and stress (rho = 0.51, rho = 0.49 and rho = 0.49), and adverse life events (rho = 0.30). CONCLUSION: The results of this study show that PASS-IR has good validity and reliability. Therefore, it can be used to screen for anxiety disorder among Iranian women in the perinatal stage.

Designing the minimum data set of bipolar disorder: A basis for introducing the effective factors in managing, controlling, and monitoring the bipolar disorder.

BACKGROUND AND AIM: Bipolar disorder (BD) is one of the most challenging psychiatric disorders in the management area that can lead to functional, occupational, and cognitive disorders. Without proper care, this complication can lead to profound psychological challenges and even death. The aim of this study is to design a minimum data set (MDS) for BD. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted in two steps. In the first step, a survey was conducted in PubMed, Web of Science, and SCOPUS databases to identify the demographic, managerial, and clinical data elements. Then, the required data elements were extracted from the studies by the data extraction form and used in a questionnaire. In the second step, to confirm the data element set, the designed questionnaire was distributed and collected among 20 psychiatrists and subspecialists during a two-stage Delphi technique. Descriptive statistics (frequency and mean) were conducted to analyze the data. RESULTS: Totally, 112 managerial and clinical data elements in 14 categories were extracted from the studies. Based on the experts' opinion and their consensus, 88 necessary data elements were considered to bipolar MDS. "Medication nonadherence," "history of suicide," and "substance abuse and addiction" were the most important data elements. CONCLUSION: In this study, an MDS was designed for BD. Providing this MDS, in addition to improving the clinical processes, it is possible to help electronic system designers and health data managers to know what information should be included in the health systems or any kind of self-care or self-management software to meet the information needs of these patients.

Proactive and reactive inhibitory control are differently affected by video game addiction: An event-related potential study.

INTRODUCTION: Video game addiction (VGA) is associated with physical and mental disorders, one of which is problem in executive function, particularly inhibitory control. The present study aimed to investigate reactive and proactive inhibitory controls by event-related potential (ERP). METHODS: Thirty video game (action video games)-addicted subjects and 30 matched healthy controls participated in the study, who were tested by the selective stop-signal task. RESULTS: The main results revealed that the VGA group had significantly more problems in preparatory processes and proactive stop trials, showing that VGA has a negative effect on proactive inhibition. CONCLUSION: Finding the problem in proactive inhibitory control might be helpful in developing new treatments and rehabilitation methods in these fields.

Neurocognitive Functions Related to Parietal Lobe in Patients with Schizophrenia and Methamphetamine Induced Psychotic Disorder and Healthy Individuals: A Comparative Study.

Background: There are some inconsistent findings about neurocognitive functions in schizophrenia and methamphetamine induced psychosis (MIP). This study aimed to compare these two disorders in terms of neurocognitive functions related to parietal lobe. Methods: This was a cross-sectional study in which 30 patients with schizophrenia, 30 patients with MIP, and 32 healthy individuals were compared. The two groups of patients were selected through convenience sampling from among patients hospitalized in Shahid Beheshti hospital in Kerman, Iran and healthy individuals were selected via convenience sampling from among the employees of Kerman University of Medical Sciences. The three groups were administered clock-drawing test (CDT), Rey-Osterrieth complex figure (ROCF) copying test, and interlocking finger test (IFT) and their demographic and clinical data were collected. The one-way analysis of variance (ANOVA) was used to investigate the differences between the groups. Multivariate analysis of covariance was also used to examine the effects of confounding factors. Besides, follow-up pairwise comparisons were performed after adjustment for multiple testing. Findings: The group with schizophrenia had significantly more impairment than the group with MIP with reference to the results of IFT and the ROCF test. However, the scores of patients with MIP on these two tests were not different from those of the normal controls. With regard to the CDT, the only significant difference was observed between the group with schizophrenia and controls. Conclusion: On the condition that the results are replicated in other studies, some parietal lobe neurocognitive tests might be used when it is difficult to differentially diagnose schizophrenia and MIP.

Comparing Cognitive Functions in Patients with Schizophrenia and Methamphetamine-Induced Psychosis with Healthy Controls.

Background: There are similar findings about the similarities and differences of cognitive dysfunctions in patients with schizophrenia and methamphetamine-induced psychosis (MIP). This study aimed to compare cognitive functioning in schizophrenia and MIP patients, using a performance-based cognitive assessment battery and an interview-based assessment of cognition. Methods: Three groups participated in this study including, (a) 30 patients with MIP, (b) 30 patients with schizophrenia, and (c) 30 healthy individuals. All participants received the Brief Assessment of Cognition in Schizophrenia (BACS), a standardized performance-based cognitive battery, the Schizophrenia Cognition Rating Scale (SCoRS), and the interview-based assessment of cognition. Findings: Both groups of patients with schizophrenia and MIP performed poorly on all the BACS cognitive domains compared with the healthy controls. The two patient groups were significantly different on the three BACS subscales including verbal fluency, verbal memory, and speed of information processing. Schizophrenia patients performed worse than the MIP group concerning these three subscales. However, the two patient groups were similar in executive function, working memory, and motor speed. Moreover, the SCoRS-informant, SCoRS-global, and PANSS-negative significantly differed between schizophrenia and MIP patients. Conclusion: Although cognitive dysfunctions are mostly similar in patients with MIP and schizophrenia, there are some differences especially in the functions related to prefrontal and temporal lobes.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients.

BACKGROUND: Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors. MATERIALS AND METHODS: This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity. RESULTS: Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively). CONCLUSION: The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

Auditory processing in schizophrenia: Behavioural evidence of abnormal spatial awareness.

Spatial processing deficits are the reason for many daily life problems of schizophrenia (SCZ) patients. In this study, we aimed to examine the possibility of abnormal bias to one hemifield, in form of hemispatial neglect and extinction, in auditory modality in SCZ. Twenty-five SCZ patients and 25 healthy individuals were compared on speech tasks to study the auditory neglect and extinction, as well as an auditory localization task for studying neglect. In the speech tasks, participants reproduced some nonsense syllables, played from one or two speakers on the right and/or left sides. On the localization task, examinees discriminated the subjective location of the noise stimuli presented randomly from five speakers. On the speech task, patients had significantly lower hit rates for the right ear compared with controls (p = 0.01). While healthy controls showed right ear advantage, SCZs showed a left ear priority. In the localization task, although both groups had a left-side bias, this bias was much more prominent for the patients (all p < 0.05). SCZ could potentially alter the auditory spatial function, which may appear in the form of auditory neglect and extinction on the right side, depending on the characteristics of patient population.

Validity and reliability of a Persian version of the self- evaluation of negative symptoms (SNS).

AIM: The Self-evaluation of Negative Symptoms (SNS) has been developed to allow schizophrenia patients to evaluate themselves in five dimensions of negative symptoms. The present study aimed to examine psychometric properties of the Persian version of SNS. METHODS: A group of 50 patients with schizophrenia and a group of 50 healthy controls received the Persian-SNS. Severity of negative symptoms were evaluated by the Scale for Assessment of Negative symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS). RESULTS: The results showed that the Cronbach's alpha for the Persian SNS was 0.95. The Persian-SNS and its subscales showed significant positive correlations with the total SANS score and SANS subscales as well as BPRS negative subscale, thus confirming the validity of the scale. Finally, the Persian-SNS showed the ability to discriminate patients with schizophrenia from healthy controls. CONCLUSION: The acceptable properties of the Persian version of SNS demonstrated that it is a practical tool for screening negative symptoms in Persian-speaking schizophrenia patients.

Nanocurcumin as an Add-on to Antipsychotic Drugs for Treatment of Negative Symptoms in Patients With Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study.

PURPOSE/BACKGROUND: It is well documented that one of the pathophysiological mechanisms of negative symptoms in patients with schizophrenia is hypofunction of N-methyl-d-aspartate receptors. This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of nanocurcumin as an adjuvant agent on psychotic symptoms, especially negative symptoms, in patients with chronic schizophrenia. METHODS/PROCEDURES: Fifty-six inpatients with stable chronic schizophrenia and predominant negative symptoms were randomized in a 1:1 ratio to nanocurcumin soft gel capsule (160 mg/d) and control groups, along with their antipsychotic regimen for 16 weeks. The efficacy of treatment was assessed by Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement scales. Extrapyramidal symptoms were evaluated by Simpson-Angus Scale and Barnes Akathisia Rating Scale. Patients were assessed at baseline and weeks 4, 8, 12, and 16 after the medication started. FINDINGS/RESULTS: No significant differences were observed in demographic or clinical variables between both groups at baseline. The nanocurcumin group showed significantly greater improvement on the negative subscale (P = 0.05), the general psychopathology subscale (P < 0.001), the positive subscale (P = 0.004), total Positive and Negative Syndrome Scale (P < 0.001), Clinical Global Impressions-Severity (P < 0.001), and Clinical Global Impressions-Improvement scores (P < 0.001) in comparison with the control group at the endpoint. Extrapyramidal symptom rating scales and Calgary Depression Scale for Schizophrenia and frequency of other adverse effects were comparable between 2 groups. IMPLICATIONS/CONCLUSIONS: The present study indicates nanocurcumin as a safe and potential adjunctive treatment strategy for treatment of primary negative symptoms of schizophrenia.

Looking into a Deluded Brain through a Neuroimaging Lens.

Delusions are irrational, tenacious, and incorrigible false beliefs that are the most common symptom of a range of brain disorders including schizophrenia, Alzheimer's, and Parkinson's disease. In the case of schizophrenia and other primary delusional disorders, their appearance is often how the disorder is first detected and can be sufficient for diagnosis. At this time, not much is known about the brain dysfunctions leading to delusions, and hindering our understanding is that the complexity of the nature of delusions, and their very unique relevance to the human experience has hampered elucidation of their underlying neurobiology using either patients or animal models. Advances in neuroimaging along with improved psychiatric and cognitive modeling offers us a new opportunity to look with more investigative power into the deluded brain. In this article, based on data obtained from neuroimaging studies, we have attempted to draw a picture of the neural networks involved when delusion is present and evaluate whether different manifestations of delusions engage different regions of the brain.

Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial.

OBJECTIVE: The objective of this study was to examine the effect of mobile phone applications (App) based cognitive behavioral therapy (CBT) on postpartum depression. METHOD: A non-blinded parallel-group randomized controlled trial was conducted. The study population consisted of women attended to three health care centers in Kerman, Iran. Participants were recruited between September and November 2018, and randomized 1:1 to either the intervention group (mobile application access) or control group (no mobile application access). All participants completed the Edinburgh Postnatal Depression Scale (EPDS) at the baseline and 2 months after baseline. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression. RESULTS: A total of 75 women with an average age of 27 years participated in this study. Before the intervention, there was no statistically significant difference between the EPDS score between the two groups (p > 0.001). However, in the intervention group, the average EPDS score after intervention was 8.18 and in the control group was 15.05, which was statistically significant (p < 0.001). CONCLUSION: These findings provide proof that providing a CBT program using a mobile application can lead to clinically important improvements in outcomes for mothers who suffer from postpartum depression.

Comparing Copper Serum Level and Cognitive Functioning in Patients With Schizophrenia and Healthy Controls.

INTRODUCTION: The altered serum profiles of several trace elements have been reported in Schizophrenia (SCZ). This study was designed to elucidate whether the serum levels of Copper (Cu) and Magnesium (Mg), the two essential trace elements which contribute to neurotransmitter transmission, are altered in patients with SCZ. We also investigated whether there is an interrelation between cognitive functioning and the serum levels of Cu and Mg. METHODS: Sixty patients with SCZ and 30 healthy controls participated in this study. The patient group was divided into the following: i) early patients (n=35, ≤5 years of illness initiation), and ii) chronic patients (n=25, ≥5 years of illness duration). The serum levels of Cu and Mg were measured by atomic absorption spectroscopy and ion-selective electrode potentiometry, respectively. To assess cognitive abilities, a Persian adaptation of the Brief Assessment of Cognition in Schizophrenia (BACS) was administered. RESULTS: The present research results revealed significantly higher Cu serum levels in both patient groups [early patients (M=94.6), chronic patients (M=97.5)], compared to the controls (M=71.0) (P<0.001); however, no significant difference was observed among the study groups for Mg [patients with the recent onset (M=2.0), chronic patients (M=2.0), and controls (M=1.9)] P=0.1. While the serum Cu profile of healthy individuals revealed a negative correlation with working memory (r=-0.42, P=0.02), and executive functioning (r=-0.40, P=0.03), no significant correlation was observed between Cu serum levels of patients and BACS cognitive domains. CONCLUSION: findings suggested that the high Cu serum concentration might impact the cognitive decline in healthy individuals; however, no significant correlation was observed in the Patients; i.e. most likely because cognition is severely impaired in SCZ. Additional studies examining trace elements in drug-naïve patients with SCZ are required.

Symmetrical electrophysiological brain responses to unilateral and bilateral auditory stimuli suggest disrupted spatial processing in schizophrenia.

Research has found auditory spatial processing deficits in patients with schizophrenia (SCZ), but no study has examined SCZ patients' auditory spatial processing at both pre-attentional and attentional stages. To address this gap, we investigated schizophrenics' brain responses to sounds originating from different locations (right, left, and bilateral sources). The event-related potentials (ERPs) of 25 chronic schizophrenic patients and 25 healthy subjects were compared. Mismatch negativity (MMN) in response to frequency and duration deviants was assessed. Two P3 components (P3a and P3b) were elicited via a frequency discrimination task, and MMN and P3 were recorded through separate monaural and dichotic stimulation paradigms. Our results corroborated the previously published finding that MMN, P3a, and P3b amplitudes are reduced in SCZ patients, but they showed no significant effect of stimulus location on either MMN or P3. These results indicated similarity between the SCZ patients and healthy individuals as regards patterns of ERP responses to stimuli that come from different directions. No evidence of auditory hemispatial bias in the SCZ patients was found, supporting the existence of non-lateralized spatial processing deficits in such patients and suggesting compensatory changes in the hemispheric laterality of patients' brains.

Evaluating the Diagnostic Agreement between Telepsychiatry Assessment and Face-to-Face Visit: A Preliminary Study.

Objective: Despite accumulated evidence that demonstrates clinical outcome of telepsychiatry is comparable with conventional method; little research has been done on telepsychiatry in developing countries. This study aimed to evaluate the diagnostic agreement between telepsychiatry assessment and face-to-face assessment. Moreover, patient and doctor satisfaction was assessed by self-report questionnaire. Method : This study was conducted in an inpatient department of a university-affiliated hospital in Kerman University of Medical Sciences, Iran. The study sample consisted of 40 inpatients aged over 18 years who were selected from October 2016 to February 2017. All patients were visited onc e by face-to-face conventional method and once by interactive video teleconsultation by 2 psychiatric consultants. Results: Results of this study revealed that the diagnostic agreement between the 2 interviewers was 75%. Moreover, about 85% of the patients preferred telepsychiatry for follow-up visits. Also, more than 82% of the patients would recommend telepsychiatry to others although 95% of them perceived contact via telepsychiatry as uncomfortable to some extent. Conclusion: Telepsychiatry service can be used for psychiatric evaluation in Iran, and it has a desirable effect on patient and doctor satisfaction. The results of this study showed the capacity of moving towards using telepsychiatry.

Bipolar disorder and the endocannabinoid system.

OBJECTIVE: Bipolar disorder (BD) is a debilitating, lifelong neuropsychiatric illness characterised by unsteady mood states which vacillate from (hypo)mania to depression. Despite the availability of pharmaceutical agents which can be effective in ameliorating the acute affective symptoms and prevent episodic relapse, BD is inadequately treated in a subset of patients. The endocannabinoid system (ECS) is known to exert neuromodulatory effects on other neurotransmitter systems critical in governing emotions. Several studies ranging from clinical to molecular, as well as anecdotal evidence, have placed a spotlight on the potential role of the ECS in the pathophysiology of BD. In this perspective, we present advantages and disadvantages of cannabis use in the management of illness course of BD and provide mechanistic insights into how this system might contribute to the pathophysiology of BD. RESULTS: We highlight the putative role of selective cannabinoid receptor 2 (CB2) agonists in BD and briefly discuss findings which provide a rationale for targeting the ECS to assuage the symptoms of BD. Further, data encourage basic and clinical studies to determine how cannabis and cannabinoids (CBs) can affect mood and to investigate emerging CB-based options as probable treatment approaches. CONCLUSION: The probable role of the ECS has been almost neglected in BD; however, from data available which suggest a role of ECS in mood control, it is justified to support conducting comprehensive studies to determine whether ECS manipulation could positively affect BD. Based on the limited available data, we suggest that activation of CB2 may stabilise mood in this disorder.

Comparison of Buprenorphine and Buprenorphine/naloxone in Detoxification of Opioid-dependent Men.

BACKGROUND: Buprenorphine sublingual tablets are now available in Iran for opioid detoxification in clinics. Aim of the present study was to compare the efficiency of buprenorphine with buprenorphine/naloxone in short-term detoxification in a group of Iranian male opioid-dependent patients. METHODS: A double-blind trial was carried out on a group of male opioid dependent patients in a psychiatric hospital in Kerman, Iran, during year 2017. A group of 100 men who met the diagnostic criteria for opiate dependence were included in the study from individuals who had referred for detoxification. They were allocated to the two groups receiving either buprenorphine (n = 51) or buprenorphine/naloxone (n = 49). Severity of withdrawal symptoms and signs were evaluated by Clinical Opiate Withdrawal Scale (COWS) and Adjective Rating Scale for Withdrawal (ARSW). FINDINGS: The mean scores of COWS and ARSW in the two groups treated with buprenorphine and buprenorphine/naloxone significantly reduced from the first day to the fifth day of detoxification (P < 0.050). Moreover, there was no significant difference between the two groups in terms of objective and subjective symptom reduction (P > 0.050). CONCLUSION: Buprenorphine/naloxone is as effective as buprenorphine in controlling opiate withdrawal symptoms.

Validation of the Persian version of the Schizophrenia Cognition Rating Scale (SCoRS) in patients with schizophrenia.

The Schizophrenia Cognition Rating Scale (SCoRS) is an interview-based assessment of cognition that involves interviews with patients and informants. The SCoRS has shown good reliability, validity, and sensitivity to cognitive impairment in schizophrenia, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the SCoRS. A group of 35 patients with schizophrenia and a group of 35 healthy controls received the Persian-SCoRS in the first session, and a standardized performance-based cognitive battery, the Brief Assessment of Cognition in Schizophrenia (BACS), in the second session.Our results indicated that the Persian version of the SCoRS was sensitive to cognitive impairment in the patients. The Persian SCoRS global rating was significantly associated with the composite score generated from the Persian version of the BACS and predicted functional outcomes as measured by Global Assessment of Functioning (GAF) and World Health Organization Quality of Life (WHO QOL). A Persian version of the SCoRS, an interview based measure of cognition that included informants, is related to cognitive performance and global functioning.

Chlorpromazine versus clotiapine for schizophrenia.

BACKGROUND: Schizophrenia is a chronic, disabling and severe mental disorder, characterised by disturbance in perception, thought, language, affect and motor behaviour. Chlorpromazine and clotiapine are among antipsychotic drugs used for the treatment of people with schizophrenia. OBJECTIVES: To determine the clinical effects, safety and cost-effectiveness of chlorpromazine compared with clotiapine for adults with schizophrenia. SEARCH METHODS: We searched Cochrane Schizophrenia's Trials Register (last update search 16/01/2016), which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the Register. SELECTION CRITERIA: All randomised clinical trials focusing on chlorpromazine versus clotiapine for schizophrenia. We included trials meeting our selection criteria and reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. MAIN RESULTS: We have included four studies, published between 1974 and 2003, randomising 276 people with schizophrenia to receive either chlorpromazine or clotiapine. The studies were poor at concealing allocation of treatment and blinding of outcome assessment. Our main outcomes of interest were clinically important change in global and mental state, specific change in negative symptoms, incidence of movement disorder (dyskinesia), leaving the study early for any reason, and costs. All reported data were short-term (under six months' follow-up).The trials did not report data for the important outcomes of clinically important change in global or mental state, or cost of care. Improvement in mental state was reported using the Positive and Negative Syndrome Scale (PANSS). When chlorpromazine was compared with clotiapine the average improvement scores for mental state using the PANSS total was higher in the clotiapine group (1 RCT, N = 31, MD 11.50 95% CI 9.42 to 13.58, very low-quality evidence). The average change scores on the PANSS negative sub-scale were similar between treatment groups (1 RCT, N = 21, MD -0.97 95% CI -2.76 to 0.82, very low-quality evidence). There was no clear difference in incidence of dyskinesia (1 RCT, N = 68, RR 3.00 95% CI 0.13 to 71.15, very low-quality evidence). Similar numbers of participants left the study early from each treatment group (3 RCTs, N = 158, RR 0.68 95% CI 0.24 to 1.88, very low-quality evidence). AUTHORS' CONCLUSIONS: Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult.