Efficacy of beta-blocker supplementation for schizophrenia: a systematic review of randomized trials.

Adrenergic beta-receptor antagonists, commonly used in the field of cardiovascular diseases, have also been recommended for treatment-resistant schizophrenia. We systematically review quality assessed trials on beta-blocker supplementation of antipsychotic treatment for schizophrenia. All randomized controlled trials comparing any beta-blocking agent added to any antipsychotic with a placebo added to any antipsychotic, and lasting for at least 1 week, were located through electronic searches in all languages of several databases. The trials were assessed by at least two independent reviewers for inclusion, quality score, and data extraction. The reviewers located five studies with 117 participants. The data were poorly presented in these short-term studies and did not evidence any effect of beta-blockers as an adjunct to conventional antipsychotic medication. At present beta-blockers cannot be recommended in the treatment of schizophrenia, and schizophrenia treatment guidelines advocating use of beta-blockers should be revised.

Pharmacological treatment of schizophrenia resistant to first-line treatment: a critical systematic review and meta-analysis.

Schizophrenia resistance to conventional antipsychotics is a common phenomenon. In 5-25% of cases, satisfactory treatment response is not achieved, and intolerance to conventional antipsychotics occurs in 5-20% of patients. Numerous reasons for refractoriness have been proposed. However, up to now only a few pharmacological agents have been found useful in the treatment of schizophrenia resistant to conventional antipsychotics. This paper critically reviews quality-assessed trials on the pharmacological treatment of refractory schizophrenia. Randomized blinded trials of conventional antipsychotics at high doses, atypical antipsychotics, lithium, propranolol, and agents not traditionally used in the treatment of schizophrenia are reviewed. On the basis of the methodologically sound studies included, we conclude that only clozapine has proved to be clinically effective in the treatment of refractory schizophrenia. In the short term, the odds ratio for clinical improvement on clozapine treatment when compared to conventional treatment is calculated to be 2.4 (95% confidence interval [CI] 1.7-3.5) and the number of patients needed to treat (NNT) is 7 (95% CI 5-13). In single inconclusive trials, olanzapine and risperidone have been found as effective as clozapine. In order to establish the usefulness of other pharmacological treatments, more randomized clinical trials are needed.