50 Years of randomised controlled trials relevant to the care of schizophrenia: 2000 studies, 18 outcomes, 670 rating scales

Tags: Oral
Thomley B, Adams C, Adams C

Introduction/Objective: The Cochrane Schizophrenia Group (CSG) has constructed a comprehensive register of trials relating to the care of those with schizophrenia or unspecified chronic/serious mental illnesses. The MRC UK supported a detailed survey of the first 2000 controlled trials on this register and the quality, interventions used for those with schizophrenia and outcomes measured have all been profiled.

Methods: The CSG's register is the product of methodical electronic searches of Biological Abstracts, Cochrane Library, CINAHL, EMBASE, LILACS, MEDLINE, PsycLIT, PSYNDEX, Sociofile and hand searches of the major relevant journals. The first 2000 trials were reliably inspected and data recorded.

Results: The quality of reporting of randomisation, blinding and those withdrawing early has not changed in 50 years: it is generally poor. In these 2000 trials, 658 different drugs have been evaluated and 18 other 'physical' treatments including ECT and insulin coma therapy. About 85 different non-pharmacological [talking] therapies have been trialed, as well as 39 different care policies both in the ward and community. The trials record some 18 different outcomes, with mental state, general functioning, behaviour and side effects being the most common. Economic evaluations, quality of life and satisfaction with care are rarely measured. However, over 670 different scales have been used to record these 18 outcomes. The validity and usefulness of these scales is investigated, and the person-hours spent rating is calculated.

Discussion: Schizophrenia researchers have enthusiastically adopted the explanatory trial and many treatments have been investigated. Unfortunately, trials are often poorly reported and outcomes measured on scales which often only meet the needs of researchers rather than people with schizophrenia or their carers. There is a strong tradition of trials within this sub-speciality but not, with a few notable exceptions, of a pragmatic and collaborative approach. The next 50 years must build on this tradition but take a radical change in course if the needs of carers and recipients of care are to be addressed.