Background: Ethnic and regional variations has been found in the pharmacological treatment response. Though many efficacy studies have been conducted in India for antipsychotic treatment modalities of schizophrenia, there is a lack meta-analysis data of the existing literature from India. Aim: To conduct a systematic review and meta-analysis of the antipsychotic treatment trials of schizophrenia in the Indian context. Methodology: All controlled trials from India evaluating the clinical efficacy of antipsychotic treatment trials of schizophrenia were evaluated and 28 trials were included in the metanalysis. Effect sizes were computed using Cohen’s ‘d’ and risk of bias was evaluated. Results: Twenty eight studies were included in the metanalysis. Meta analysis revealed superiority of first generation antipsychotics over placebo (mean effect size [ES] of 1.387, confidence interval [CI] of 1.127 to 1.648). Second generation antipsychotics were marginally better than first generation antipsychotics (ES 0.106, CI 0.009 to 0.204). There was improvement in the methodology of the trials over time (Kendall tau = 0.289, p = 0.049), though no statistically significant increases in trial duration and sample size. There is lack of data on long term efficacy of antipsychotic in schizophrenia from India. Conclusions: First generation antipsychotics have demonstrated benefits over placebo in patients with schizophrenia in the Indian context, though marginally lesser than second generation ones.
Keywords: Schizophrenia, India, Antipsychotics, meta-analysis
Schizophrenia is a severe mental illnesses associated with significant morbidity and poor quality of life.[1–4] The disorders are not only associated with significant personal distress, but it also causes increased mortality due to suicides and associated medical illnesses, results in increased rates of substance use disorders, high care giver burden and occurrence of violence. The social and economic costs of this disorder are...