***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas Background Weight gain is common for people with schizophrenia and this has serious implication s for health and well being . Objectives To determine the effects of both pharmacological ( excluding medication switching ) and non pharmacological strategies for reducing or preventing weight gain in people with schizophrenia . Search methods We search ed key data bases and the Cochrane Schizophrenia Group 's trials register ( April 2006 ) , reference sections within relevant papers , h and search ed key journals , and contacted the first author of each relevant study and other experts to collect further information . Selection criteria We included all clinical r and omised controlled trials comparing any pharmacological or non pharmacological intervention for weight gain  ( diet and exercise counselling ) with st and ard care or other treatments for people with schizophrenia or schizophrenia-like illnesses . Data collection and analysis We reliably selected , quality assessed and extracted data from studies . As weight is a continuous outcome measurement , weighted mean differences ( WMD ) of the change from baseline were calculated . The primary outcome measure was weight loss . Main results Twenty-three r and omised controlled trials met the inclusion criteria for this review . Five trials assessed a cognitive/behavioural intervention and eighteen assessed a pharmacological adjunct . In terms of prevention , two cognitive/behavioural trials showed significant treatment effect ( mean weight change ) at end of treatment ( n=104 , 2 RCTs , WMD -3.38 kg CI -4.2 to -2.0 ) . Pharmacological adjunct treatments were significant with a modest prevention of weight gain ( n=274 , 6 RCTs , WMD - 1.16 kg CI -1.9 to -0.4 ) . In terms of treatments for weight loss , we found significantly greater weight reduction in the cognitive behavioural intervention group ( n=129 , 3 RCTs , WMD -1.69 kg CI -2.8 to -0.6 ) compared with st and ard care . Authors ' conclusions Modest weight loss can be achieved with selective pharmacological and non pharmacological interventions . However , interpretation is limited by the small number of studies , small sample size , short study duration and by variability of the interventions themselves , their intensity and duration . Future studies adequately powered , with longer treatment duration and rigorous methodology will be needed in further evaluating the efficacy and safety of weight loss interventions for moderating weight gain . At this stage , there is insufficient evidence to support the general use of pharmacological interventions for weight management in people with schizophrenia Fifty-four hospitalized chronic schizophrenics were included in a double-blind controlled trial to assess the value of clopenthixol in treating [ See Table 4 in Source Pdf . ] such cases and compare its effects with those of chlorpromazine . Two rating scales were used to assess the patients clinical ly : a behavioural scale with items fairly objective and concrete , and an inferential one with items more " speculative " or " interpretative " . The patients were rated without medication and four weeks later with medication . Clopenthixol result ed in a change at the behavioural level . Chlorpromazine result ed in changes at the behavioural and inferential levels . No changes occurred with the placebo .  Side-effects were not severe at therapeutically effective levels Molindone , a new indole derivative , was evaluated as an  antipsychotic agent  with the use of a double‐blind placebo‐controlled technique . Antipsychotic activity relative to placebo was apparent , although it did not appear as impressive as that of the st and ard drug , chlorpromazine . A possible alerting effect associated with molindone was not apparent with chlorpromazine .  Side effects were no more frequent than those seen with the usual psychotropic drugs In a series of 6 separate controlled clinical trials of  antipsychotic agents in chronic schizophrenic patients , it was shown repeatedly that chlorpromazine ( CPZ ) exhibited hypercholesterolemic activity . In the analysis of covariance , the adjusted final mean difference in serum cholesterol concentrations between the placebo and  CPZ  groups ranged from 14 to 28 mg . per 100 ml . This activity was dose related in that it occurred with a fixed daily dose of 600 mg . administered for 24 weeks , but not with a fixed daily dose of 150 mg . or 300 mg . over the same period of time . The serum concentration of triglycerides remained unaffected under similar experimental conditions . This action of CPZ appeared unrelated to thyroid function and liver function as presently measured in the clinical laboratory . A consistent relationship to body weight changes could not be demonstrated even though increased body weight was noted to be a consistent result of CPZ therapy . In view of its extensive use as long‐term therapy , the possible role of CPZ as an atherogenic agent deserves consideration Twenty-nine overweight schizophrenic patients maintained on depot neuroleptic injections who wished to lose weight took part in a double-blind , placebo-controlled trial of 30 mg D-fenfluramine . All subjects received dietary advice . Sixteen patients completed the 12-week trial .  Rate of weight loss was significantly greater in those taking D-fenfluramine .  Side-effects were reported , but no deterioration in mental state was noted The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating In a double-blind placebo controlled clinical trial in chronic schizophrenic patients , haloperidol and clopenthixol were found to be effective antipsychotic agents , favorably altering behavior as observed by the psychiatrist , the nurse , and ward attendants . In this respect they appeared to compare adequately to the st and ard drug , chlorpromazine . In this experiment , neither the st and ard drug nor the investigational drugs affected psychological test performance . The expected side effects such as extrapyramidal signs and sedation did occur and in some instances required dose reduction for alleviation . One case of possible hepatoxicity in the CX group occurred at the end of the study and was considered of serious import requiring cessation of medication . It was concluded that these chemically unrelated antipsychotics could be used in practice as therapeutic alternatives , the particular choice depending on side effects and possibly symptomatology BACKGROUND A recent review suggested an association between using unpublished scales in clinical trials and finding significant results . AIMS To determine whether such an association existed in schizophrenia trials . METHOD Three hundred trials were r and omly selected from the Cochrane Schizophrenia Group 's Register . All comparisons between treatment groups and control groups using rating scales  were identified . The publication status of each scale was determined and cl aims of a significant treatment effect were recorded . RESULTS Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison ( relative risk 1.37 ( 95 % CI 1.12 - 1.68 ) ) . This effect increased when a ' gold-st and ard ' definition of treatment superiority was applied ( RR 1.94 ( 95 % CI 1.35 - 2.79 ) ) . In non-pharmacological trials , one-third of ' gold-st and ard ' cl aims of treatment superiority would not have been made if published scales had been used . CONCLUSIONS Unpublished scales are a source of bias in schizophrenia trials The present s tudy was design ed to compare the effects of chlorpromazine , phenobarbital , and placebo in a r and omly selected sample of chronic schizophrenic women in a state hospital setting . The purpose of this s tudy was to determine the possible therapeutic efficacy ol ehlorpromazine and to describe the effects of this agent in several areas of psychological functioning . The most comprehensive review of controlled studies with ehlorpromazine which has come to our attention is that of ttErLIZE~ ( 1960 ) . His annotated bibliography includes reference to over 60 titles in which chlorpromazine effects are compared with placebo controls . The inherent difficulties in this area of research are sharply highlighted by his criticM analysis of these articles . The appheation ( and sometimes misapplication ) of a gTeat number of variations in methodology , design , subject.s , and analysis of results may be a basis for the seemingly contradictory conclusions often reported . One of the most extensive controlled investigations of ehlorpromazine was the Veterans Administration study recently summarized by CASEY et al. ( 1960 ) . Thirty-seven hospitals contributed nearly 700 male subjects to the experiment i~ which the therapeutic superiority of ehlorpromazine over phenobarbital and placebo was demonstrated . The Multidimensional Scale for l ~ ating Psychiatric Patients ( L o ~ et al. 1953 ) was the principal measure of change . This report is particularly convincing in view of the extremely large sample , objective ly 
    Output:
    
Global state measured by clinical global impression scale ( CGI ) improvement showed different ratings when assessed by a psychiatrist or a nurse .
AUTHORS ' CONCLUSIONS For people with schizophrenia this review shows that zuclopenthixol dihydrochloride may help with the symptoms of schizophrenia .
The review provides some trial evidence that , if taking zuclopenthixol dihydrochloride , people may experience some adverse effects and sedation compared with placebo .
There are no data for zuclopenthixol decanoate or zuclopenthixol acetate .
Zuclopenthixol in all three forms is a commonly used antipsychotic and it is disappointing that there are so few data regarding its use