***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 A double-blind , placebo-controlled trial was carried out to determine the value of maintenance therapy with phenothiazines in a population of out patients who had recently recovered from an acute episode of schizophrenia . The drug was shown to be significantly more effective than the placebo in preventing relapse . The relationship of the trial patients to the population from which they were selected was defined in terms of clinical , historical , and social data . Maintenance therapy seems of little value in patients with a good prognosis and in the severely ill , but it is of value in the indeterminate group between these two extremes Objective To determine the cost utility of treating schizophrenic patients with olanzapine  compared with other antipsychotics in a naturalistic outpatient setting . Methods The pan-European SOHO study is a 3-year , prospect i ve , outpatient , observational study of outcomes associated with antipsychotic treatment , focusing on olanzapine , in ten European countries . For the cost-utility analysis , healthcare re source use ( inpatient care , day care , outpatient psychiatric consultations and antipsychotic and concomitant medication use ) and EQ-5D data were collected at baseline and at 3 , 6 and 12 months . The perspective was that of the health service payer . UK healthcare unit costs ( year 2004 values ) were applied to the re source use data for the ten countries . UK population tariffs were applied to the EQ-5D data to determine utility values . An Epoch analysis was used to analyze the longitudinal data . Multivariate regression analyses that adjusted for baseline covariates were used to estimate the incremental cost and utility gains for patients treated with olanzapine compared with each of the other antipsychotics ( risperidone , quetiapine , amisulpride , clozapine and oral or depot typical antipsychotics ) . Results A total of 10 972 patients were enrolled at baseline , of which 9107 completed the 12-month study period . Treatment with olanzapine was more effective in terms of QALYs gained than all of the other antipsychotic treatments . Treatment with olanzapine dominated quetiapine and amisulpride . The incremental cost  for olanzapine compared with risperidone was £ 226 per patient over 12 months and the incremental cost per QALY gained was £ 5156 , with bootstrap analyses showing 100 % of the replications falling below a £ 30 000 per QALY gained threshold . Compared with treatment with clozapine , olanzapine was found to be marginally more effective , at an additional cost of £ 13 per patient over 12 months and to have an incremental cost per QALY gained of £ 775 . Bootstrap analyses showed that 81 % of replications fell below a £ 30 000 per QALY gained threshold . Comparing olanzapine with oral and depot typical antipsychotics , the incremental cost was £ 849 and £ 1106 per patient over 12 months and the incremental cost per QALY gained was £ 15 696 and £ 23 331 , respectively . Bootstrap analyses showed that 98 % of the replications fell below a £ 30 000 per QALY gained threshold for the comparison with oral typical antipsychotics , and 79 % of replications for the comparison with depot preparations . Conclusions Among SOHO patients , if a funding threshold of £ 30 000 per QALY gained is assumed , this analysis suggests that olanzapine has a high probability of being the most cost-effective treatment compared with other antipsychotic treatments . However , comparison of olanzapine with clozapine and typical depot antipsychotics should be viewed with caution because clozapine is a second-line treatment and depot treatment is used for patients who do not adhere to their oral medication Because the importance of tranquilizing drugs has been difficult to assess precisely , the author undertook a study on the effect of the withdrawal of chlorpromazine and trifluoperazine on hospitalized male schizophrenics in Engl and . Although there were no major relapses among the placebo group , changes occurred that were sometimes disabling 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 There are cl aims that the extra costs of atypical ( second-generation ) antipsychotic drugs over conventional ( first-generation ) drugs are offset by improved health-related quality of life . AIMS To determine the relative costs and value of treatment with conventional or atypical antipsychotics in people with schizophrenia . METHOD Cost-effectiveness acceptability analysis integrated clinical and economic r and omised controlled trial data of conventional and atypical antipsychotics in routine practice . RESULTS Conventional antipsychotics had lower costs and higher quality -adjusted life-years ( QALYs ) than atypical antipsychotics and were more than 50 % likely to be cost-effective . CONCLUSIONS The primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics The st and ard drug Stelazine ( STEL ) , at a dose of 50 mg/day , exhibited therapeutic activity significantly different from placebo ( PL ) activity on several variables , most notably BPRS , attesting to the sensitivity of the experiment . On the other h and , the investigational drug , loxapine ( LOX ) , in doses of 100 mg/day for four weeks , could be differentiated from PL as treatment in the described population on only one variable ( NGI-Imp . ) and one item of the BPRS . On several variables , positive trends were noted , but the differences from PL did not attain the critical values necessary for statistical significance at P smaller than 0.05 . One might speculate that the relatively short duration of treatment in this study might account for the difference between these disappointing results and the more gratifying results of a previous loxapine study in chronic long-term institutionalized schizophrenics with the same oral dose Twenty adult female schizophrenics were included in a double-blind , between-patient trial . Patients received either 20 mg . trifluoperazine or 150 mg . oxypertine daily in capsule form . The dose could be altered to 10 or 30 mg . trifluoperazine ( or 120 to 180 mg . oxypertine ) at the doctor 's discretion , still maintaining the double-blind discipline . The trial drugs were administered for six weeks , after a three-week period of placebo treatment . Ratings were made throughout the trial period and for four subsequent weeks , using the Wing ` A ' and Venables rating scales . Laboratory tests , including S.G.O.T. , S.P.G.T. , alkaline phosphatase , P.C.V. , E.S.R. haemoglobin , and total and differential white cell counts , were also carried out . The results of this trial do not suggest that oxypertine is superior to trifluoperazine in activating withdrawn schizophrenics . Significantly lower values for white cell count and haemoglobin were found in the  oxypertine group . Side-effects , which comprised mainly vomiting , diarrhoea , dizziness and tremor , and were not clinical ly significant , were observed more frequently after administration of trifluoperazine than after oxypertine OBJECTIVES To determine the clinical and cost-effectiveness of different classes of antipsychotic drug treatment in people with schizophrenia responding inadequately to , or having unacceptable side-effects from , their current medication . DESIGN Two pragmatic , r and omised controlled trials ( RCTs ) were undertaken . The first RCT ( b and 1 ) compared the class of older , inexpensive conventional drugs with the class of new atypical drugs in people with schizophrenic disorders , whose current antipsychotic drug treatment was being changed either because of inadequate clinical response or owing to side-effects . The second RCT ( b and 2 ) compared the new ( non-clozapine ) atypical drugs with clozapine in people whose medication was being changed because of poor clinical response to two or more antipsychotic drugs . Both RCTs were four-centre trials with concealed r and omisation and three follow-up assessment s over 1 year , blind to treatment . SETTING Adult mental health setting s in Engl and . PARTICIPANTS In total , 227 participants aged 18 - 65 years ( 40 % of the planned sample ) were r and omised to b and 1 and 136 ( 98 % of the planned sample ) to b and 2 . INTERVENTIONS Participants were r and omised to a class of drug . The managing clinician selected the individual drug within that class , except for the clozapine arm in b and 2 . The new atypical drugs included risperidone , olanzapine , quetiapine and amisulpride . The conventional drugs included older drugs , including depot preparations . As in routine practice , clinicians and participants were aware of the identity of the prescribed drug , but clinicians were asked to keep their participating patient on the r and omised medication for at least the first 12 weeks . If the medication needed to be changed , the clinician was asked to prescribe another drug within the same class , if possible . MAIN OUTCOME MEASURES The primary outcome was the Quality of Life Scale ( QLS ) . Secondary clinical outcomes included symptoms [ Positive and Negative Syndrome Scale ( PANSS ) ] , side-effects and participant satisfaction . Economic outcomes were costs of health and social care and a utility measure . RESULTS Recruitment to b and 1 was less than anticipated ( 40 % ) and diminished over the trial . This appeared largely due to loss of perceived clinical equipoise ( clinicians progressively becoming more convinced of the superiority of new atypicals ) . Good follow-up rates and a higher than expected correlation between QLS score at baseline and at follow-up meant that the sample as recruited had 75 % power to detect a difference in QLS score of 5 points between the two treatment arms at 52 weeks . The recruitment to b and 2 was approximately as planned . Follow-up assessment s were completed at week 52 in 81 % of b and 1 and 87 % of b and 2 participants . B and 1 data showed that , on the QLS and symptom measures , those participants in the conventional arm tended towards greater improvements . This suggests that the failure to find the predicted advantage for new atypicals was not due to inadequate recruitment and statistical power in this sample . Participants reported no clear preference for either class of drug . There were no statistically significant differential outcomes for participants entering b and 1 for reasons of treatment intolerance to those entering because of broadly defined treatment resistance . Net costs over the year varied widely , with a mean of 18,850 pounds sterling in the conventional drug group and 20,123 pounds sterling in the new atypical group , not a statistically significant difference . 
    Output:
    
Comparison between low and high-dose trifluoperazine with placebo from a single study provided equivocal evidence of effects .
Our results agree with existing evidence that compared to placebo , trifluoperazine is an effective antipsychotic for people with schizophrenia .
Furthermore , our review provides supportive evidence that trifluoperazine  increases the risk of extrapyramidal adverse effects .