***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 
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    Input: Poor neuroleptic response is a major unresolved clinical problem . Precise data concerning the frequency of poor neuroleptic response are not available . The implementation of treatment modalities that are specifically recommended for non‐responders ( such as clozapine ) increases the desirability of such data . This study evaluated the proportion of acutely exacerbated schizophrenics who remained unimproved by consecutive administration of haloperidol , chlorpromazine and perphenazine , in r and omly determined order . The overall improvement rate was 95 % . The frequency of good responses to the first , second and third drug were 67 % , 55 % , and 67 % respectively . Differences in receptor affinity profile might explain the added beneficial effect of a second or third drug The relative efficacy of 4 tranquilizers was investigated in 66 chronic schizophrenics who had been hospitalized for 10.01 years ( mean ) . The role of adding an anti-depressant was also studied . Following a 4 week placebo period , high dosage tranquilizers were given for 16 weeks and amitriptyline was added for the following 16 weeks . Statistical analyses of the various change measures revealed that patients worsened significantly on placebo , all 4 tranquilizers were significantly better than placebo for symptom reduction and maximum improvement was attained within 16 weeks of tranquilizer administration . No significant differences in efficacy were observed among the 4 tranquilizers and addition of amitriptyline did not confer any additional therapeutic advantage The results of a prospect i ve study on the incidence of  thrombocytopenia in matched psychiatric in patients receiving different antipsychotics are reported . Patients were receiving haloperidol ( N = 159 ) , chlorpromazine ( N = 164 ) , fluphenazine decanoate ( N = 152 ) , or no drug therapy ( control , N = 102 ) . The groups did not differ statistically in respect to the incidence of thrombocytopenia , mean platelet levels , age , chlorpromazine equivalent dosages , or duration of drug therapy ( p > 0.05 ) . The two phenothiazine-treated groups had significantly higher numbers of patients with lownormal platelet levels when compared to both the haloperidol and control groups ( p < 0.05 ) . Also , a nonsignificant trend was noted for increased incidence of thrombocytopenia among the phenothiazine groups compared with the haloperidol and control groups . Upon retrospective analysis of preneuroleptic treatment platelet levels , significant decreases in platelet values were observed with the phenothiazine-treated patients ( p < 0.001 ) , but not with haloperidol ( p > 0.05 ) . The results indicate that neuroleptic drug-induced thrombocytopenia is rare but may be more common with phenothiazine antipsychotics 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 The effectiveness of injectable chlorpromazine was compared with the effectiveness of injectable haloperidol with highly agitated , acute psychotic patients and chronic patients with acute exacerbations . While both groups improved , haloperidol effected a significantly greater improvement in patients 40 years of age or older than did  chlorpromazine .  This result is consistent with those reported in other studies In a double-blind , cross-over study , the comparative therapeutic effects of 6-week courses of two prototypic neuroleptics — haloperidol and chlorpromazine — and the reversal of those effects with benztropine were investigated in a group of 18 schizophrenics . Periodic measurements were made for 32 dimensions of psychopathology , social participation , span of attention , sleeplessness , pulse rate and neurological side effects . The results showed that haloperidol was generally a more effective drug over the period studied . This was particularly apparent in terms of social and emotional responsiveness , communicativeness and cognitive processes . The only superiority of chlorpromazine seemed to be that patients felt less dysphoric on it than they did on haloperidol . Haloperidol also proved to be more rapid in its action . The data failed to support the clinical validity of the distinction often made between “ sedative ” and “ activating ” neuroleptics . Consistent with previous reports , benztropine had the effect of diminishing therapeutic response to both neuroleptics . However , haloperidol again proved less susceptible to this effect . The slowness and lesser therapeutic efficiency of chlorpromazine and its greater susceptibility to benztropine reversal were all considered to be due to its built-in anticholinergic properties acting in opposition to its antipsychotic activity . The low potency of chlorpromazine-like drugs was attributed to their inherent anticholinergic characteristics . It was suggested that one of the factors determining potency differences among neuroleptics may be the degree of built-in anticholinergic activity A study of anti‐Parkinsonism agents in prolonged phenothiazine therapy seeks to clarify some anecdotal misconceptions . Antiparkinsonian agents do not appear to affect the therapeutic efficiency of phenothiazines , nor does using them on a “ dem and ” basis increase the problems of control of parkinsonian side effects .  Older patients , however , appear to require the extended usage of antiparkinsonian agents rather more than some studies would suggest . Sustained release antiparkinsonian agents may yet further simplify the management of schizophrenia A study design ed to assess the relative efficacy of chlorpromazine and Serenace in the control of chronic schizophrenics is described . Twenty-five cases were selected for the study and were r and omly allocated to treatment . The condition of the patients was assessed at fortnightly intervals over the eight-week duration of trial period . No significant differences in side-effects emerged in patients on chlorpromazine and Serenace in the dosages administered . The statistically significant trends all showed a superiority of Serenace  above  chlorpromazine  which was in accord with the clinical picture The schizophrenic patient 's early psychological response to neuroleptic treatment has been demonstrated to be a significant predictor of treatment response . The validity of the construct of subjective response is evaluated by comparison of two measures . Fifty-five recently admitted and unmedicated schizophrenic patients were r and omly allocated to chlorpromazine or haloperidol .  Subjective responses at 24 and 48 hours as assessed by two different scales , the Van Putten & May scale and the self-administered Drug Attitude Inventory , were strongly correlated with outcome at three weeks . Early emergence of extrapyramidal symptoms was not related to subjective response , but dysphoric patients had a greater incidence of EPS by the end of treatment than did non-dysphoric patients . The two measures showed high concordance in identification of early drug dysphoria In this paper we have described early applications of computerized EEG techniques in psychopharmacology . Perhaps our most remarkable finding was there were practically no differences between very chronic drug free schizophrenic patients and normals , which contradicts much of the EEG imaging literature . To us , the most likely explanation is that most of the anterior slowing observed in other studies was due to contamination from orbital artifacts , which we took exceptional pains to remove . Lingering effects of neuroleptic medications may also have contributed . Alternatively , EEG deviations in schizophrenia may recede when the illness reaches a very chronic stage , although this hypothesis is less tenable . There were significant differences between placebo and the three neuroleptics in terms of increased amplitudes in the delta and theta frequency b and s in the anterior head regions , which is compatible with data from other studies . These changes were most pronounced with clozapine and least prominent with haloperidol , with chlorpromazine occupying an intermediate position . This order happens to parallel their relative antiserotonergic , antihistaminic and anticholinergic properties . The latter may have been partially obscured by the addition of benztropine . In a subgroup of patients who were recorded under each of the treatment conditions , there were more fast frequencies with clozapine than with the other neuroleptics agreeing with Roubicek and Major . This could be a function of clozapine 's increased adrenergic activity as reported by Ackenheil . An unexpected finding was that patients who responded to clozapine had higher amplitudes in the alpha spectrum , most pronounced in the left anterior quadrant , than did the nonresponders . These differences between responders and nonresponders obtained whether patients were on placebo , haloperidol or clozapine . Curiously , Buchsbaum et al. found that anxious patients who responded to benzodiazepines also had higher alpha amplitudes in the same brain regions , which differentiated them from nonresponders . These findings clearly warrant future scientific investigation . In this regard , the generalizability of our data is limited by the extremely chronic , treatment-resistant population studied . However , promising directions for further research in EEG and psychopharmacology have been identified In a controlled study ,  inpatient violence  was measured during placebo , high-potency ( haloperidol ) and low-potency ( chlorpromazine or clozapine ) neuroleptics . Some patients had a marked increase in violent behavior with the moderately high-dose haloperidol , but not with low-potency neuroleptics . The authors discuss reasons for the increased violence with haloperidol , including akathisia and drug-induced behavioral toxicity The purpose of this study was to investigate whether L-DOPA antagonizes  chlorpromazineor haloperidol-induced parkinsonism in schizophrenic patients . The following considerations motivated our research : a ) in Parkinson ’s disease there is a decrease in the dopamine content of the corpus striaturn and the substantia nigra ( Ehringer & Hornykiewicz 1960 ; Hornykiewicz 1963 ; Barolin et al. 1964 ) ; b ) L-DOPA increases dopamine concentration in the extrapyramidal centres ( Bertler & Rosengren 1959 ) : c ) L-DOPA antagonizes reserpine-induced parkinsonism ( Degkwitz et al. 1960 ) and the extrapyramidal symptoms of Parkinson ’s disease ( Birkmayer & Hornykiewicz 1961 , 1962 , 1964 ; Barbeau et al. 1962 ; Friedhoff et al. 1963 ; Gerstenbr and et al. 1963 ) ; d ) chlorpromazine and haloperidol produce a very significant increase in dopamine and homovanillic acid ( HVA ) urinary excretion when schizophrenics , treated with large therapeutic doses , show marked extrapyramidal symptoms ( Bruno et al. 1963 ; Bruno & Allegranza 1965 ) Extrapyramidal side effects of neuroleptics are important in clinical practice . Study of extra-pyramidal side effects is also of importance for research ers who test new antipsychotic agents or study tardive dyskinesia . A french translation of the Simpson-Angus Rating Scale of extra-pyramidal side effects thus appeared useful . This scale contains 10 items : Gait , Arm dropping , Shoulder shaking . Elbow rigidity , Wrist rigidity , Leg pendulousness , Head dropping , Glabella Tap , Tremor , Salivation . Each item is rated between 0 and 4 . A total score is obtained by adding the items and dividing by 10 . Scores of up to 0.3 are considered within the normal range . The scale original has been vali date d in a population of fourteen psychotic in patients taking , in a double-blind procedure ,  placebo , haloperidol 6 mg/day or haloperidol 30 mg/day . Patients receiving haloperidol 30 mg/day presented more extrapyramidal symptoms than patients under placebo .  The Simpson Angus rating scale has also been shown to have clinical validity and high inter-rater reliability . It can be routinely used in clinical drug evaluation . The french version was used in a population of 30 psychotic in patients fulfilling the DSM III-R criteria of schizophrenic disorder . Patients were treated for at least two weeks , orally , either with a phenothiazine ( chlorpromazine 350 mg ) or a butyrophenone ( haloperidol 15 mg ) . 10 of the 30 patients received , in addition , anticholinergic agents ( trihexiphenidyl , 5 mg ) . The french version of The Simpson Angus Rating Scale appeared to be easy to use and not time-consuming . Interraters correlation was high . Patients receiving butyrophenones or phenothiazines had no significantly different ages and sociodemographic characteristics . ( ABSTRACT TRUNCATED AT 250 WORDS Trade names of drugs mentioned in this paper : haloperidol , Haldol ( McNeil Laboratories , Fort Washington , Pa. ) ; ehlorpromazine , Thorazine ( Smith Kline and French , Philadelphia , Pa. ) ; ben 
    Output:
    
Given that haloperidol and chlorpromazine are global st and ard antipsychotic treatments for schizophrenia , it is surprising that less than 800 people have been r and omised to a comparison and that incomplete reporting still makes it difficult for anyone to draw clear conclusions on the comparative effects of these drugs .
However , it seems that haloperidol causes more movement disorders than chlorpromazine , while chlorpromazine is significantly more likely to lead to hypotonia .