***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: Taking even this restricted group of patients , the aim of establishing clear cut differences between the drugs has not been achieved . The most clear cut finding was that no statistically significant difference was found between the ability of the two drugs , chlorpromazine and trifluoperazine , to improve motor activity in underactive schizophrenic patients . There were however , a number of observations which may be of interest . For the more active patients an overall measure of performance at the factory task showed an inconstant and non-significant initial improvement with both active drugs with maximum effect at the end of six weeks . There-after performance deteriorated , and when active drugs were reintroduced this deterioration was not reversed . The less active behaved differently . At the factory task they improved progressively through-out the experiment , but the greatest increment in their performance occurred during the Pl phase . No group 's speed of work was changed differentially by the two drugs . The least active group A increased their speed of work more during the six weeks Pl phase than at any other time ; Group B showed similar improvement during the P1 phase , but did not improve further when drugs were reintroduced ; Group C showed virtually no change in speed of work during the three phases of the experiment . When on drugs there was a small but highly statistically significant improvement over pre-drug scores on the Venables scale , indicating that the two drugs were effective . No significant difference between drugs was found , and after the first six weeks of treatment the maximum response was reached , with some worsening thereafter . There is a strong suggestion that the worsening in behaviour during the intervening placebo phase seen on the Venables scale occurs only in those previously treated with chlorpromazine . To this extent , therefore , trifluoperazine is to be preferred as a treatment . On this scale , as with the factory task , gains in behaviour obtained during the first six weeks of treatment were not repeated during the latter part of the cross-over . Strenuous attempts were made to maintain the environment constant for all groups , so that it is unlikely that chance environmental stimulation could be the sole explanation for these changes . A more likely explanation seems to be that , for the very inactive , once new patterns of behaviour have been initiated with the aid of drugs further improvement may occur without continuous medication . For the more active , however , starting drugs may also produce a temporary improvement , but the improvement is inconstant , it does not last as long and may be lost even when drugs are continued . Intermittent medication is evidently effective for inactive patients and may be advantageous . The more active seem to be improved to a much smaller extent by these drugs . The correlation , steadily increasing with treatment , between the two factors of the Venables scale suggests that both drugs have a beneficial effect on another puzzling aspect of the chronic schizophrenic : the differences between tests within individuals which they show on most measures of behaviour . This is an area of performance of importance therapeutically , but one which hitherto has been neglected in drug studies . We found no evidence to suggest that intermittent medication would have an adverse effect on this aspect of behaviour The attempt in one hospital to model a drug study after the NIMH nine-hospital collaborative study result ed in a useful modification in which relatively small numbers of newly admitted , acutely exacerbated chronic schizophrenic patients were studied for a period of four weeks . Statistically significant drug : placebo differences were easily detected on most psychiatric and behavioral variables , but not on the psychological performance tasks used . The overall design appears to be suitable for sequential analysis and might provide the basis for an early screening program for antipsychotic drugs in which very small numbers of subjects would be required for relatively short periods of observation . A possible differential drug response favoring thioridazine over chlorpromazine hydrochloride and fluphenazine hydrochloride on several variables was not statistically significant • Presently marketed antiparkinsonism drugs are potent anticholinergic agents that , while effective in treating extrapyramidal symptoms ( EPS ) , also are productive of or can exacerbate a number of side effects associated with psychotropic drugs . Some of these include gastrointestinal disturbances , visual difficulties , and tardive dyskinesia . A double-blind study was carried out to assess the efficacy ( and adverse effects ) of amantadine hydrochloride — an agent without appreciable anticholinergic activity — for the treatment of drug-induced EPS .  Amantadine was found to be comparable in effect to benztropine mesylate , but with fewer side effects . The potential role of amantadine may be in the treatment of patients with druginduced EPS for whom medication with anticholinergic properties is contraindicated Out of 253 patients fulfilling criteria for a first episode of schizophrenic illness , 120 entered a r and omised placebo-controlled trial of maintenance neuroleptic medication on discharge ; they were followed to relapse or loss to follow-up , for two years or to the end of the study . Of those on active medication , 46 % relapsed , as did 62 % of those on placebo ; the most important determinant of relapse was duration of illness prior to starting neuroleptic medication . This finding might be because extended duration of symptoms before admission is more likely to be present in illnesses which in any case will have poor prognosis , or because susceptibility to relapse is reduced by early institution of treatment . The study provides no data on which a decision between these alternative explanations can be based 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 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 CONTEXT Second-generation ( atypical ) antipsychotics ( SGAs ) are more expensive than first-generation ( typical ) antipsychotics ( FGAs ) but are perceived to be more effective , with fewer adverse effects , and preferable to patients . Most evidence comes from short-term efficacy trials of symptoms . OBJECTIVE To test the hypothesis that in people with schizophrenia requiring a change in treatment , SGAs other than clozapine are associated with improved quality of life across 1 year compared with FGAs . DESIGN A noncommercially funded , pragmatic , multisite , r and omized controlled trial of antipsychotic drug classes , with blind assessment s at 12 , 26 , and 56 weeks using intention-to-treat analysis . SETTING Fourteen community psychiatric services in the English National Health Service . PARTICIPANTS Two hundred twenty-seven people aged 18 to 65 years with DSM-IV schizophrenia and related disorders assessed for medication review because of inadequate response or adverse effects . INTERVENTIONS R and omized prescription of either FGAs or SGAs ( other than clozapine ) , with the choice of individual drug made by the managing psychiatrist . MAIN OUTCOME MEASURES Quality of Life Scale scores , symptoms , adverse effects , participant satisfaction , and costs of care . RESULTS The primary hypothesis of significant improvement in Quality of Life Scale scores during the year after commencement of SGAs vs FGAs was excluded . Participants in the FGA arm showed a trend toward greater improvements in Quality of Life Scale and symptom scores . Participants reported no clear preference for either drug group ; costs were similar . CONCLUSIONS In people with schizophrenia whose medication is changed for clinical reasons , there is no disadvantage across 1 year in terms of quality of life , symptoms , or associated costs of care in using FGAs rather than nonclozapine SGAs . Neither inadequate power nor patterns of drug discontinuation accounted for the result 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 efficacy of oral concentrate in the rapid tranquilization of 159 acutely disturbed patients in a psychiatric emergency service was evaluated . Patients were r and omly assigned to 1 of 10 treatment groups : 7 oral groups and 3 comparison intramuscular groups . Although intramuscular medication produced a faster response , concentrate also proved to be effective for rapid tranquilization . Side effects were benign and minimal . Age , sex , race , and diagnosis had no effect on outcome . The use of concentrate as a paradigm for treating acutely psychotic patients is discussed Research on strategies using low doses of neuroleptics in the long-term maintenance and /or prophylactic treatment of schizophrenia is review ed . The evidence available from prospect i ve controlled trials suggests that substantial dosage reduction is feasible for a subgroup of outpatient schizophrenics and that the incidence of abnormal involuntary movements might be reduced by such a strategy . In addition , lowering dosages may bring about some improvement in psychosocial adjustment . Further work is clearly needed to explore fully the benefit to risk ratio of this strategy and to identify those patients for whom it is most appropriate Urinary MHPG excretion in patients with acute schizophrenia was studied before and during a trial of the isomers of flupenthixol and placebo . Pretrial MHPG excretion was not related to severity of illness before the trial or to other pretrial clinical variables . In male subjects higher pretrial MHPG excretion was associated with a better outcome 1 year post-trial . However in females no relationship between MHPG excretion and outcome was established . During the trial there was a reduction in MHPG excretion in patients treated with β-flupenthixol but no decrease in the group treated with α-flupenthixol or chlorpromazine . In patients on placebo  there was a reduction in MHPG excretion in those who dit well clinical ly , but not in those who did poorly . Thus low MHPG excretion may be a predictor of poor outcome in schizophrenia , but MHPG excretion also changes both as a function of clinical state and of neuroleptic drug administration Subjects Thirty-four newly admitted acute schizophrenic patients were studied : they included first admissions and others undergoing acute exacerbations with a history of previous acute schizophrenic episodes . None of these patients had received tranquillizing medication for at least one month prior to admission to hospital , or electroconvulsive therapy for at least two months . They ranged in age from seventeen to fifty-four years with a mean age of thirty-four . Some preliminary . findings with the first twenty subjects in this series have already been published ( 4 ) . coefficient of variation ( CV ) than the other fifty-five patients who were receiving a variety of drugs . The procedure described here permitted a more detailed analysis of the effects of two antipsychotic agents ( quite different in chemical structure ) upon the integrated EEG measures in a more systematic comparative design of shortterm drug effects . It also permitted a comparison of effects , both clinical and EEG , over a time period ( seven days ) similar to that in which the clinician might ordinarily decide whether his patient was showing 
    Output:
    
AUTHORS ' CONCLUSIONS The results did not show a difference in efficacy between trifluoperazine and low-potency antipsychotics .
Trifluoperazine produced more movement disorders .