How Should Large ‘naturalistic’ Trials of Antipsychotics Change the Practice of the Practicing Clinician?

Abstract

A number of large naturalistic trials of anti-psychotic medication have been carried out in recent years. These include SOHO, CATIE, CAFÉ, EUFEST, and CUTLASS.

These studies have attempted to demonstrate the efficacy in practice of second generation drugs as compared to first generation drugs. the results of these studies have been hotly debated and various conclusions have been drawn.

However, it is necessary to question what methodological issues have arisen in these studies, and hence how safe are the conclusions.

It is now also necessary to examine what findings appear to have been demonstrated by these trials, and whether certain findings are corroborated by several trials, while other trial results contradict each other.

In the presentation, each of the five studies will be critically appraised by a contributor who is a practicing clinician, but who has not participated as a principal investigator in the study concerned. Conclusions will be drawn as to whether the trials are useful for developing guidelines for the use of antipsychotics in the management of psychotic illness, what findings are corroborated by several trials, and indeed, whether methodological flaws might undermine some conclusions from some of the studies.