You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Adherence and persistence to typical and atypical antipsychotics in the naturalistic treatment of patients with schizophrenia
Abstract 1:
Objective To compare adherence and persistence to typical versus atypical antipsychotics and between specific atypical agents in the usual care of schizophrenia and to examine the association between adherence and persistence . Method Data were drawn from a 3-year prospect i ve , nonr and omized , noninterventional study of schizophrenia conducted during 1997–2003 . Initiators on haloperidol , risperidone , olanzapine , quetiapine , and clozapine with at least 1 year of follow-up were included ( n = 878 ) .  Adherence ( Medication Possession Ratio , MPR ) and persistence ( time to all-cause medication discontinuation ) were assessed using medical record prescription information . Analyses employed multivariate statistics adjusted for group differences . Results Overall , 58 % of the patients were deemed adherent ( MPR > 80 % ) . Adherence rates were higher : for atypical ( 59.4 % ) than typical antipsychotics ( 34.5 % , p < 0.001 ) , for clozapine ( 77 % ) than each comparator excluding olanzapine ( p < 0.01 ) , and for olanzapine ( 64 % ) than risperidone ( 57 % , p = 0.027 ) and quetiapine ( 52 % , p = 0.019 ) . Differences between risperidone and quetiapine were not statistically significant . Adherence and persistence were highly correlated ( r = 0.957 , p < 0.001 ) . Conclusion In the usual care of schizophrenia , medication adherence and persistence appear to be highly correlated and to significantly differ between typical and atypical antipsychotics and among atypical agents . The choice of antipsychotic may play a meaningful role in patients ’ adherence to and persistence with antipsychotic medications


Title 2:
Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.
Abstract 2:
BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more commonly . We compared a first-generation antipsychotic , perphenazine , with several newer drugs in a double-blind study . METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and r and omly assigned to receive olanzapine ( 7.5 to 30 mg per day ) , perphenazine ( 8 to 32 mg per day ) , quetiapine ( 200 to 800 mg per day ) , or risperidone ( 1.5 to 6.0 mg per day ) for up to 18 months . Ziprasidone ( 40 to 160 mg per day ) was included after its approval by the Food and Drug Administration . The primary aim was to delineate differences in the overall effectiveness of these five treatments . RESULTS Overall , 74 percent of patients discontinued the study medication before 18 months ( 1061 of the 1432 patients who received at least one dose ) : 64 percent of those assigned to olanzapine , 75 percent of those assigned to perphenazine , 82 percent of those assigned to quetiapine , 74 percent of those assigned to risperidone , and 79 percent of those assigned to ziprasidone . The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine ( P<0.001 ) or risperidone ( P=0.002 ) group , but not in the perphenazine ( P=0.021 ) or ziprasidone ( P=0.028 ) group . The times to discontinuation because of intolerable side effects were similar among the groups , but the rates differed ( P=0.04 ) ; olanzapine was associated with more discontinuation for weight gain or metabolic effects , and perphenazine was associated with more discontinuation for extrapyramidal effects . CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons . Olanzapine was the most effective in terms of the rates of discontinuation , and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine , risperidone , and ziprasidone . Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism


Title 3:
A RATING SCALE FOR EXTRAPYRAMIDAL SIDE EFFECTS
Abstract 3:
A modification of an earlier rating scale for extrapyramidal system disturbance is described , and evidence for the validity and reliability of the scale is presented . The usefulness of the scale in studies of neuroleptic drugs is discussed . By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors


Title 4:
Predictive Value of Self-Stigma, Insight, and Perceived Adverse Effects of Medication for the Clinical Outcomes in Patients With Depressive Disorders
Abstract 4:
The aims of this prospect i ve study were to examine the predictive values of self-stigma , insight , and perceived adverse effects of medication for remission of depressive symptoms , suicidal risk , and medication adherence in patients with depressive disorders over a 1-year follow-up period . One hundred seventy-four participants who were in a state of obvious depression underwent an index interview to determine their degree of self-stigma , insight , and perceived adverse effects of medication .  One year later , they were reassessed to determine the severity of their depressive symptoms , suicidal risk , and the level of the medication adherence , and their associations with the 3 possible predictors at the index interview were examined . The results of this study indicated that perceiving more severe adverse effects of medication at the index interview increased the risks of the nonremission of depressive symptoms , occurrence of suicidal ideation or attempt , and medication nonadherence in patients with depressive disorders in the 1-year period . However , the degrees of self-stigma and insight did not predict the severity of depressive symptoms , suicidal risk , or the level of the medication adherence . Based on the results of this study , we suggest that it is important for clinicians to prevent the occurrence of and to help patients manage the adverse effects of medication . We also suggest that further prospect i ve studies are needed to examine the predictive values of self-stigma and insight for clinical outcomes and medication adherence
Results : Content validity was appropriately established for only one of the tools , reliability was inappropriately evaluated for all but one tool , and the assessment of responsiveness was not acceptable for any tool .