BACKGROUND: Typical antipsychotic drugs are widely used as the first line 
treatment for people with schizophrenia. However, the atypical class of 
antipsychotic drugs is making important inroads into this approach. 'Atypical' 
is a term widely used to describe some antipsychotics which have a low 
propensity to produce movement disorders, sedation and raised serum prolactin. 
There is some suggestion that the different adverse effect profiles of the 
atypical antipsychotic group make them more acceptable to people with 
schizophrenia. Molindone has a similar profile to quetiapine (a novel atypical 
antipsychotic), with very low binding to all receptors. Some authors have 
suggested that molindone is safer than other 'typical' antipsychotics in that 
extrapyramidal adverse effects are not usually seen at clinically effective 
antipsychotic doses and that it should therefore be classed as an atypical 
antipsychotic.
OBJECTIVES: To determine the effects of molindone compared with placebo, typical 
and other atypical antipsychotic drugs for schizophrenia and related psychoses.
SEARCH STRATEGY: Electronic searches of Biological Abstracts (1980-1999), The 
Cochrane Library CENTRAL (Issue 1, 1999), The Cochrane Schizophrenia Group's 
Register (January 1999), CINAHL (1982-1999), EMBASE (1980-1999), MEDLINE 
(1966-1999), LILACS (1982-1999), PSYNDEX (1977-1999), and PsycLIT (1974-1999) 
were undertaken. In addition, pharmaceutical databases on the Dialog Corporation 
Datastar and Dialog services were searched. References of all identified studies 
were searched for further trials. The manufacturer of molindone and authors of 
trials were contacted.
SELECTION CRITERIA: All randomised controlled trials that compared molindone to 
other treatments for schizophrenia and schizophrenia-like psychoses were 
included by independent assessment.
DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were 
independently inspected by reviewers, papers ordered, re-inspected and quality 
assessed. Data were independently extracted. Data were excluded if loss to 
follow up was greater than 50%. For homogeneous dichotomous data the risk ratio 
(RR), 95% confidence interval (CI) and, where appropriate, the number needed to 
treat (NNT) were calculated on an intention-to-treat basis. For continuous data, 
weighted mean differences (WMD) were calculated. All data were inspected for 
heterogeneity.
MAIN RESULTS: Thirteen studies were included in the review. Data for this 
compound range from very short (10 day) studies of the intramuscular preparation 
to trials lasting over three months. For measures of global state available data 
do not justify any conclusions on the comparative efficacy of molindone and 
placebo. When compared to other typical antipsychotics no difference in 
effectiveness was evidenced (doctors' RR 1.13, CI 0.69 to 1.86; nurses' RR 1.23, 
CI 0.82 to 1.86). It is no more or less likely than typical drugs to cause 
movement disorders, but causes significantly more weight loss (RR 2.78, CI 1.10 
to 6.99).
REVIEWER'S CONCLUSIONS: The strength of the evidence relating to this compound 
is limited, owing to small sample size, poor study design, limited outcomes and 
incomplete reporting. Molindone may be an effective antipsychotic; however, its 
adverse effect profile does not differ significantly from that of typical 
antipsychotics, apart from the event of weight loss. At present there is no 
evidence to suggest that it may have an atypical profile.