Clinical trials and schizophrenia

The rise of the clinical trial In trying to treat any disorder, how do we know what works and what doesn’t? The familiar hierarchy of expert opinion at the bottom, then up through case studies and case series, case control and cohort studies, ending with the gold standard of randomized controlled trials, is well accepted now (Table 27.1). Most academics would now agree that not only are randomized controlled trials the benchmark level of evidence to demonstrate efficacy, they are the only way. This, of course, is a pity because randomized controlled trials, perhaps particularly in mental health, are difficult to do. They are cumbersome, expensive and long-winded. Because of this, they are easy to do badly, again perhaps particularly in mental health.