did haloperidol cause the most movement side effects of seven antipsychotics in the sino trial
“Hello Paridol had the highest rate of extra pyramidal symptoms of all anti-psychotics, including when directly compared with Prefenisine.”
a guest, a psychiatrist (co-director of the MGH Psychosis Clinical and Research program) said on Psychopharmacology and Psychiatry Updates, 2026-10-09, at 07:44. hear it in context → the speaker cited: the SINO trial.
the episode: Schizophrenia: Which of Seven Antipsychotics Wins? (at 07:44). we link the show's own page; we do not re-host audio.
first, the part that holds
the trial exists and the abstract supports the claim. In a 32-hospital randomized trial of seven antipsychotics in 3,067 acutely ill adults with schizophrenia, the authors report that "haloperidol was associated with a higher risk of extrapyramidal symptoms than all other drugs," and the other drugs include perphenazine, the other first-generation drug in the trial.
what we found when we went and looked
we went and looked at the published abstract of the Schizophrenia in Non-Occidental Participants trial (SINO; American Journal of Psychiatry, February 2026, 183(2):112-123). It randomized 3,067 acutely ill patients to olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, perphenazine or haloperidol for six weeks. The abstract states that "haloperidol was associated with a higher risk of extrapyramidal symptoms than all other drugs (relative risks: 0.13-0.61)". In other words, each of the other six drugs carried between about 13% and 61% of haloperidol's risk. Because perphenazine is one of those six, the comparison the speaker singled out is covered by the abstract's own wording. The abstract does not report perphenazine's individual relative risk, so we can't say how wide the gap was. We could not open the full-text tables.
assertion by assertion
| assertion | verdict | what the record says |
|---|---|---|
| the SINO trial compared seven antipsychotics head to head | confirmed | the abstract describes a multicenter (32 hospitals), industry-independent, assessor-blinded, flexible-dose randomized trial named Schizophrenia in Non-Occidental Participants. It enrolled 3,067 patients across seven arms: olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, perphenazine and haloperidol. 82% completed follow-up. The acronym SINO itself does not appear in the abstract. [1] |
| in that trial, haloperidol had the highest rate of extrapyramidal symptoms of all seven antipsychotics | confirmed | verbatim from the abstract: "Haloperidol was associated with a higher risk of extrapyramidal symptoms than all other drugs (relative risks: 0.13-0.61)." The abstract reports this as relative risk against haloperidol, not as a raw rate for each drug. [1] |
| haloperidol's extrapyramidal risk was higher than perphenazine's in direct comparison | confirmed | perphenazine is one of the six drugs covered by "all other drugs", so the abstract's statement includes it. The abstract does not give perphenazine's own relative risk, only the 0.13-0.61 range across all six comparators. Perphenazine may sit near the 0.61 end, but we did not verify that. The size of this gap is unverified. [1] |
| the trial only measured short-term, acute-phase effects | confirmed | treatment lasted six weeks in hospitalized patients with an acute exacerbation. The result says nothing about tardive dyskinesia or long-term movement effects. [1] |
both directions
for the speaker: the abstract's own sentence matches the claim almost word for word: haloperidol carried a higher risk of extrapyramidal symptoms than every other drug in the trial, and perphenazine was one of them. The design adds weight to the result. It is large (3,067 randomized), runs across 32 hospitals, has blinded assessors and no industry funding, and compares all seven drugs at once in a single randomized population instead of stitching separate trials together.
against: the abstract gives one relative-risk range (0.13-0.61) for all six comparators, so the haloperidol-versus-perphenazine gap could be the smallest in the trial. "Highest rate" is the speaker's phrasing. The abstract reports relative risks against haloperidol, not a ranked table of event rates. Dosing was flexible and doctors knew which drug they were giving (only assessors were blinded), so how each drug was dosed may have shaped the extrapyramidal results. The acronym SINO comes from secondary coverage; the abstract uses the full trial name.
what this cannot say
we read the PubMed abstract only. The publisher's full text returned an access error, so we did not see the per-drug extrapyramidal tables, how extrapyramidal symptoms were defined, rating scales, anticholinergic co-prescription or dose levels. All participants were from a non-Western (Chinese hospital) population; East Asian patients may have different extrapyramidal susceptibility, so the absolute rates may not carry over to other populations. Six weeks of acute treatment cannot speak to long-term movement disorders.
sources, each one fetched and read
- Efficacy and tolerability of seven antipsychotic drugs in acutely ill patients with schizophrenia: a randomized, multicenter, assessor-blinded trial. Am J Psychiatry. 2026 Feb 1;183(2):112-123. doi:10.1176/appi.ajp.20250111. PMID 41152254 (PubMed abstract via NCBI E-utilities) What we read there: "Haloperidol was associated with a higher risk of extrapyramidal symptoms than all other drugs (relative risks: 0.13-0.61)." Also: "multicenter (32 hospitals), industry-independent, parallel, assessor-blinded, flexible-dosage randomized trial (Schizophrenia in Non-Occidental Participants)"; "A total of 3,067 patients were randomized, of whom 82% completed follow-up." Fetched 2026-10-15 (HTTP 203). https://pubmed.ncbi.nlm.nih.gov/41152254/
speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam