Antipsychotic drugs systematic reviews

Antipsychotics may be widely used in the treatment of elderly people with schizophrenia, however, based on this systematic review, there are little robust data available to guide the clinician with respect to the most appropriate drug to prescribe. Clearly reported large short, medium and long-term randomised controlled trials with participants, interventions and primary outcomes that are familiar to those wishing to help elderly people with schizophrenia are long overdue. 

Lee PE, Gill SS, Freedman M, et al. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia systematic review. BrMed J 2004 doi 10.H36/bmj.38125.465579.55. 

Geriatric Considerations - Summary Sink and colleagues systematic review showed statistically significant improvements on neuropsychiatric and behavioral scales for some drugs, but improvements were small and unlikely to be clinically important. Because of documented risks, and uncertain benefits, antipsychotic drugs should be used with caution in demented elderly persons, with frequent monitoring for side effects and a low threshold for discontinuing use. 

A systematic review of 31 studies comparing clozapine to first-generation antipsychotics concluded that improvement was more frequent with clozapine than with the comparators (OR 0.4 Cl 0.2-0.6 NNT 6) and patients receiving clozapine had fewer relapses than patients receiving first-generation drugs (OR 0.6 Cl ... 

Systematic reviews Amisulpride and other atypical antipsychotic drugs (olanzapine, risperidone, and ziprasidone) have been compared in people with schizophrenia and schizophrenia-like psychoses in an analysis of 10 short- to medium-term trials with 1549 participants [56 ]. The overall attrition rate was considerable (35%), with no significant difference between the groups. Amisulpride was as effective as olanzapine and risperidone and more effective than ziprasidone. Amisulpride caused less weight gain than risperidone and olanzapine. Olanzapine was associated with a greater rise in blood glucose. There were no differences in cardiac and extrapyrami-dal reactions. 

Systematic reviews In a meta-analysis of randomized comparisons of clozapine with other atypical antipsychotic drugs, the... 

Systematic reviews Ziprasidone has been compared with other atypical antipsychotic drugs in a systematic review [151 ]. The rate of premature study discontinuation was very high (59% n=3361). Ziprasidone was less efficacious than amisulpride, olanzapine, and risperidone, but based on limited data there were no significant differences in tolerability between ziprasidone and amisulpride or clozapine. Ziprasidone produced less weight gain than olanzapine (median difference, -3.8 95% Cl = -4.7, -3.0 ... 

Systematic reviews First-generation and second-generation antipsychotic drugs in patients with schizophrenia have been compared in a meta-analysis [14= ] (for an in-depth review, see SEDA-27, 50). The study included 150 double-blind, mostly shortterm, randomized clinical trials with 21 533 participants. Four second-generation antipsychotic drugs (amisulpride, clozapine, olanzapine, and risperidone) were better than first-generation ones for overall... 

A systematic review of antipsychotic use in patients with HIV identified one study involving the use of FGAs for the control of delirium and case reports concerning the use of SGAs [24 ]. Increased sensitivity to extrapyramidal symptoms, increased risk of metabolic and bone marrow toxicities and drug-drug interactions with antiretrovirals are discussed. 

OzbQen M, Adams CE, Marley J. Anticholinergic effects of oral antipsychotic drugs of typicals versus atypicals over medium- and long-term systematic review and meta-analysis. Ciur Med Chem 2012 19(30) 5214-8. 

Haddad PM, Das A, Keyhani S, Chaudhry IB. Antipsychotic drugs and extrapyramidal side effects in first episode psychosis a systematic review of head-head comparisons. J Psychopharmacol 2012 26(Suppl. 5) 15-26. 

Almandil NB, Liu Y, Murray ML, Besag FM, Aitchison KJ, Wong 1C. Weight gain and other metaboKc adverse effects associated with atypical antipsychotic treatment of children and adolescents a systematic review and meta-analysis. Paediatr Drugs 2013 15(2) 139-50. 

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