Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis

Geddes, John; Freemantle, Nick; Harrison, Paul J.; Bebbington, Paul

doi:10.1136/bmj.321.7273.1371

Cited by 954 publications

(567 citation statements)

References 16 publications

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“…Moreover, the neurological scale scores (SAS, AIMS and BAS) were low at baseline and did not increase during the study, thus indicating that neither drug induced a significant level of extrapyramidal symptoms. These findings are consistent with those from previous studies showing that the atypical antipsychotics are associated with a lower incidence of extrapyramidal symptoms than the typical neuroleptics (Geddes et al 2000). In addition, both drugs produced low incidences of other adverse events, as indicated by the relatively small numbers of patients that withdrew from treatment for this reason.…”

Section: Discussionsupporting

confidence: 92%

“…It also possesses some short-acting norepinephrine receptor antagonist activity, as well as some antihistaminergic activity (Leysen et al 1988;Janssen et al 1988). Studies have shown that it is at least as effective as the typical neuroleptics in patients with acute and chronic schizophrenia with positive and/or negative symptoms (Chouinard et al 1993;Hoyberg et al 1993;Marder and Meibach 1994;Carman et al 1995;Huttunen et al 1995;Peuskens and the Risperidone Study Group 1995) and that it is better tolerated than typical neuroleptics in terms of extrapyramidal side effects (Geddes et al 2000).…”

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confidence: 99%

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Amisulpride vs. Risperidone in Chronic Schizophrenia Results of a 6-month Double-blind Study

Sechter

Fleurot

Rein

et al. 2002

Neuropsychopharmacology

106

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Schizophrenia is a chronic and disabling disorder with a lifetime prevalence of approximately 1% (American Psychiatric Association 1994). It results in significant long-term functional handicap, severely impairs the quality of life of both the patient and the caregivers and places a considerable financial burden on society.The clinical efficacy of amisulpride against acute psychotic symptoms at high doses (400-800 mg/day) and prominent negative symptoms at low doses (50-300 mg/day) may be explained by its preferential affinity for pre-synaptic dopaminergic D 2 and D 3 autoreceptor subtypes at low doses, while higher doses result in predominant antagonism of post-synaptic dopamine receptors (Perrault et al. 1997;Schoemaker et al. 1997). It also shows selectivity for dopamine receptors in limbic and hippocampal structures, rather than striatal structures, thus suggesting a lower propensity to induce extrapyramidal effects than seen with the classical antipsychotics (Perrault et al. 1997). Studies in

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Amisulpride vs. Risperidone in Chronic Schizophrenia Results of a 6-month Double-blind Study

Sechter

Fleurot

Rein

et al. 2002

Neuropsychopharmacology

106

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“…These advantages observed in some, but not all, studies include improvement in measures of negative symptoms, cognitive test performance, depression, adherence, time to relapse, aggression, and suicide. A few studies using low doses of first-generation antipsychotic drugs, and recent head-to-head comparisons with public sponsorship in the United States and United Kingdom fail to support the superiority of second generation drugs (Jones et al, 2006, Lieberman et al, 2003aGeddes et al, 2005;Schooler et al, 2005;Lieberman, 2007). Some second-generation antipsychotic drugs cause very substantial adverse effects.…”

Section: Introductionmentioning

confidence: 99%

The Evolution of Drug Development in Schizophrenia: Past Issues and Future Opportunities

Carpenter

Koenig

2007

Neuropsychopharmacol

185

128

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“…Several meta-analyses of RCTs have shown that atypical antipsychotics are less likely to cause EPS than conventional agents (Bagnall et al, 2003;Geddes et al, 2000). The EPS advantage of the atypical antipsychotics was the major reason why the National Institute of Clinical Excellence (NICE) Schizophrenia Guideline in the UK recommended that atypical antipsychotics should be first line drugs in the treatment of those with newly diagnosed schizophrenia and that patients treated with conventional antipsychotics who have unacceptable EPS should be switched to an atypical agent (National Institute for Clinical Excellence, 2002).…”

Section: Differential Risk Of Eps Among Antipsychotic Drugsmentioning

confidence: 99%

Neurological complications of psychiatric drugs: clinical features and management

Haddad

Dursun

2007

Hum. Psychopharmacol. Clin. Exp.

190

106

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This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyperreflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders.

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Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis

Abstract: Objective To develop an evidence base for recommendations on the use of atypical antipsychotics for patients with schizophrenia.

Cited by 954 publications

References 16 publications

Amisulpride vs. Risperidone in Chronic Schizophrenia Results of a 6-month Double-blind Study

Amisulpride vs. Risperidone in Chronic Schizophrenia Results of a 6-month Double-blind Study

The Evolution of Drug Development in Schizophrenia: Past Issues and Future Opportunities

Neurological complications of psychiatric drugs: clinical features and management

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