[Efficacy and adverse reactions of antipsychotics for neuropsychiatric symptoms in dementia: a systematic review].
OBJECTIVE
To assess the efficacy and adverse reactions of typical and atypical antipsychotics in the treatment of neuropsychiatric symptoms in dementia, and to examine the evidence for the cerebrovascular events warning for atypical antipsychotics.


METHODS
Systematic review.


METHODS
Using Medline, Cinahl, PsyclNFO, Embase and the Cochrane central register of controlled trials (1980-2005), double-blind randomized controlled trials with intention-to-treat analysis were selected, which evaluated efficacy and adverse reactions of antipsychotics in the treatment of neuropsychiatric symptoms in dementia. The studies underwent a standardised validity assessment.


RESULTS
After screening 950 studies, 14 studies on the effect of haloperidol, risperidone, olanzapine, quetiapine, tiapride, loxapine and perphenazine were selected. In 7 out of 10 studies, haloperidol, risperidone and olanzapine appeared to be more effective than placebo in the treatment of aggression and psychosis. Direct comparison between typical and atypical antipsychotics revealed no statistically significant difference. The most common adverse reactions were extrapyramidal symptoms and somnolence. These adverse reactions were less frequent with low-dose risperidone than with haloperidol or olanzapine, but risperidone and olanzapine were found to be associated with a higher risk of cerebrovascular events in two studies.


CONCLUSIONS
The efficacy of typical and atypical antipsychotics is comparable, but only low-dose risperidone seems to be associated with fewer (extrapyramidal) side effects. The adverse reactions are inadequately described in the published data and consequently the warning of an increased risk of mortality could not be confirmed.
Zuidema
S U
SU
Universitair Medisch Centrum St. Radboud, Postbus 9101, 6500 HB Nijmegen. S.Zuidema@vphg.umcn.nl
van Iersel
M B
MB
Koopmans
R T C M
RT
Verhey
F R J
FR
Olde Rikkert
M G M
MG
D000374:Aggression / Q000187:drug effects / Q000523:psychology; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D003704:Dementia / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000188:drug therapy*; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine