Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis.
BACKGROUND
There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.


OBJECTIVE
To examine the evidence base for this recommendation.


METHODS
Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.


RESULTS
Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = -0.1, 95% CI -0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = -0.4, 95% CI -0.5 to -0.2).


CONCLUSIONS
There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.
Division of Psychological Medicine, Institute of Psychiatry PO 67, De Crespigny Park, London SE58AF. nicolas.crossley@kcl.ac.uk
Nicolas A
NA
Crossley
Miguel
M
Constante
Philip
P
McGuire
Paddy
P
Power
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002755:Choice Behavior / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D015430:Weight Gain / Q000187:drug effects*
D014150:Antipsychotic Agents