title: [Antipsychotic Treatment of the Adult Patient in the Acute Phase of Schizophrenia].
abstract: OBJECTIVE
  To determine the efficacy and safety of different antipsychotic drugs in the management of patients diagnosed with schizophrenia in the acute phase. To formulate evidence-based recommendations on the antipsychotic (AP) drug management strategies for the treatment of the adult diagnosed with schizophrenia in the acute phase.
  
  
  METHODS
  Clinical practice guidelines were prepared, using the guidelines of the Methodology Guide of the Ministry of Health and Social Protection, in order to identify, synthesise, and evaluate the evidence and formulate recommendations as regards the management and follow-up of adult patients diagnosed with schizophrenia. The evidence of the NICE 82 guideline was adopted and updated, which answered the question on the management of the acute phase of adults with a diagnosis of schizophrenia. The evidence and its level were presented to the Guideline Development Group (GDG) in order to formulate recommendations following the methodology proposed by the GRADE approach.
  
  
  RESULTS
  Clozapine, olanzapine, risperidone, ziprasidone, amisulpride, paliperidone, haloperidol, quetiapine, and aripiprazole were more effective than placebo for the majority of psychotic symptoms and the abandonment of treatment, but asenapine was not. Paliperidone, risperidone, quetiapine, clozapine, and olanzapine showed significant increases in weight compared to placebo. Haloperidol, risperidone, ziprasidone, and paliperidone had a higher risk of extrapyramidal symptoms than placebo. There was a significant risk of sedation or drowsiness with, risperidone, haloperidol, ziprasidone, quetiapine, olanzapine, and clozapine in the comparisons with placebo. Of the results of the comparisons between AP, it was shown that clozapine and paliperidone had a clinically significant effect compared to haloperidol and quetiapine, respectively. Olanzapine and risperidone had a lower risk of abandoning the treatment in general, and due to adverse reactions in two comparisons of each one, haloperidol was the drug with more risk of abandoning due to adverse effects, followed by clozapine. Amisulpride, haloperidol and ziprasidone had favourable results as regards weight increase in several comparisons. Aripiprazole and paliperidone obtained a higher number of favourable results as regards sedation, and all the atypical drugs (except paliperidone) had a lower risk than the use of anti-parkinsonian drugs. Of the evidence from observational studies, it was found that, in subjects with risk factors for diabetes, such as age, hypertension, and dyslipidaemia, the initial treatment and current treatment with olanzapine, as well as current treatment with clozapine, may promote the development of this disease.
  
  
  CONCLUSIONS
  Although it is imperative to prescribe an antipsychotic for treatment of the acute phase, the selection of the drug depends on the particular clinical condition of each patient and their collateral effects profile.
authors.affiliation: Médica psiquiatra, magístra en Epidemiología Clínica. Profesora asistente del departamento de Psiquiatría y Salud Mental. Pontificia Universidad Javeriana, Bogotá, Colombia. Electronic address: abohorquez@javeriana.edu.co.
authors.forename: Adriana
authors.initials: A
authors.lastname: Bohórquez Peñaranda
authors.affiliation: Médico psiquiatra, psicoanalista, psiquiatra de enlace, magíster en Epidemiología Clínica. Profesor titular y Director del Departamento de Epidemiología Clínica y Bioestadística. Pontificia Universidad Javeriana. Hospital Universitario San Ignacio, Bogotá, Colombia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez Restrepo
authors.affiliation: Médica psiquiatra, Doctora en Epidemiología Clínica. Profesora asociada del Departamento de Psiquiatría, Facultad de Medicina. Universidad de Antioquia, Medellín, Antioquia, Colombia.
authors.forename: Jenny
authors.initials: J
authors.lastname: García Valencia
authors.affiliation: Médico psiquiatra, Master en Farmacología. Profesor Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Jaramillo González
authors.affiliation: Médica y cirujana, Magister en Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Ana María
authors.initials: AM
authors.lastname: de la Hoz
authors.affiliation: Médico psiquiatra, Magister en Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Arenas
authors.affiliation: Médica psiquiatra, candidata a magístra Epidemiología Clínica. Pontificia Universidad Javeriana, Bogotá, Colombia.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Tamayo Martínez
keywords: Acute phase treatment; Antipsicóticos; Antipsychotics; Clinical practice guidelines; Esquizofrenia; Guía de práctica clínica; Schizophrenia; Tratamiento de fase aguda