title: Is There Room for Second-Generation Antipsychotics in the Pharmacotherapy of Panic Disorder? A Systematic Review Based on PRISMA Guidelines.
abstract: A role for second-generation antipsychotics (SGAs) in the treatment of panic disorders (PD) has been proposed, but the actual usefulness of SGAs in this disorder is unclear. According to the PRISMA guidelines, we undertook an updated systematic review of all of the studies that have examined, in randomized controlled trials, the efficacy and tolerability of SGAs (as either monotherapy or augmentation) in the treatment of PD, with or without other comorbid psychiatric disorders. Studies until 31 December 2015 were identified through PubMed, PsycINFO, Embase, Cochrane Library and Clinical trials.gov. Among 210 studies, five were included (two involving patients with a principal diagnosis of PD and three involving patients with bipolar disorder with comorbid PD or generalized anxiety disorder). All were eight-week trials and involved treatments with quetiapine extended release, risperidone and ziprasidone. Overall, a general lack of efficacy of SGAs on panic symptoms was observed. Some preliminary indications of the antipanic effectiveness of risperidone are insufficient to support its use in PD, primarily due to major limitations of the study. However, several methodological limitations may have negatively affected all of these studies, decreasing the validity of the results and making it difficult to draw reliable conclusions. Except for ziprasidone, SGAs were well tolerated in these short-term trials.
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. pernagp@gmail.com.|Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 Maastricht, The Netherlands. pernagp@gmail.com.|Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, FL 33136, USA. pernagp@gmail.com.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Perna
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. alessandra.alciati@gmail.com.
authors.forename: Alciati
authors.initials: A
authors.lastname: Alessandra
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. ballettalello@gmail.com.
authors.forename: Balletta
authors.initials: B
authors.lastname: Raffaele
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. elisamingotto@gmail.com.
authors.forename: Mingotto
authors.initials: M
authors.lastname: Elisa
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. g.diaferia@ospedaliere.it.
authors.forename: Diaferia
authors.initials: D
authors.lastname: Giuseppina
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. p.cavedini@paolocavedini.com.
authors.forename: Cavedini
authors.initials: C
authors.lastname: Paolo
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. maria.nobile4@gmail.com.|Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, 23842 Lecco, Italy. maria.nobile4@gmail.com.
authors.forename: Nobile
authors.initials: N
authors.lastname: Maria
authors.affiliation: Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, via Roma 16, Albese con Cassano, 22032 Como, Italy. caldiroladaniela@gmail.com.
authors.forename: Caldirola
authors.initials: C
authors.lastname: Daniela
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D006801:Humans; D016584:Panic Disorder / Q000188:drug therapy*; D010879:Piperazines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate / Q000627:therapeutic use; D018967:Risperidone / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D018967:Risperidone
keywords: bipolar disorder; panic disorder; quetiapine; risperidone; second-generation antipsychotics; ziprasidone