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Evidence summaries

Risperidone Versus other Antipsychotics for People with Severe Mental Illness and Cooccurring Substance Misuse

The evidence is insufficient to determine the effects of risperidone compared with other antipsychotics in people with a dual diagnosis. Level of evidence: "D"

Comment: The quality of evidence is downgraded by the study quality (unclear allocation concealment and lack of blinding), inconsistency (heterogeneity in outcomes), indirectness (differences in study designs: post hoc and subgroup studies) and imprecise results (few studies for each outcome).

Summary

A Cochrane review [Abstract] 1 included 8 studies with a total of 1073 patients with serious mental illness and co-occurring substance misuse. Few trials examined participants with a dual diagnosis from the outset and most trials only contained separate analyses of subgroups with a dual diagnosis or were secondary data analyses of subgroups of people with a dual diagnosis from existing larger trials.

  • Risperidone vs. clozapine: There was no clear differences between them in the reduction of positive psychotic symptoms (MD 0.90, 95% CI −2.21 to 4.01; 1 trial, n = 36), or reduction in cannabis use (RR 1.00, 95% CI 0.30 to 3.35; 1 trial, n = 14), improvement in subjective well-being (MD −6.00, 95% CI −14.82 to 2.82; 1 trial, n = 36), numbers discontinuing medication (RR 4.05, 95% CI 0.21 to 78.76; 1 trial, n = 36), extrapyramidal side-effects (RR 2.71, 95% CI 0.30 to 24.08; 2 trials, n = 50), or leaving the study early (RR 0.49, 95% CI 0.10 to 2.51; 2 trials, n = 45). Clozapine was associated with lower levels of craving for cannabis (MD 7.00, 95% CI 2.37 to 11.63; 1 RCT, n = 28).
  • Risperidone vs. olanzapine: There were no clear differences in the reduction of positive psychotic symptoms (MD −1.50, 95% CI −3.82 to 0.82; 1 trial, n = 37), reduction in cannabis use (MD 0.40, 95% CI −4.72 to 5.52; 1 trial, n = 41), craving for cannabis (MD 5.00, 95% CI −4.86 to 14.86; 1 trial, n = 41), parkinsonism (MD −0.08, 95% CI −1.21 to 1.05; 1 trial, n = 16), or leaving the study early (RR 0.68, 95% CI 0.34 to 1.35; 2 trials, n = 77).
  • Risperidone vs. perphenazine: There were no clear differences in the number of patients leaving the study early (RR 1.05, 95% CI 0.92 to 1.20, 1 trial, n = 281).
  • Risperidone vs. quetiapine: There were no clear differences in the number of patients leaving the study early (RR 0.96, 95% CI 0.86 to 1.07, 1 trial, n = 294).
  • Risperidone vs. ziprasidone: There were no clear differences in the number of patients leaving the study early (RR 0.96, 95% CI 0.85 to 1.10; 1 trial, n = 240).

Clinical comments

Note

Date of latest search:

    References

    • Temmingh HS, Williams T, Siegfried N et al. Risperidone versus other antipsychotics for people with severe mental illness and co-occurring substance misuse. Cochrane Database Syst Rev 2018;1():CD011057. [PubMed]

Primary/Secondary Keywords