A Cochrane review [Abstract] 1 included 13 RCTs with a total of 711 participants. There was no clinically important improvement in tardive dyskinesia (TD) favouring switch to risperidone vs. antipsychotic cessation (with placebo) (RR 0.45 CI 0.23 to 0.89; 1 RCT, n=42). There was no difference in antipsychotic dose reduction vs. antipsychotic maintenance (RR 0.42 95% CI 0.17 to 1.04; 2 RCTs, n=17), or in switch to a new antipsychotic vs. switch to another new antipsychotic (5 comparisons, 5 RCTs, n=140). There was significant difference on extrapyramidal symptoms: use of antiparkinsonism medication favouring switch to quetiapine vs. switch to haloperidol (RR 0.45 CI 0.21 to 0.96; 1 RCT, n=45). There was no evidence of a difference for switch to risperidone or haloperidol vs. antipsychotic cessation (with placebo) (RR 2.08 95% CI 0.74 to 5.86; RR 1 RCT, n=48) or for switch to risperidone vs. switch to haloperidol (RR 0.68 95% CI 0.34 to 1.35; 1 RCT, n=37). No trials reported on social confidence, social inclusion, social networks, or personalised quality of life, outcomes being important to patients.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and imprecise results (few patients and wide confidence intervals).
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