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Q Are atypical antipsychotics effective as monotherapies or as adjunctive therapy for bipolar mania?
Systematic review and meta-analysis.
MEDLINE and PubMed (search date 2004); abstracts from the 2003 meetings of the American College of Neuropsychiatry, American Psychiatric Association, and International Conference on Bipolar Disorder; and contact with investigators and drug manufacturers.
Study selection and analysis:
Placebo controlled, randomised controlled trials (RCTs) of atypical antipsychotics (aripiprazole, clozapine, quetiapine, risperidone, ziprasidone, olanzapine) as monotherapy or adjunctive therapy (in addition to lithium, valproate, or carbamazepine) for acute bipolar mania. Meta-analysis was conducted using a random-effects model.
Manic symptoms (change in Young Mania Rating Scale (YMRS) or Mania Rating Scale (MRS) from baseline to endpoint using last observation carried forward analysis).
Eighteen RCTs met inclusion criteria. Atypical antipsychotic monotherapy significantly improved mania symptoms compared with placebo at 3–4 weeks (12 RCTs, 13 atypical antipsychotic …
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