Article Text

Review: no evidence to support gradual over abrupt switching of antipsychotics

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 Q Is a gradual change of antipsychotic medication safer and more effective than an abrupt change?


Embedded ImageDesign:

Systematic review with meta analysis.

Embedded ImageData sources:

MEDLINE (to April 2004), and manual search of selected journals (January 1980 to April 2004).

Embedded ImageStudy selection and analysis:

Studies were included if they were English language randomised controlled trials (RCTs) comparing two or more strategies for switching between two non-depot antipsychotic medications, including abrupt or gradual discontinuation of current medication and abrupt or gradual replacement with new medication. Meta-analysis was conducted to calculate correlation measure of effect size (r) for outcomes common to more than one study. These were calculated separately for the discontinuation and the replacement phases of the trials.

Embedded ImageOutcomes:

Symptoms (including Clinical Global Impressions—Severity Scale; Positive and Negative Syndrome Scale); adverse events (including drowsiness, insomnia disturbance, and weight gain).


Four RCTs met inclusion criteria (n = 209, 108, 311, and 270), all of which evaluated …

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