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No difference in extrapyramidal side effects between first-generation and second-generation antipsychotics

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Question: Do second-generation antipsychotics (SGAs) reduce extra-pyramidal side effects (EPS) compared with first-generation antipsychotics (FGAs)?

Patients: 227 adults (18–65 years) with DSM-IV schizophrenia or schizophreniform, schizoaffective or delusional disorders. Participants were included if positive symptoms had lasted >1 month and their clinician was considering a change to their prescription due to poor clinical response or drug-related impairment of global function.

Setting: 14 community psychiatry services, England; July 1999–January 2002.

Intervention: FGA (n=118) or SGA (n=109). Clinicians chose a drug within the randomised class, and were asked to keep participants on the medication prescribed for at least 12 weeks, within good practice. Clozapine was not used. Where it was necessary to change drugs, clinicians were asked to switch to another drug within the same class. In an additional analysis, groups were stratified into those prescribed and not prescribed anticholinergics (which are prescribed to treat or prevent EPS).

Outcomes: EPS, including akathisia (score ≥2 on the Barnes Akathisia Rating Scale); parkinsonism (score ≥3 on the Simpson-Angus scale) and tardive dyskinesia (a score of 3, or two scores of …

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