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What is already known on this topic?
Using various end points, the comparative effectiveness and safety of antipsychotics in patients with schizophrenia and other psychiatric indications have been demonstrated by a number of experimental and observational studies.1 While atypical antipsychotics (AAPs) are indicated more frequently and extensively, their long-term safety in older patients, including the risk of weight gain, metabolic syndrome, cardiovascular and cerebrovascular events, has been a growing concern.2
What does this paper add?
The study indicated lack of effectiveness and a high incidence of side effects across the four commonly prescribed AAPs, namely aripiprazole, olanzapine, quetiapine and risperidone. Caution in the use of these drugs is warranted in middle-aged and older patients.
The authors designed a pragmatic clinical trial using equipoise-stratified randomisation that allowed the patient and the treating psychiatrist to exclude one or two of the study medications for …
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