This pharmacoepidemiology study examines associations between first-trimester antipsychotic exposure and risk for overall congenital and cardiac malformations among children born to women enrolled in Medicaid.
This network meta-analysis assesses the efficacy of all antipsychotics used in patients with treatment-resistant schizophrenia.
This study reports on the effects of antipsychotic dose reduction in patients with late-life schizophrenia.
This randomized clinical trial shows that long-acting injectable risperidone resulted in better clinical outcomes than oral risperidone.
This case-control study examines whether mortality increases in elderly patients with dementia who receive antipsychotic medications.
This prospective controlled study reports that corticostriatal functional dysconnectivity in psychosis is a state-dependent phenomenon. Increased functional connectivity of the striatum with prefrontal and limbic regions may be a biomarker for improvement in symptoms associated with antipsychotic treatment.
This meta-analysis of 6 placebo-controlled studies examines whether the baseline severity of schizophrenia influences the efficacy of antipsychotic drugs.
Simpson et al compare the effects of 2 serotonin reuptake inhibitor augmentation strategies, risperidone or cognitive-behavioral therapy consisting of exposure and ritual prevention, vs pill placebo in adults with obsessive-compulsive disorder. See related editorial by Ressler.
The increased mortality associated with schizophrenia is largely due to cardiovascular disease. Treatment with antipsychotics is associated with weight gain and changes in other cardiovascular risk factors. Early identification of modifiable cardiovascular risk factors is a clinical imperative but prospective longitudinal studies of the early cardiometabolic adverse effects of antipsychotic drug treatment other than weight gain have not been previously reviewed.
To assess the methods and reporting of cardiometabolic outcome studies of the first treated episode of psychosis, review key findings, and suggest directions for future research.
PsycINFO, MEDLINE, and Scopus from January 1990 to June 2010.
Subjects were experiencing their first treated episode of psychosis. Subjects were antipsychotic naive or had been exposed to antipsychotics for a short known period at the beginning of the study. Cardiometabolic indices were assessed. Studies used a longitudinal design.
Sixty-four articles were identified describing 53 independent studies; 25 studies met inclusion criteria and were retained for detailed review.
Consolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the methods and reporting of studies. A qualitative review of findings was conducted.
Two key hypotheses were identified based on this review: (1) in general, there is no difference in cardiovascular risk assessed by weight or metabolic indices between individuals with an untreated first episode of psychosis and healthy controls and (2) cardiovascular risk increases after first exposure to any antipsychotic drug. A rank order of drugs can be derived but there is no evidence of significant class differences. Recommended directions for future research include assessing the effect on cardiometabolic outcomes of medication adherence and dosage effects, determining the therapeutic window for antipsychotic use in adults and youth, and testing for moderation of outcomes by demographic factors, including sex and age, and clinical and genetic factors.