Risperidone versus other antipsychotics for people with severe mental illness and co‐occurring substance misuse

摘要: Background Up to 75% of people with serious mental illness (SMI) such as schizophrenia and bipolar disorder have co-occurring substance use disorders (dual diagnosis). Dual diagnosis can an adverse effect on treatment prognosis SMI. Objectives To evaluate the effects risperidone compared other antipsychotics (first-generation second-generation antipsychotics) used in misuse. Search methods On 6 January 2016 9 October 2017, we searched Cochrane Schizophrenia Group's Study-Based Register Trials (including trial registers). Selection criteria We selected randomised trials versus any antipsychotic SMI abuse included meeting our inclusion reporting useable data. excluded that either did not meet or met but report Data collection analysis independently inspected citations studies. For studies, extracted data appraised study quality. binary outcomes calculated risk ratios (RRs) their 95% confidence intervals. continuous mean differences (MDs) pooled using random-effects meta-analyses assessed quality evidence, creating a 'Summary findings' table GRADE approach. Main results identified eight containing total 1073 participants Seven these contributed review. There was heterogeneity design measurement. Risperidone clozapine, olanzapine, perphenazine, quetiapine ziprasidone. Few first-generation agents. examined dual from outset most only contained separate analyses subgroups were secondary existing larger trials.For clozapine found no clear between two reduction positive psychotic symptoms (1 controlled (RCT), n = 36, difference (MD) 0.90, CI -2.21 4.01, very low evidence), cannabis RCT, 14, ratio (RR) 1.00, 0.30 3.35, improvement subjective well-being MD -6.00, -14.82 2.82, numbers discontinuing medication RR 4.05, 0.21 78.76, extrapyramidal side-effects (2 RCTs, 50, 2.71, 24.08; I² 0%, leaving early 45, 0.49, 0.10 2.51; 34%, evidence). Clozapine associated lower levels craving for 28, 7.00, 2.37 11.63, evidence).For olanzapine 37, -1.50, -3.82 0.82, 41, 0.40, -4.72 5.52, 5.00, -4.86 14.86, parkinsonism 16, -0.08, -1.21 1.05, 77, 0.68, 0.34 1.35; number 281, 0.92 1.20, low-quality quetiapine, 294, 0.96, 0.86 1.07, ziprasidone, 240, 0.85 1.10, many comparisons, important missing; reported metabolic disturbances, global impression severity, life mortality. Authors' conclusions is sufficient good-quality evidence available determine diagnosis. agents, leading limited applicability settings where access agents limited, low- middle-income countries. Moreover, measurement precluded analyses. Future this area need be sufficiently powered also conform consistent population selection, scales, definition outcomes, measures counter bias. Investigators should adhere CONSORT guidelines results.