Cochrane · systematic review · CD000459
Antipsychotic reduction and/or cessation and antipsychotics as specific treatments for tardive dyskinesia
Bergman, H, Rathbone, J, Agarwal, V, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SchizophreniaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
17
No studies
1
Included studies
NR
No studies 1 · 3.6%Ungraded 10 · 35.7%Very low 15 · 53.6%Low 2 · 7.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Reduced dose of antipsychotics compared with antipsychotic maintenance for antipsychotic‐induced tardive dyskinesia
Population: psychiatric patients (schizophrenia or schizoaffective disorder) with antipsychotic‐induced tardive dyskinesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tardive dyskinesia: no clinically important improvement Reduced dose of antipsychotics vs antipsychotic maintenance | RR 0.42 [0.17, 1.04] | 2 studies · 17 participants | Very low Downgraded: risk of bias, imprecision |
Tardive dyskinesia: deterioration of symptoms Reduced dose of antipsychotics vs antipsychotic maintenance | RR 0.61 [0.11, 3.31] | 2 studies · 17 participants | Very low Downgraded: risk of bias, imprecision |
General mental state: relapse Reduced dose of antipsychotics vs antipsychotic maintenance | RR 3 [0.16, 57.36] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effect: any ‐ not reported Reduced dose of antipsychotics vs antipsychotic maintenance | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effect: extrapyramidal symptoms ‐ not reported Reduced dose of antipsychotics vs antipsychotic maintenance | no estimate extracted | 0 studies · 0 participants | Ungraded |
Acceptability of the treatment: leaving the study early Reduced dose of antipsychotics vs antipsychotic maintenance | RR 0.33 [0.06, 1.99] | 1 study · 8 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social confidence, social inclusion, social networks, or personalised quality of life ‐ not reported Reduced dose of antipsychotics vs antipsychotic maintenance | no estimate extracted | 0 studies · 0 participants | Ungraded |
Switch to another antipsychotic compared with antipsychotic cessation for antipsychotic‐induced tardive dyskinesia
Population: psychiatric patients (schizophrenia) with antipsychotic‐induced tardive dyskinesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tardive dyskinesia: no clinically important improvement Switch to another antipsychotic vs antipsychotic cessation | RR 0.45 [0.23, 0.89] | 1 study · 42 participants | Low Downgraded: risk of bias, imprecision |
Tardive dyskinesia: deterioration of symptoms ‐ not reported Switch to another antipsychotic vs antipsychotic cessation | no estimate extracted | 0 studies · 0 participants | Ungraded |
General mental state: average endpoint score (BPRS, high = poor) Switch to another antipsychotic vs antipsychotic cessation | no estimate extracted | 1 study · 42 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effect: any ‐ not reported Switch to another antipsychotic vs antipsychotic cessation | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effects: use of antiparkinsonism drugs Switch to another antipsychotic vs antipsychotic cessation | RR 2.08 [0.74, 5.86] | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Acceptability of the treatment: leaving the study early Switch to another antipsychotic vs antipsychotic cessation | RR 0.6 [0.16, 2.25] | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social confidence, social inclusion, social networks, or personalised quality of life ‐ not reported Switch to another antipsychotic vs antipsychotic cessation | no estimate extracted | 0 studies · 0 participants | Ungraded |
Switch to a specific antipsychotic compared with switch to a different specific antipsychotic for antipsychotic‐induced tardive dyskinesia
Population: psychiatric patients (mainly schizophrenia) with antipsychotic‐induced tardive dyskinesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tardive dyskinesia: no clinically important improvement Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 4 studies · 140 participants | Very low Downgraded: risk of bias, imprecision |
Tardive dyskinesia: deterioration Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 2 studies · 35 participants | Very low Downgraded: risk of bias, imprecision |
General mental state: deterioration Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 3 studies · 120 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: extrapyramidal symptoms (need of antiparkinsonism drugs) Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 2 studies · 53 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects: general adverse events (UKU Average change score) Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Acceptability of the treatment: leaving the study early Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | 7 studies · 466 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social confidence, social inclusion, social networks, or personalised quality of life ‐ not reported Switch to a specific antipsychotic vs switch to a different specific antipsychotic | no estimate extracted | NR | No studies |
Specific antipsychotic compared with other drugs for antipsychotic‐induced tardive dyskinesia
Population: psychiatric patients (mainly schizophrenia) with antipsychotic‐induced tardive dyskinesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tardive dyskinesia: not improved to a clinically important extent Specific antipsychotic vs other drugs | RR 1.07 [0.51, 2.23] | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision |
Tardive dyskinesia: deterioration of symptoms Specific antipsychotic vs other drugs | RR 0.86 [0.07, 10.96] | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision |
Mental state ‐ not reported Specific antipsychotic vs other drugs | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effect: any ‐ not reported Specific antipsychotic vs other drugs | no estimate extracted | 0 studies · 0 participants | Ungraded |
Adverse effect: extrapyramidal symptoms ‐ not reported Specific antipsychotic vs other drugs | no estimate extracted | 0 studies · 0 participants | Ungraded |
Acceptability of the treatment: leaving the study early Specific antipsychotic vs other drugs | RR 4.38 [0.25, 76.54] | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Social confidence, social inclusion, social networks, or personalised quality of life ‐ not reported Specific antipsychotic vs other drugs | no estimate extracted | 0 studies · 0 participants | Ungraded |