The use of antipsychotic drugs for the treatment of psychosis in patients diagnosed with schizophrenia

Zina Sherzad Qadir, Hana Morrissey, Patrick Ball

Research output: Other contribution to conferenceAbstractpeer-review


Methods: A rigorous comparative analysis of antipsychotics used for treating schizophrenia was conducted to determine their relative efficacy, risk of all-cause discontinuations, reasons for discontinuation and potential side effects. A systematic review was developed following PRISMA-P guidelines, the RevMan statistical analysis tool and the Effective Public Health Practice Project (EPHPP) methodological rating tool to assess the quality of included studies. The primary outcome of interest was the difference in overall clinical efficacy between various antipsychotic medications. Then a survey of psychiatrists from the UK and India was conducted to understand their opinions regarding their choice of antipsychotic medications, their experience with tolerance and efficacy in managing psychosis. The survey was open for three months, from 26 April 2022 to 31 July 2022.
Results: Aripiprazole was found to have significantly fewer long-term side effects than ziprasidone (p= 0.008, NNH=27, RR=0.84, CI=0.74-0.96) and quetiapine (p= 0.009, NNH=38, RR=0.79, CI=0.66-0.94). Quetiapine was found to have a significant advantage over ziprasidone in long-term treatment-emergent akathisia (p= 0.005, NNH=7, RR=1.87, CI=1.21‒2.90). The long-term treatment of akathisia between olanzapine and haloperidol showed significant differences, with haloperidol being significantly favoured in weight gain (p< 0.00001, NNH=4, RR=1.56, CI=1.31‒1.86), and olanzapine being significantly favoured in treatment akathisia (p= 0.002, NNH=6, RR=3.09, CI=1.49‒6.39). Moreover, the forest plot outcomes for treatment akathisia showed a significant advantage of quetiapine over haloperidol (p= 0.02, NNH=8, RR=1.80, CI=1.08‒3). Additionally, weight gain was significantly better in ziprasidone than against both haloperidol (p= 0.04, NNH=6, RR=1.45, CI=1.03‒2.04) and olanzapine (p< 0.00001, NNH=2, RR=2.27, CI=1.69‒3.03) in long-term analysis. In the long-term analysis, olanzapine (p= 0.001, NNT=17, RR=0.67, CI (0.53‒0.85)) and ziprasidone (p= 0.003, NNT=17, RR=1.47, CI=1.14‒1.90) were found to have significantly lower discontinuation rates than haloperidol, with longer time to discontinuation.The survey showed that Olanzapine, Risperidone, and Aripiprazole remain popular antipsychotic medications in India and the UK. The primary consideration for prescribing, switching, or adding a second antipsychotic was efficacy, and psychiatrists preferred adding a second medication after 4‒6 weeks (28.4%) or 3‒6 months (24.2%). Illicit drug use was the main cause of relapse among patients who had discontinued antipsychotics. Non-adherence to treatment was also identified as the main challenge in treating psychosis, using long-acting injectable (LAI) formulations of antipsychotics preferred over oral formulations. Indian psychiatrists reported greater acceptance of LAIs among patients (57%) than their UK counterparts (36%). Non-adherence was the leading cause of hospitalisation, and illicit drug use was the primary cause of relapse. Weight gain was the most commonly reported troublesome side effect causing poor adherence. Psychiatrists also reported weight gain as the most common reason for switching antipsychotic medications and the most common side effect leading them to seek termination of treatment patients.
Conclusions: The analysis revealed more pronounced variations relating to side effects compared to efficacy. The findings have important implications for selecting and managing antipsychotic treatment for individuals with psychiatric disorders and inform the development of tailored treatment plans for patients, optimising their overall treatment outcomes.
Original languageEnglish
Number of pages2
Publication statusPublished - 2023
EventFIP Pharmacy Practice Research summer meeting 2023 - University of Granada, Granada, Spain
Duration: 03 Jul 202304 Jul 2023


OtherFIP Pharmacy Practice Research summer meeting 2023
Internet address


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