Summary of findings for the main comparison. HALOPERIDOL versus OTHER ANTIPSYCHOTICS for long‐term aggression in psychosis.
| Haloperidol versus other antipsychotic drugs for long‐term aggression in psychosis | ||||||
| Patient or population: people with long‐term aggression in psychosis Settings: state hospitals ‐ New York, USA Intervention: haloperidol versus other antipsychotic drugs | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | haloperidolaloperidol versus other antipsychotic drugs | |||||
| Specific behaviour: aggression ‐ important decrease in aggression | We identified no trials reporting important decrease in aggression. When we compared haloperidol with olanzapine or clozapine, skewed data (n=83) from 1 small trial at high risk of bias suggested some advantage in terms of scores of unclear clinical meaning for olanzapine/clozapine for 'total aggression'. | |||||
| Specific behaviour: repeated need for tranquillisation | We identified no trials reporting repeated need for tranquillisation. | |||||
| Specific behaviours ‐ threat or injury to others/self | We identified no trials reporting threat or injury to others/self. When we compared haloperidol with olanzapine or clozapine, skewed data (n=83) from 1 small trial at high risk of bias suggested some advantage in terms of scores of unclear clinical meaning for olanzapine/clozapine for 'aggression against property' and 'aggression ‐ physical'. Verbal aggression was not changed. | |||||
| Adverse effects ‐ any serious, specific adverse effects | We identified no trials reporting any serious, specific adverse effects. | |||||
| Global outcomes ‐ overall improvement | We identified no trials reporting overall improvement. When we compared haloperidol with olanzapine or clozapine, skewed data (n=83) from 1 small trial at high risk of bias suggested some advantage in terms of scores of unclear clinical meaning for olanzapine/clozapine for a series of mental state ratings. | |||||
| Leaving the study early | Low1 | RR 1.37 (0.84 to 2.24) | 110 (1 study) | ⊕⊕⊝⊝ low2,3,4 | ‐ | |
| 100 per 1000 | 137 per 1000 (84 to 224) | |||||
| Moderate1 | ||||||
| 300 per 1000 | 411 per 1000 (252 to 672) | |||||
| High1 | ||||||
| 500 per 1000 | 685 per 1000 (420 to 1000) | |||||
| Economic outcomes | We identified no trials reporting economic outcomes. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; n: number of participants; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Moderate control risk equivalent to that of people in the included study. 2 Risk of bias: rated 'serious' ‐ stated to be randomised, but no description on randomisation method provided. 3 Imprecision: rated 'serious' ‐ total number of events was 40, which is significantly lower than 300, 95% confidence interval of the best estimate of effect crosses over the line of no effect. 4 Publication bias: rated 'undetected' ‐ however, it is possible that we did not identify small studies due to a degree of publishing bias.