Summary of findings 8. Lithium compared to haloperidol for acute mania.
| Lithium compared to haloperidol for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients (one study did not specify a setting) Intervention: lithium Comparison: haloperidol | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with haloperidol | Risk with lithium | |||||
|
Efficacy: response (categorical) MSRS/YMRS ≥ 50% decrease in score by end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
|
Efficacy: response (continuous) change in BPRS (total) from baseline to end of study ‐all data |
The mean efficacy: response (continuous) change in BPRS (total) from baseline to end of study in the haloperidol group ranged from 1.24 to 12 | The mean efficacy: response (continuous) change in BPRS (total) from baseline to end of study in the lithium group ranged from 0.99 to 1 | ‐ | 80 (3 RCTs) | ⊕⊝⊝⊝ Very low1 | |
|
Efficacy: remission (categorical) YMRS ≤ 12 at end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| Acceptability: total withdrawals | Study population | OR 0.29 (0.03 to 3.12) | 30 (1 RCT) | ⊕⊝⊝⊝ Very low2 | ||
| 200 per 1000 | 68 per 1000 (7 to 438) | |||||
| Adverse events | ‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
| *The risk in the intervention group (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). BPRS: Brief Psychiatric Rating Scale; CI: confidence interval; MSRS: Manic‐State Rating Scale; OR: odds ratio; RCT: randomised controlled trial; YMRS: Young Mania Rating Scale | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1Downgraded two levels for potential risk of bias. Includes studies from 1980 and 1975 with sparse published methodology. Downgraded for inconsistency. Heterogeneity very high (88%); even with removal of outlier in Analysis 8.1 (95%). 2Downgraded for imprecision. Single study with wide confidence interval. Downgraded for publication bias. Similar to other categories, haloperidol versus lithium is a question we would have expected to see more literature on. It is not possible to do funnel plots with such a limited number of studies.