Summary of findings 9. Lithium compared to zuclopenthixol for acute mania.
| Lithium compared to zuclopenthixol for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients Intervention: lithium Comparison: zuclopenthixol | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with zuclopenthixol | Risk with lithium | |||||
|
Efficacy: response (categorical) BMRS change ≥ 50% from baseline to end of study |
Study population | OR 1.33 (0.30 to 5.91) | 28 (1 RCT) | ⊕⊝⊝⊝ Very low1,2,3 | ||
| 462 per 1000 | 533 per 1000 (205 to 835) | |||||
|
Efficacy: response (continuous) change in BPRS (total) from baseline to end of study ‐all data |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
|
Efficacy: remission (categorical) YMRS ≤ 12 at end of study |
‐ | ‐ | ‐ | ‐ | ‐ | |
| Acceptability: total withdrawals | Study population | OR 0.78 (0.17 to 3.49) | 28 (1 RCT) | ⊕⊝⊝⊝ Very low1,2,3 | ||
| 462 per 1000 | 401 per 1000 (127 to 749) | |||||
| 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; BRMS: Bech‐Rafaelsen Mania Scale; CI: confidence interval; OR: odds ratio | ||||||
| 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 one level: single study with high risk of bias for blinding and selective reporting. 2Downgraded one level for imprecision. Single small study with wide confidence interval. 3Downgraded one level for publication bias. Only a single study found in the literature fitting our inclusion criteria.