Summary of findings 10. Lithium compared to risperidone for acute mania.
| Lithium compared to risperidone for acute mania | ||||||
| Patient or population: acute mania Setting: inpatients and specialist mood disorders clinic (one study did not describe the setting) Intervention: lithium Comparison: risperidone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with risperidone | Risk with lithium | |||||
|
Efficacy: response (categorical) BMRS change ≥ 50% from baseline to end of study |
‐ | ‐ | ‐ | ‐ | ‐ | No study measured this outcome |
|
Efficacy: response (continuous) YMRS/MRS change at the end of the study |
The mean efficacy: response (continuous): YMRS/MRS change at the end of the study was 0 | MD 7.28 more (5.22 to 9.34) | ‐ | 241 (3 RCTs) | ⊕⊕⊝⊝ Low1,2 | |
|
Efficacy: remission (categorical) YMRS ≤ 12/absence of DSM‐IV mania by end of study |
Study population | OR 1.30 (0.11 to 14.95) | 211 (2 RCTs) | ⊕⊕⊝⊝ Low3,4 | ||
| 590 per 1000 | 652 per 1000 (137 to 956) | |||||
| Acceptability: total withdrawals | Study population | OR 1.85 (1.02 to 3.34) | 255 (3 RCTs) | ⊕⊕⊕⊝ Moderate2 | ||
| 181 per 1000 | 290 per 1000 (184 to 425) | |||||
| Adverse events: drowsiness/ somnolence | Study population | OR 0.43 (0.24 to 0.75) | 219 (2 RCTs) | ⊕⊕⊕⊝ Moderate2 | ||
| 455 per 1000 | 264 per 1000 (167 to 385) | |||||
| *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). BRMS: Bech‐Rafaelsen Mania Scale; CI: confidence interval; DSM‐IV: Diagnostic and Statistical Manual of Mental Disorders, fourth edition; OR: odds ratio; MRS: Mania Rating Scale; 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 one level for imprecision. All studies have wide confidence intervals. 2Downgraded one level for publication bias. Very few studies found for this important clinical question using widely used medications. 3Downgraded one level for imprecision. Two studies each with wide confidence interval. 4Downgraded one level for high probability of publication bias. This is an important clinical question using widely used medications. Seems probable few studies were long enough to show remission and so this outcome has not been reported.