Shafti 2010.

Methods	Study design: parallel group, double‐blind, randomised study
Participants	Diagnosis: bipolar I disorder, manic episode Method of diagnosis: according to DSM‐IV‐TR diagnostic criteria Age: not described Sex: 40 women; 0 men Location: Tehran, Iraq Co‐morbidities: not described Adjunctive therapy: no Adjunctive medication: prescription of lorazepam, as a sedating agent, was allowed during assessment
Interventions	Participants were randomly assigned to either: Experimental arm ‐ lithium N = 20 Duration: 3 weeks Treatment protocol: "after 3–5 days washout period Patients in the first group (n = 20) were given lithium carbonate (300 mg uncoated tablets).The cases in the second group (n = 20) were prescribed olanzapine (5 mg uncoated tablets). Both of theses drugs were prescribed according to practice guidelines and standard titration protocols. no supplementary anticonvulsant or additional antipsychotic was permissible through‐ out the appraisal. Also no psychosocial intervention, except for usual care, was acceptable during evaluation. Upon completion of all baseline assessments, the tablets were prescribed. Identical‐looking capsules were prepared with the separate medication(s) to ensure the subjects in each group and the evaluator(s) were unaware of any distinction in the visual appearance, in the types of medication given in this study.Mean serum level of lithium 0.78 mmol/L." Therapist/face‐to‐face contact: as above Comparator arm ‐olanzapine N = 20 Duration: 3 weeks Treatment protocol: "after 3–5 days washout period Patients in the first group (n = 20) were given lithium carbonate (300 mg uncoated tablets).The cases in the second group (n = 20) were prescribed olanzapine (5 mg uncoated tablets). Both of theses drugs were prescribed according to practice guidelines and standard titration protocols. no supplementary anticonvulsant or additional antipsychotic was permissible through‐ out the appraisal. Also no psychosocial intervention, except for usual care, was acceptable during evaluation. Upon completion of all baseline assessments, the tablets were prescribed. Identical‐looking capsules were prepared with the separate medication(s) to ensure the subjects in each group and the evaluator(s) were unaware of any distinction in the visual appearance, in the types of medication given in this study."
Outcomes	Primary outcome: MSRS Secondary outcome: Withdrawal from study MSRS (frequency + intensity) Other MSRS Adverse events (tremor)
Notes	‐
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Random assignment to olanzapine or lithium carbonate in a 1:1 ratio.
Allocation concealment (selection bias)	Unclear risk	Not described
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Not described
Incomplete outcome data (attrition bias) All outcomes	Low risk	Three participants (15%) in the olanzapine group and two participants (10%) in the lithium group left the appraisal in the second half of the study due to unwillingness or adverse events of the prescribed drugs.
Selective reporting (reporting bias)	Low risk	Well reported
Other bias	Low risk	None identified