Table 1.
The table summarizes the studies on atypical antipsychotic drugs included in the review
| Drug | Comparison groups, study design | Dose | Outcome | AE | Ref |
|---|---|---|---|---|---|
| Risperidone | Risperidone vs. Placebo, randomized double blind, placebo controlled | 1 and 2 mg 0.5 mg | BEHAV-AD scale p < 0.0001 at 2 mg BEHAV-AD psychosis sub-scale p = 0.01 at 1 mg | Dose dependent: EPS Somnolence Mild peripheral oedema for 2mg > 1mg. EPS at 1 mg NS > than placebo | (Katz et al., 1999) |
| Risperidone vs. placebo/randomised controlled | Flexible dose | (-) BPRS | Reported elsewhere | (Vigen et al., 2011) | |
| Risperidone vs. Placebo, double blind, placebo controlled | Flexible dose | (+) BPRS psychosis factor (p = 0.01) and CGI (p < 0.001) (+) NPI total score (p = < 0.001) and BPRS suspiciousness factor (p = 0.003) | Higher withdrawn depression factor in Olanzapine group (p = 0.03) | (Sultzer et al., 2008) | |
| Risperidone or olanzapine vs. placebo, double blind, placebo controlled | 0.5 mg or 2.5 mg | (+) NPI and CGI-S of Psychosis | Higher rate of EPS symptoms and increased prolactin levels compared to olanzapine or placebo | (Schneider et al., 2006) | |
| Olanzapine | Olanzapine vs. placebo, double blind, placebo controlled | Flexible dose | (-) BPRS | Greater cognitive decline | (Vigen et al., 2011) |
| Olanzapine vs. placebo, double blind, placebo controlled | Flexible dose | (+) NPI total score (p = 0.007) and BPRS suspiciousness factor (p = 0.006) | Higher withdrawn depression factor in Olanzapine group (p = 0.03) | (Sultzer et al., 2008) | |
| Olanzapine vs. placebo, double blind, placebo controlled | 1mg, 2.5 mg, 5 mg or 7.5 mg | (+) NPI/NH Psychosis Total scores in all groups (p < 0.001). (+)NPI/NH Psychosis Total scores at 7.5 mg (p = 0.008) and CGI-C at 2.5 (p = 0.030). | Significant overall treatment-group differences in weight gain, Anorexia or and urinary incontinence. NS increase in EPS or total AE | (De Deyn et al., 2004) | |
| Olanzapine vs. placebo, multicentre double blind, placebo controlled | 5mg, 10 mg or 15 mg | (+) Summed score of agitation/aggression, delusion and hallucination items in the NPI-NH with 5 or 10 mg (p < 0.001 and p = 0.006 respectively) | Higher somnolence and gait disturbances in the olanzapine group. NS difference in EPS or anticholinergic effects | (Street et al., 2000) | |
| Olanzapine or risperidone vs. placebo, double blind, placebo controlled | 2.5 mg or 10 mg | (+) NPI CGI-S of Psychosis | Higher weight gain compared to risperidone or placebo, NS | (Schneider et al., 2006) | |
| Aripiprazole | Aripiprazole vs. placeb, double blind, placebo controlled, multicentre | 2 mg titrated according to tolerability to 5 mg, 10 mg or 15 mg | (+) in NPI psychosis subscale in treated and placebo group, NS (+)CGI-S, in patients more severely affected (p = 0.035). (+) BPRS psychosis (p = 0.029) and BPRS core scores (p = 0.042) | Higher urinary tract infections, somnolence and bronchitis. NS difference in EPS or weight gain | (De Deyn et al., 2005) |
| Aripiprazole vs. placebo, double blind, placebo controlled, multicentre | 2mg, 5mg or 10 mg | (+) in NPI-NH psychosis subscale (p = 0.013), CGI-S (p = 0.030), BPRS Core (0.007), CMAI (p = 0.023) and NPI-NH Psychosis response rate (p = 0.019) at 10 mg. (+) in BPRS and CMAI at 5 mg No efficacy at 2 mg | Cerebrovascular events increasing with dose. | (Mintzer et al., 2007) | |
| Aripiprazole vs. placebo, placebo controlled, multicentre | 2 mg to be titrated to 5, 10 or 15 mg | NS in NPI-NH psychosis score (p = 0.08) or CGI-S (p = 0.19). Improvement in NPI-NH total score, BPRS, CMAI, Cornell Depression scale. (+) in CGI-S was seen in more severely affected patients |
Higher somnolence in treatment group | (Streim et al., 2008) | |
| Quetiapine | Quetiapine vs. placebo, double blind, fixed dose study | 100 mg or 200 mg | (+) in PANNS-EC (OC p = 0.014) and CGI-C (OC p = 0.002) at 200 mg. No difference with placebo at 100 mg |
Mortality numerically higher in the quetiapine group | (Zhong et al., 2007) |
| Quetiapine vs. placebo, double blind, placebo controlled | Flexible dose | No benefit | Greater cognitive decline | (Vigen et al., 2011) | |
| Quetiapine vs. placebo, randomised, placebo controlled | No improvement in agitation inventory scores | Significantly greater cognitive decline | (Ballard et al., 2005) |
BEHAV-AD, Behavioural Pathology in Alzheimer’s Disease; BPRS, Brief Psychiatric Rating Scale; NPI, Neuropsychiatric Inventory; NPI/NH, nursing home version; CGI-S, Clinical Global Impression–Severity; CGI-C, Clinical Global Impression of Changes; CMAI, Cohen-Mansfield Agitation Inventor; PANNS-EC, Positive and Negative Syndrome Scale (PANSS)-Excitement Component (EC).