Skip to main content

Maximizing response to first-line antipsychotics in schizophrenia: a review focused on finding from meta-analysis

Abstract

Rationale

There are many psychotropic drugs available for treatment of schizophrenia. The clinician’s choice of the most effective first-line antipsychotic treatment for patients with schizophrenia should balance considerations of differential efficacy of antipsychotics against the relative risk of different side effects.

Method

We reviewed recent studies using meta-analytic techniques and additional studies of new antipsychotics which quantitatively evaluate the efficacy of side effects of first- and second-generation antipsychotics and studies of the efficacy on add-on secondary medications. We present an integrated summary of these results to guide a clinician’s decision-making.

Results

Recent meta-analyses have suggested that antipsychotics are not equivalent in efficacy. Clozapine (effect size [SMD] 0.88 vs. placebo), amisulpride (effect size 0.6 vs placebo), olanzapine (effect size 0.59 vs. placebo), and risperidone (effect size 0.56 vs placebo) show small but statistically significant differences compared to a number of other antipsychotics on measures of overall efficacy (effect sizes 0.33–0.50). However, increasing placebo response remains a concern in interpreting these data. Amisulpride (effect size 0.47 vs placebo) and cariprazine (effect size in one trial compared to risperidone 0.29) have the strongest evidence indicating greater efficacy for treating primary negative symptoms relative to other antipsychotics. In terms of side effects, clozapine and olanzapine have among the highest weight gain potential and sertindole and amisulpride have more effects on QTc prolongation than other commonly used antipsychotics. Prolactin elevation is highest with paliperidone, risperidone, and amisulpride. Adjunctive treatment with an antidepressant drug may improve response in patients with schizophrenia who also have severe depressive or negative symptoms. For multi-episode patients with an inadequate response to an adequate dose and duration of the initial antipsychotic choice, switching to another antipsychotic, with a different receptor profile, may improve response, although evidence is very limited. In first-episode patients, a recent study on switching to another antipsychotic, with a different receptor profile after 4 weeks demonstrated no beneficial effects. There is little evidence to support using doses above the therapeutic range other than in exceptional circumstances.

Conclusions

Our review of recent studies using meta-analytic techniques has provided evidence that all antipsychotics are not equal in the severity of different side effects and in some measures of clinical efficacy. Comparative analysis and rankings from network meta-analyses can provide guidance to clinicians in choosing the most appropriate antipsychotic for first-line treatment, if used in conjunction with available information of the patient’s history of previous clinical response or higher risks for specific side effects.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Agid O, Arenovich T, Sajeev G, Zipursky RB, Kapur S, Foussias G, Remington G (2011) An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. J Clin Psychiatry 72:1439–1444

    Article  PubMed  Google Scholar 

  2. Ascher-Svanum H, Stensland MD, Kinon BJ, Tollefson GD (2005) Weight gain as a prognostic indicator of therapeutic improvement during acute treatment of schizophrenia with placebo or active antipsychotic. J Psychopharmacol (Oxford, England) 19:110–117

  3. Asssociation AD, Association AP (2004) Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 27:596–601

    Article  Google Scholar 

  4. Borenstein M, Hedges L, Higgins J, Rothstein H (2009) Introduction to meta-analysis. Wiley, West Sussex

    Book  Google Scholar 

  5. Carbon M, Hsieh CH, Kane JM, Correll CU (2017) Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry 78:e264–e278

    Article  PubMed  Google Scholar 

  6. Cipriani A, Higgins JP, Geddes JR, Salanti G (2013) Conceptual and technical challenges in network meta-analysis. Ann Intern Med 159:130–137

    Article  PubMed  Google Scholar 

  7. Citrome L, Jaffe A, Levine J, Allingham B, Robinson J (2004) Relationship between antipsychotic medication treatment and new cases of diabetes among psychiatric inpatients. Psychiatr Serv (Washington, DC) 55:1006–1013

    Article  Google Scholar 

  8. Correll CU, Skuban A, Hobart M, Ouyang J, Weiller E, Weiss C, Kane JM (2016) Efficacy of brexpiprazole in patients with acute schizophrenia: review of three randomized, double-blind, placebo-controlled studies. Schizophr Res 174:82–92

    Article  PubMed  Google Scholar 

  9. Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S (2017) Efficacy of 42 pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. JAMA Psychiatry 74:675–684

    Article  PubMed  PubMed Central  Google Scholar 

  10. Czobor P, Volavka J, Sheitman B, Lindenmayer JP, Citrome L, McEvoy J, Cooper TB, Chakos M, Lieberman JA (2002) Antipsychotic-induced weight gain and therapeutic response: a differential association. J Clin Psychopharmacol 22:244–251

    Article  CAS  PubMed  Google Scholar 

  11. Davidson M, Saoud J, Staner C, Noel N, Luthringer E, Werner S, Reilly J, Schaffhauser JY, Rabinowitz J, Weiser M, Luthringer R (2017) Efficacy and safety of MIN-101: a 12-week randomized, double-blind, placebo-controlled trial of a new drug in development for the treatment of negative symptoms in schizophrenia. Am J Psychiatry 174(12):1195–1202 appiajp201717010122

    Article  PubMed  Google Scholar 

  12. Davis JM, Andriukaitis S (1986) The natural course of schizophrenia and effective maintenance drug treatment. J Clin Psychopharmacol 6:2s–10s

    Article  CAS  PubMed  Google Scholar 

  13. Davis JM, Chen N (2004) Dose response and dose equivalence of antipsychotics. J Clin Psychopharmacol 24:192–208

    Article  CAS  PubMed  Google Scholar 

  14. Davis JM, Schaffer CB, Killian GA, Kinard C, Chan C (1980) Important issues in the drug treatment of schizophrenia. Schizophr Bull 6:70–87

    Article  CAS  PubMed  Google Scholar 

  15. Davis JM, Matalon L, Watanabe MD, Blake L, Metalon L (1994) Depot antipsychotic drugs. Place in therapy. Drugs 47:741–773

    Article  CAS  PubMed  Google Scholar 

  16. Desamericq G, Schurhoff F, Meary A, Szoke A, Macquin-Mavier I, Bachoud-Levi AC, Maison P (2014) Long-term neurocognitive effects of antipsychotics in schizophrenia: a network meta-analysis. Eur J Clin Pharmacol 70:127–134

    Article  CAS  PubMed  Google Scholar 

  17. Ganguli R, Brar JS, Garbut R, Chang CC, Basu R (2011) Changes in weight and other metabolic indicators in persons with schizophrenia following a switch to aripiprazole. Clin Schizophr Relat Psychoses 5:75–79

    Article  PubMed  Google Scholar 

  18. Guilera G, Pino O, Gomex-Benito J, Rojo J (2009) Antipsychotic effects on cognition in schizophrenia: a meta-analysis of randomized controlled trials. Eur J Psychatr 23:77–89

    Google Scholar 

  19. Helfer B, Samara MT, Huhn M, Klupp E, Leucht C, Zhu Y, Engel RR, Leucht S (2016) Efficacy and safety of antidepressants added to antipsychotics for schizophrenia: a systematic review and meta-analysis. Am J Psychiatry 173:876–886

    Article  PubMed  Google Scholar 

  20. Heres S, Davis J, Maino K, Jetzinger E, Kissling W, Leucht S (2006) Why olanzapine beats risperidone, risperidone beats quetiapine, and quetiapine beats olanzapine: an exploratory analysis of head-to-head comparison studies of second-generation antipsychotics. Am J Psychiatry 163:185–194

    Article  PubMed  Google Scholar 

  21. Heres S, Cirjaliu DM, Dehelean L, Matei VP, Podea DM, Sima D, Stecher L, Leucht S (2016) The SWITCH study: rationale and design of the trial. Eur Arch Psychiatry Clin Neurosci 266:513–521

    Article  PubMed  Google Scholar 

  22. Higgins J, Green S (2008) Cochrane handbook for systematic review of interventions. Wiley, West Sussex

    Book  Google Scholar 

  23. Howes OH, Kaar SJ (2018) Antipsychotic drugs: challenges and future directions. World Psychiatry 17:170–171

    Article  PubMed  PubMed Central  Google Scholar 

  24. Howes OD, Vergunst F, Gee S, McGuire P, Kapur S, Taylor D (2012) Adherence to treatment guidelines in clinical practice: study of antipsychotic treatment prior to clozapine initiation. Br J Psychiatry J Ment Sci 201:481–485

    Article  Google Scholar 

  25. Isbister GK, Balit CR, Macleod D, Duffull SB (2010) Amisulpride overdose is frequently associated with QT prolongation and torsades de pointes. J Clin Psychopharmacol 30:391–395

    Article  PubMed  Google Scholar 

  26. Kahn RS, Winter van Rossum I, Leucht S, McGuire P, Lewis SW, Leboyer M, Arango C, Dazzan P, Drake R, Heres S, Diaz-Caneja CM, Rujescu D, Weiser M, Galderisi S, Glenthoj B, Eijkemans MJC, Fleischhacker WW, Kapur S, Sommer IE (2018) Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching study. Lancet Psychiatry 5:797–807

    Article  PubMed  Google Scholar 

  27. Kane JM, Skuban A, Hobart M, Ouyang J, Weiller E, Weiss C, UC C (2016) Overview of short- and long-term tolerability and safety of brexpiprazole in patients with schizophrenia. Schizophr Res 174:93–98

    Article  PubMed  Google Scholar 

  28. Kinon BJ, Chen L, Ascher-Svanum H, Stauffer VL, Kollack-Walker S, Zhou W, Kapur S, Kane JM (2010) Early response to antipsychotic drug therapy as a clinical marker of subsequent response in the treatment of schizophrenia. Neuropsychopharmacology 35:581–590

    Article  CAS  PubMed  Google Scholar 

  29. Kirson NY, Weiden PJ, Yermakov S, Huang W, Samuelson T, Offord SJ, Greenberg PE, Wong BJ (2013) Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatry 74:568–575

    Article  CAS  PubMed  Google Scholar 

  30. Kishi T, Ikuta T, Matsunaga S, Matsuda Y, Oya K, Iwata N (2017) Comparative efficacy and safety of antipsychotics in the treatment of schizophrenia: a network meta-analysis in a Japanese population. Neuropsychiatr Dis Treat 13:1281–1302

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU (2013) Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. J Clin Psychiatry 74:957–965

    Article  PubMed  Google Scholar 

  32. Kishimoto T, Robenzadeh A, Leucht C, Leucht S, Watanabe K, Mimura M, Borenstein M, Kane JM, Correll CU (2014) Long-acting injectable vs oral antipsychotics for relapse prevention in schizophrenia: a meta-analysis of randomized trials. Schizophr Bull 40:192–213

    Article  PubMed  Google Scholar 

  33. Krause M, Zhu Y, Huhn M, Schneider-Thoma J, Bighelli I, Nikolakopoulou A, Leucht S (2018) Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 268:625–639

    Article  PubMed  Google Scholar 

  34. Lao KS, He Y, Wong IC, Besag FM, Chan EW (2016) Tolerability and safety profile of cariprazine in treating psychotic disorders, bipolar disorder and major depressive disorder: a systematic review with meta-analysis of randomized controlled trials. CNS Drugs 30:1043–1054

    Article  CAS  PubMed  Google Scholar 

  35. Leucht S, Komossa K, Rummel-Kluge C, Corves C, Hunger H, Schmid F, Asenjo Lobos C, Schwarz S, Davis JM (2009) A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia. Am J Psychiatry 166:152–163

    Article  PubMed  Google Scholar 

  36. Leucht S, Hierl S, Kissling W, Dold M, Davis JM (2012) Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry J Ment Sci 200:97–106

    Article  Google Scholar 

  37. Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lassig B, Salanti G, Davis JM (2013) Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 382:951–962

    Article  CAS  PubMed  Google Scholar 

  38. Leucht S, Samara M, Heres S, Patel MX, Woods SW, Davis JM (2014) Dose equivalents for second-generation antipsychotics: the minimum effective dose method. Schizophr Bull 40:314–326

    Article  PubMed  PubMed Central  Google Scholar 

  39. Leucht S, Winter-van Rossum I, Heres S, Arango C, Fleischhacker WW, Glenthoj B, Leboyer M, Leweke FM, Lewis S, McGuire P, Meyer-Lindenberg A, Rujescu D, Kapur S, Kahn RS, Sommer IE (2015) The optimization of treatment and management of schizophrenia in Europe (OPTiMiSE) trial: rationale for its methodology and a review of the effectiveness of switching antipsychotics. Schizophr Bull 41:549–558

    Article  PubMed  PubMed Central  Google Scholar 

  40. Leucht S, Chaimani A, Cipriani AS, Davis JM, Furukawa TA, Salanti G (2016a) Network meta-analyses should be the highest level of evidence in treatment guidelines. Eur Arch Psychiatry Clin Neurosci 266:477–480

    Article  PubMed  Google Scholar 

  41. Leucht S, Samara M, Heres S, Davis JM (2016b) Dose equivalents for antipsychotic drugs: the DDD method. Schizophr Bull 42(Suppl 1):S90–S94

    Article  PubMed  PubMed Central  Google Scholar 

  42. Leucht S, Leucht C, Huhn M, Chaimani A, Mavridis D, Helfer B, Samara M, Rabaioli M, Bacher S, Cipriani A, Geddes JR, Salanti G, Davis JM (2017) Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, Bayesian meta-analysis, and meta-regression of efficacy predictors. Am J Psychiatry 174:927–942

    Article  PubMed  Google Scholar 

  43. Lieberman J, Stroup T, MCevoy J, Swartz M, Rosenheck R, Perkins D, Keefe R, Davis S, Davis C, BD L, Severe J, Hsiao J, Investigators C (2005) Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 353:1209–1223

    Article  CAS  PubMed  Google Scholar 

  44. Marder SR, Hakala MJ, Josiassen MK, Zhang P, Ouyang J, Weiller E, Weiss C, Hobart M (2017) Brexpiprazole in patients with schizophrenia: overview of short- and long-term phase 3 controlled studies. Acta Neuropsychiatr 29:278–290

    Article  PubMed  Google Scholar 

  45. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 62:975–983

    Article  PubMed  Google Scholar 

  46. May PR, Tuma AH, Yale C, Potepan P, Dixon WJ (1976) Schizophrenia—a follow-up study of results of treatment. Arch Gen Psychiatry 33:481–486

    Article  CAS  PubMed  Google Scholar 

  47. McCutcheon R, Beck K, Bloomfield MA, Marques TR, Rogdaki M, Howes OD (2015) Treatment resistant or resistant to treatment? Antipsychotic plasma levels in patients with poorly controlled psychotic symptoms. J Psychopharmacol (Oxford, England) 29:892–897

  48. Meyer JM, Davis VG, Goff DC, McEvoy JP, Nasrallah HA, Davis SM, Rosenheck RA, Daumit GL, Hsiao J, Swartz MS, Stroup TS, Lieberman JA (2008) Change in metabolic syndrome parameters with antipsychotic treatment in the CATIE schizophrenia trial: prospective data from phase 1. Schizophr Res 101:273–286

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nemeth G, Laszlovszky I, Czobor P, Szalai E, Szatmari B, Harsanyi J, Barabassy A, Debelle M, Durgam S, Bitter I, Marder S, Fleischhacker WW (2017) Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet 389:1103–1113

    Article  CAS  PubMed  Google Scholar 

  50. Nielsen RE, Levander S, Kjaersdam Telleus G, Jensen SO, Ostergaard Christensen T, Leucht S (2015) Second-generation antipsychotic effect on cognition in patients with schizophrenia—a meta-analysis of randomized clinical trials. Acta Psychiatr Scand 131:185–196

    Article  CAS  PubMed  Google Scholar 

  51. O'Brien A (2016) Comparing the risk of tardive dyskinesia in older adults with first-generation and second-generation antipsychotics: a systematic review and meta-analysis. Int J Geriatr Psychiatry 31:683–693

    Article  PubMed  Google Scholar 

  52. Penttila M, Jaaskelainen E, Hirvonen N, Isohanni M, Miettunen J (2014) Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry J Ment Sci 205:88–94

    Article  Google Scholar 

  53. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JP (2014) Evaluating the quality of evidence from a network meta-analysis. PLoS One 9:e99682

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Samara MT, Leucht C, Leeflang MM, Anghelescu IG, Chung YC, Crespo-Facorro B, Elkis H, Hatta K, Giegling I, Kane JM, Kayo M, Lambert M, Lin CH, Moller HJ, Pelayo-Teran JM, Riedel M, Rujescu D, Schimmelmann BG, Serretti A, Correll CU, Leucht S (2015) Early improvement as a predictor of later response to antipsychotics in schizophrenia: a diagnostic test review. Am J Psychiatry 172:617–629

    Article  PubMed  Google Scholar 

  55. Sharma E, Rao NP, Venkatasubramanian G (2014) Association between antipsychotic-induced metabolic side-effects and clinical improvement: a review on the evidence for “metabolic threshold”. Asian J Psychiatr 8:12–21

    Article  PubMed  Google Scholar 

  56. Smith RC, Strizich M, Klass D (1978) Drug history and tardive dyskinesia. Am J Psychiatry 135:1402–1403

    Article  CAS  PubMed  Google Scholar 

  57. Smith R, Lindenmayer J-P, Bark N, Warner-Cohen J, Vaidhyanathaswamy S, Khandat A (2005) Clozapine, risperidone, olanzapine, and conventional antipsychotic drug effects on glucose, lipids, and leptin in schizophrenic patients. Int J Neuropsychopharmacol 8:183–194

    Article  CAS  PubMed  Google Scholar 

  58. Smith M, Hopkins D, Peveler RC, Holt RI, Woodward M, Ismail K (2008) First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis. Br J Psychiatry J Ment Sci 192:406–411

    Article  CAS  Google Scholar 

  59. Sommer IE, Begemann MJ, Temmerman A, Leucht S (2012) Pharmacological augmentation strategies for schizophrenia patients with insufficient response to clozapine: a quantitative literature review. Schizophr Bull 38:1003–1011

    Article  PubMed  Google Scholar 

  60. Spurling RD, Lamberti JS, Olsen D, Tu X, Tang W (2007) Changes in metabolic parameters with switching to aripiprazole from another second-generation antipsychotic: a retrospective chart review. J Clin Psychiatry 68:406–409

    Article  CAS  PubMed  Google Scholar 

  61. Strom BL, Eng SM, Faich G, Reynolds RF, D'Agostino RB, Ruskin J, Kane JM (2011) Comparative mortality associated with ziprasidone and olanzapine in real-world use among 18,154 patients with schizophrenia: the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC). Am J Psychiatry 168:193–201

    Article  PubMed  Google Scholar 

  62. Takeuchi H, Kantor N, Uchida H, Suzuki T, Remington G (2017a) Immediate vs gradual discontinuation in antipsychotic switching: a systematic review and meta-analysis. Schizophr Bull 43:862–871

    PubMed  PubMed Central  Google Scholar 

  63. Takeuchi H, Thiyanavadivel S, Fervaha G, Remington G (2017b) Neurocognitive benefits of second-generation antipsychotics versus placebo: insufficient evidence based on a systematic review. J Clin Psychopharmacol 37:274–276

    Article  CAS  PubMed  Google Scholar 

  64. Valmaggia LR, Byrne M, Day F, Broome MR, Johns L, Howes O, Power P, Badger S, Fusar-Poli P, McGuire PK (2015) Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase. Br J Psychiatry J Ment Sci 207:130–134

    Article  Google Scholar 

  65. Vancampfort D, Correll CU, Galling B, Probst M, De Hert M, Ward PB, Rosenbaum S, Gaughran F, Lally J, Stubbs B (2016) Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 15:166–174

    Article  PubMed  PubMed Central  Google Scholar 

  66. Wani RA, Dar MA, Chandel RK, Rather YH, Haq I, Hussain A, Malla AA (2015) Effects of switching from olanzapine to aripiprazole on the metabolic profiles of patients with schizophrenia and metabolic syndrome: a double-blind, randomized, open-label study. Neuropsychiatr Dis Treat 11:685–693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Yood MU, DeLorenze G, Quesenberry CP Jr, Oliveria SA, Tsai AL, Willey VJ, McQuade R, Newcomer J, L'Italien G (2009) The incidence of diabetes in atypical antipsychotic users differs according to agent—results from a multisite epidemiologic study. Pharmacoepidemiol Drug Saf 18:791–799

    Article  PubMed  Google Scholar 

  68. Zhang S, Lan G (2014) Prospective 8-week trial on the effect of olanzapine, quetiapine, and aripiprazole on blood glucose and lipids among individuals with first-onset schizophrenia. Shanghai Arch Psychiatry 26:339–346

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Zhu Y, Krause M, Huhn M, Rothe P, Schneider-Thoma J, Chaimani A, Li C, Davis JM, Leucht S (2017a) Antipsychotic drugs for the acute treatment of patients with a first episode of schizophrenia: a systematic review with pairwise and network meta-analyses. Lancet Psychiatry 4:694–705

    Article  PubMed  Google Scholar 

  70. Zhu Y, Li C, Huhn M, Rothe P, Krause M, Bighelli I, Schneider-Thoma J, Leucht S (2017b) How well do patients with a first episode of schizophrenia respond to antipsychotics: a systematic review and meta-analysis. Eur Neuropsychopharmacol 27:835–844

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Robert C. Smith.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smith, R.C., Leucht, S. & Davis, J.M. Maximizing response to first-line antipsychotics in schizophrenia: a review focused on finding from meta-analysis. Psychopharmacology 236, 545–559 (2019). https://doi.org/10.1007/s00213-018-5133-z

Download citation

Keywords

  • Schizophrenia
  • Antipsychotic drugs
  • Meta-analysis