Journal Article

Generating Evidence to Inform Policy and Practice: The Example of the Second Generation “Atypical” Antipsychotics

John Geddes

in Schizophrenia Bulletin

Published on behalf of Maryland Psychiatric Research Center

Volume 29, issue 1, pages 105-114
Published in print January 2003 | ISSN: 0586-7614
Published online January 2003 | e-ISSN: 1745-1701 | DOI: http://dx.doi.org/10.1093/oxfordjournals.schbul.a006980
Generating Evidence to Inform Policy and Practice: The Example of the Second Generation “Atypical” Antipsychotics

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The introduction of the second generation “atypical” antipsychotics has been heralded as a major advance in the treatment of schizophrenia and other psychotic disorders. Systematic reviews have revealed only modest advantages over conventional antipsychotics and uncertainty about long-term efficacy and safety, yet the second generation antipsychotic drugs have been widely accepted into clinical practice. Although the existing evidence of the benefits and harms of atypical antipsychotics can facilitate decision making about individual patients, the randomized evidence remains inadequate to make valid and fully evidence-based policy statements such as clinical practice guidelines that are designed to apply to groups of patients. Further large randomized trials are needed, but these require patients and clinicians to be in equipoise, or substantially uncertain, about alternative therapies. Premature clinical practice guidelines or expert opinion can lead to changes in clinical practice that make it difficult or impossible to conduct the required trials and are therefore a disservice to patients.

Keywords: Schizophrenia; antipsychotics; atypical; health policy; clinical practice guidelines; systematic reviews; randomized trials

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Subjects: Child and Adolescent Psychiatry

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