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First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness

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Comparative Adverse Effects

For most comparisons of first-generation antipsychotics (FGAs) with second-generations antipsychotics (SGAs), the evidence about the adverse events of greatest clinical importance (diabetes mellitus, tardive dyskinesia, metabolic syndrome, and mortality) is insufficient to permit conclusions about risk differences.

For the adverse effects diabetes mellitus and metabolic syndrome, no statistically significant difference in risk of metabolic syndrome was found in comparisons of olanzapine and haloperidol. The strength of evidence for this finding is low.

For the adverse effect of mortality, there are no significant differences in risk of mortality in comparisons of chlorpromazine and clozapine or between haloperidol and aripiprazole. The strength of evidence for this finding is low.

Antipsychotics have been shown to elevate mortality risk for elderly patients; however, the evidence examined for this report was insufficient to permit conclusions about differences in mortality risks between SGAs and FGAs in patient subgroups, including the elderly.