As violence against self and others is an important outcome in the treatment of patients with psychosis-spectrum disorders and hostility is an important indicator for violence, we set out to evaluate the effects of different types of antipsychotic agents in reducing hostility. We performed a systematic literature search, which provided 18 suitable randomized studies comparing typical to atypical antipsychotics for at least 4 weeks in patients with psychotic disorders. Results showed a small (0.26) but significant effect for atypical as compared to typical antipsychotics, with high heterogeneity, even though the mean dose of typical antipsychotics was higher. This effect size remained similar when separately analyzing sponsored and non-sponsored studies. When differentiating between high and low-dose studies, the high-dose group showed a significant difference between typical and atypical antipsychotics whereas the low-dose group did not. An analysis comparing clozapine to typical antipsychotics showed a moderate effect size (0.415), with low heterogeneity. These results are important for clinicians to help their shared decision making with patients when choosing maintenance treatment, as next to efficacy for psychosis and tolerability, safety for the patient and their environment is an important outcome.

中文翻译：

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典型和非典型抗精神病药物对精神病谱系障碍患者敌意的疗效：综述和荟萃分析。

由于针对自我和他人的暴力是治疗精神病谱系障碍患者的一个重要结果，而敌意是暴力的一个重要指标，因此我们着手评估不同类型的抗精神病药物在减少敌意方面的效果。我们进行了系统性文献检索，提供了 18 项合适的随机研究，比较了典型与非典型抗精神病药物对精神障碍患者至少 4 周的治疗效果。结果显示，与典型抗精神病药物相比，非典型抗精神病药物的效果虽小（0.26）但显着，具有高度异质性，尽管典型抗精神病药物的平均剂量较高。当单独分析赞助和非赞助研究时，这种效应大小仍然相似。在区分高剂量和低剂量研究时，高剂量组显示出典型和非典型抗精神病药物之间存在显着差异，而低剂量组则没有。一项将氯氮平与典型抗精神病药物进行比较的分析显示，其效应大小适中 (0.415)，且异质性较低。这些结果对于临床医生在选择维持治疗时帮助他们与患者共同决策非常重要，因为除了对精神病的疗效和耐受性之外，患者及其环境的安全也是一个重要的结果。