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Efficacy of typical and atypical antipsychotic medication on hostility in patients with psychosis-spectrum disorders: a review and meta-analysis

Neuropsychopharmacologyvolume 43pages23402349 (2018) | Download Citation


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.

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IS has received funding from the Dutch Research Organization (ZonMW, HAMLETT study 848041003). The remaining authors declare no competing interests.

Author information


  1. Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands

    • Margo D. M. Faay
  2. Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary

    • Pál Czobor
  3. Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands

    • Iris E. C. Sommer
  4. Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway

    • Iris E. C. Sommer


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Correspondence to Margo D. M. Faay.

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