This review found insufficient evidence to determine whether antipsychotic drugs were effective for treating anorexia nervosa. The conclusion reflects the limitations of the evidence and appears reliable.

To determine the effectiveness of antipsychotic drugs for improving core psychopathology and behavioural symptoms of anorexia nervosa.

The authors searched: the Cochrane Depression, Anxiety and Neurosis Group trials register (June 2006); reference lists of articles retrieved by the search; the contents of the journal Eating Disorders (2000-2006); and the abstracts of an international conference on eating disorders. Search terms were not reported.

Randomised controlled trials comparing antipsychotic medication as monotherapy or adjunctive therapy with any other intervention in patients with any subtype of anorexia nervosa were eligible for the review.

Included trials compared antipsychotic drugs with placebo, an antidepressant or another antipsychotic. Medication was delivered as part of a standardised treatment programme. All the included trials involved female inpatients and their mean age ranged from 23.2 to 25.3 years. Duration of treatment ranged from three weeks to three months. The placebo-controlled trials used a cross-over design.

It appeared that two or more reviewers independently selected studies for the review.

The authors stated that two or more reviewers independently assessed risk of bias. Aspects of validity were discussed in the text but the criteria used for the assessment were not fully reported.

Two or more reviewers independently extracted data for the review.

Studies were synthesised in a brief narrative by type of outcome (outcomes related to 'core psychopathology', behavioural outcomes and other outcomes).

Four trials (86 participants) were included. There were differences between groups at baseline in some trials and weaknesses in the reporting and/or conduct of the trials. Differences between groups were not statistically significant for most outcomes. Overall, none of the trials showed a significant benefit of adding antipsychotic medication over treatment as usual.

There was insufficient evidence to support or refute the use of antipsychotic drugs in anorexia nervosa.

This review addressed a clear question and had inclusion criteria for participants, intervention/comparator and study design. Inclusion criteria for outcomes were broad. The authors searched a limited range of sources. Search terms and language restrictions were not reported, which made it difficult to assess the risk that relevant studies were missed. Some attempts were made to locate unpublished studies. Risk of publication bias was not assessed.

Relevant aspects of study validity were assessed and the results were used in the synthesis. Study selection, validity assessment and data extraction were conducted by two or more independent reviewers, reducing the risk of reviewer errors or bias. Limited details of included trials were provided. A narrative synthesis was appropriate in view of the clinical heterogeneity of the included trials.

The authors' conclusions reflect the limitations of the evidence and appear reliable.

Practice: The authors stated that clear benefits of antipsychotic drugs need to be established before they can be recommended for general use in clinical practice.

Research: The authors stated that future trials should use adequate doses of antipsychotic drugs for long enough to establish any benefits. Trials should be of adequate size, with long-term follow-up and rigorous assessment.

Not stated

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.