Forty studies (47 treatment arms) in patients with schizophrenia and 33 studies in patients with affective disorder were included in the review.
Metabolic changes:
There were no statistically significant differences in weight changes in patients with schizophrenia and affective disorder for quetiapine (22 studies), aripiprazole (10 studies) and risperidone (15 studies).
There was a statistically significant increase in blood cholesterol levels with quetiapine in patients with schizophrenia (MD 8.05mg/dL, 95% CI 5.20 to 10.91; four studies) and a significant decrease in levels in patients with affective disorders (MD -2.76mg/dL, 95% CI -4.60 to -0.93; seven studies). The difference in cholesterol levels was statistically significantly different between the two patient groups. Similar findings were reported for low density lipoprotein.
Aripiprazole decreased levels of cholesterol in both patient groups (four studies); the difference between the two patient groups was not statistically significant.
Quetiapine (15 studies) and aripiprazole (four studies) increased blood glucose levels in both patient groups. The difference between the two patient groups was not statistically significant.
Quetiapine increased triglyceride levels in both patient groups (11 studies). The difference between the two patient groups was not statistically significant.
Extrapyramidal side effects:
Incidence of akathisia was higher in patients with affective disorders for quetiapine (11 studies) and ziprasidone (10 studies) but differences compared to patients with schizophrenia were not reported to be significant.
There was were statistically significant increase in incidence rates for aripiprazole treatment when both patient groups were combined (effect estimate 0.11, 95% CI 0.08 to 0.14; 16 studies). Analysis by patient group showed a statistically significant higher incidence rate in patients with affective disorders.
Incidence of parkinsonism did not significantly differ between the two patient groups when treated with quetiapine (19 studies), risperidone (nine studies) or ziprasidone (nine studies) and aripiprazole (11 studies). Findings on antiparkinson medication use were reported in the review.
All outcomes showed considerable statistical heterogeneity which was explored in the review using subgroup analyses, and the results were reported in the review.