Muñoz-Negro José Eduardo, Cervilla Jorge A
From the Mental Health Unit, Granada University Hospital, Andalusian Health Service, CIBERSAM, University of Granada, Granada, Spain.
J Clin Psychopharmacol. 2016 Dec;36(6):684-690. doi: 10.1097/JCP.0000000000000595.
Pharmacological treatment is the criterion standard in delusional disorder (DD). No second-generation antipsychotic (SGA) is specifically authorized for the treatment of DD.
To evaluate the evidence available on pharmacological treatments in adults with DD and to compare first-generation antipsychotics (FGA) versus SGA.
A systematic review on pharmacological treatment of DD following the PRISMA methodology was conducted. We selected the best evidence available and analyzed it critically assessing both, biases and quality, to finally perform a narrative and quantitative synthesis.
The evidence available was mainly limited to observational studies and case series. There were no randomized clinical trials. Three hundred eighty-five DD cases were included (177 of which were on SGAs). Overall, antipsychotics achieved a good response in 33.6%% of the patients. As a group, FGAs showed significant superiority compared to SGAs (good response rates were 39% vs 28%, respectively). We did not find superiority of any specific antipsychotic over another.
There is no strong evidence to make definite recommendations, although antipsychotics in general seem to be an effective treatment for DD with a slight superiority in favor of FGAs as compared with SGAs. Existent data are, albeit, scarce and specific clinical trials on DD, are strongly recommended.
药物治疗是妄想障碍（DD）的标准治疗方法。尚无第二代抗精神病药物（SGA）被专门批准用于治疗DD。
评估关于成人DD药物治疗的现有证据，并比较第一代抗精神病药物（FGA）与SGA。
按照PRISMA方法对DD的药物治疗进行系统评价。我们选择了现有最佳证据并对其进行严格分析，评估偏倚和质量，最终进行叙述性和定量综合分析。
现有证据主要限于观察性研究和病例系列。没有随机临床试验。纳入了385例DD病例（其中177例使用SGA）。总体而言，抗精神病药物在33.6%的患者中取得了良好疗效。作为一个整体，FGA与SGA相比显示出显著优势（良好反应率分别为39%和28%）。我们未发现任何一种特定抗精神病药物优于另一种。
尽管总体而言抗精神病药物似乎是DD的有效治疗方法，与SGA相比FGA略有优势，但尚无有力证据做出明确推荐。然而，现有数据稀缺，强烈建议开展关于DD的具体临床试验。
