{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:43:42Z","timestamp":1788515022946,"version":"build-2803163510"},"reference-count":78,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T00:00:00Z","timestamp":1708473600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although not approved for the treatment of anxiety disorders (except trifluoperazine) there is ongoing off\u2010label, unapproved use of first\u2010generation antipsychotics (FGAs) and second\u2010generation antipsychotics (SGAs) for anxiety disorders. There have been systematic reviews and meta\u2010analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The specific aims of this umbrella review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other nonantipsychotic medications; (2) Compare monotherapy with antipsychotics to first\u2010line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The review protocol is registered on PROSPERO (CRD42021237436).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An initial search was undertaken to identify systematic reviews and meta\u2010analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles. Review quality was measured using the AMSTAR\u20102 (A MeaSurement Tool to Assess Systematic Reviews) scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final review, 25 systematic reviews and meta\u2010analyses were included in the analysis. Most of the systematic reviews and meta\u2010analyses were deemed low\u2010quality through AMSTAR\u20102 with only one review being deemed high\u2010quality. In evaluating the monotherapies with antipsychotics compared with first\u2010line treatments for anxiety disorder there was insufficient evidence due to flawed study designs (such as problems with randomization) and small sample sizes within studies. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This umbrella review indicates a lack of high\u2010quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety disorders, FGAs and SGAs may have risks and side effects that outweigh their efficacy, although there were limited data. Further long\u2010term and larger\u2010scale studies of antipsychotics in anxiety disorders are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13669","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T19:09:23Z","timestamp":1708542563000},"page":"295-312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Antipsychotic agents in anxiety disorders: An umbrella review"],"prefix":"10.1111","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9749-8372","authenticated-orcid":false,"given":"Amir","family":"Garakani","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Health Greenwich Hospital  Greenwich Connecticut USA"},{"name":"Department of Psychiatry Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1324-7857","authenticated-orcid":false,"given":"Frank D.","family":"Buono","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6055-2806","authenticated-orcid":false,"given":"Mona","family":"Salehi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6846-4846","authenticated-orcid":false,"given":"Melissa C.","family":"Funaro","sequence":"additional","affiliation":[{"name":"Harvey Cushing\/John Hay Whitney Medical Library, Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9159-2813","authenticated-orcid":false,"given":"Anna","family":"Klimowicz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York University Langone Health  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7700-7102","authenticated-orcid":false,"given":"Harshit","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1290-2349","authenticated-orcid":false,"given":"Clara G. 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