Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis

Wils, Regitze Sølling; Gotfredsen, Ditte Resendal; Hjorthøj, Carsten; Austin, Stephen F.; Albert, Nikolai; Secher, Rikke Gry; Thorup, Anne; Mors, Ole; Nordentoft, Merete

doi:10.1016/j.schres.2016.10.030

Cited by 92 publications

(74 citation statements)

References 25 publications

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“…Negative evidence on the long-term efficacy of antipsychotics have emerged from our own longitudinal studies (Harrow et al, 2012; Harrow et al, 2014; Harrow and Jobe, 2007) and the longitudinal studies of Wunderink (Wunderink et al, 2013) of Moilanen, Jääskeläinena and colleagues (Moilanen et al, 2013) using data from the Northern Finland Birth Cohort Study, by data from the Danish OPUS trials (Wils et al, 2016), the study of Lincoln and Jung in Germany (Jung et al, 2016), and the studies of Bland in Canada (Bland et al, 1978). These longitudinal studies have not shown positive effects for patients with schizophrenia prescribed antipsychotic for prolonged periods.…”

Section: Discussionmentioning

confidence: 99%

“…This long term research on antipsychotic medication treatment includes that of Wunderink (Wunderink et al, 2013), the Northern Finland Birth Cohort Studies (Moilanen et al, 2013), the Danish OPUS trials (Wils et al, 2016) the study of Jung, Lincoln and colleagues (Jung et al, 2016) and our longitudinal research from the Chicago Followup Study (Harrow and Jobe, 2007; Jobe and Harrow, 2010; Harrow et al, 2012; Harrow and Jobe, 2013; Harrow et al, 2014). These and other studies have led to questions by R. Murray (Murray et al, 2016), by Barnes and Badre (2016) and others (Buchsbaum et al, 1992; Howes et al, 2012) concerning the long-term effects of antipsychotics on functioning.…”

Section: Introductionmentioning

confidence: 99%

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A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia

Harrow

Jobe

Faull

et al. 2017

Psychiatry Research

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To assess the long-term effectiveness of antipsychotic medications in facilitating work functioning in patients with schizophrenia we conducted longitudinal multi followup research on 139 initially psychotic patients. The 70 patients with schizophrenia and 69 initially psychotic mood disordered control patients were followed up 6 times over 20 years. We compared the influence on work functioning of patients with schizophrenia continuously prescribed antipsychotics with patients with schizophrenia not prescribed antipsychotics, using statistical controls for inter-subject differences. While antipsychotics reduce or eliminate flagrant psychosis for most patients with schizophrenia at acute hospitalizations, four years later and continually until the 20 year followups, patients with schizophrenia not prescribed antipsychotics had significantly better work functioning. The work performance of the patients who were continuously prescribed antipsychotics was at a low rate and did not improve over time. Multiple other factors also interfere with work functioning. The data suggest that some patients with schizophrenia not prescribed antipsychotics for prolonged periods can function relatively well. Multiple other factors are associated with poor post-hospital work performance. The longitudinal data raise questions about prolonged treatment of schizophrenia with antipsychotic medications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia

Harrow

Jobe

Faull

et al. 2017

Psychiatry Research

View full text Add to dashboard Cite

show abstract

“…In the Northern Finland 1966 Birth Cohort, which followed patients for almost 20 years, those who were off antipsychotics were more often in remission, and no differences in remission rates between treatment groups were found. Similarly, the OPUS cohort in Denmark found that, among the 90% of the individuals who did not have sustained remission 10 years after their first episode, more were on than off antipsychotics.…”

Section: Efficacy Effectiveness and Tolerabilitymentioning

confidence: 99%

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

2018

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The long-term benefit-to-risk ratio of sustained antipsychotic treatment for schizophrenia has recently been questioned. In this paper, we critically examine the literature on the long-term efficacy and effectiveness of this treatment. We also review the evidence on the undesired effects, the impact on physical morbidity and mortality, as well as the neurobiological correlates of chronic exposure to antipsychotics. Finally, we summarize factors that affect the risk-benefit ratio. There is consistent evidence supporting the efficacy of antipsychotics in the short term and mid term following stabilization of acute psychotic symptoms. There is insufficient evidence supporting the notion that this effect changes in the long term. Most, but not all, of the long-term cohort studies find a decrease in efficacy during chronic treatment with antipsychotics. However, these results are inconclusive, given the extensive risk of bias, including increasing non-adherence. On the other hand, long-term studies based on national registries, which have lower risk of bias, find an advantage in terms of effectiveness during sustained antipsychotic treatment. Sustained antipsychotic treatment has been also consistently associated with lower mortality in people with schizophrenia compared to no antipsychotic treatment. Nevertheless, chronic antipsychotic use is associated with metabolic disturbance and tardive dyskinesia. The latter is the clearest undesired clinical consequence of brain functioning as a potential result of chronic antipsychotic exposure, likely from dopaminergic hypersensitivity, without otherwise clear evidence of other irreversible neurobiological changes. Adjunctive psychosocial interventions seem critical for achieving recovery. However, overall, the current literature does not support the safe reduction of antipsychotic dosages by 50% or more in stabilized individuals receiving adjunctive psychosocial interventions. In conclusion, the critical appraisal of the literature indicates that, although chronic antipsychotic use can be associated with undesirable neurologic and metabolic side effects, the evidence supporting its long-term efficacy and effectiveness, including impact on life expectancy, outweighs the evidence against this practice, overall indicating a favorable benefit-to-risk ratio. However, the finding that a minority of individuals diagnosed initially with schizophrenia appear to be relapse free for long periods, despite absence of sustained antipsychotic treatment, calls for further research on patient-level predictors of positive outcomes in people with an initial psychotic presentation.

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“…These studies have been conducted by eight different investigator groups. They include those by Wunderink et al in the Netherlands, our own Chicago Followup Study, the Suffolk County study of Kotov et al in the US, and the long‐term data provided by the Danish OPUS trial, the AESOP‐10 study in England, the Finnish Birth Cohort Study, the Alberta Hospital Follow‐Up Study in Western Canada, and the international follow‐up study by Harrison et al. These research programs included samples studied from 7 to 20 years.…”

mentioning

confidence: 99%

Long‐term antipsychotic treatment of schizophrenia: does it help or hurt over a 20‐year period?

Harrow

Jobe

2018

World Psychiatry

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Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis

Cited by 92 publications

References 25 publications

A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia

A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia

What is the risk‐benefit ratio of long‐term antipsychotic treatment in people with schizophrenia?

Long‐term antipsychotic treatment of schizophrenia: does it help or hurt over a 20‐year period?

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