Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China

Ran, Mao‐Sheng; Weng, Xue; Chan, Cecilia Lai-Wan; Chen, Eric; Tang, Cui-Ping; Lin, Fuchun Joseph; Mao, Wenjun; Hu, Shi-Hui; Huang, Yueqin; Xiang, Meng-Ze

doi:10.1192/bjp.bp.114.157685

Cited by 77 publications

(112 citation statements)

References 42 publications

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“…Interestingly, different results were found in a retrospective cohort study of individuals with schizophrenia whose access to antipsychotic treatment had been restricted. In this cohort from rural China, those who had access to antipsychotics did substantially better after 14 years than those without access.…”

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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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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“…Correll et al quote for support a study by Ran et al favoring long‐term use of antipsychotics for schizophrenia in China. However, there are many weaknesses in that study.…”

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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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“…Historical data suggest that approximately 15% of first episode patients will recover spontaneously and will sustain their recovery but far fewer will do so after several subsequent episodes. The literature suggests that the introduction of antipsychotics improved this outcome (Alem et al, ; Hegarty, Baldessarini, Tohen, & Waternaux, ; Hegarty, Baldessarini, Tohen, Waternaux, & Oepen, ; Jaaskelainen et al, ; Kurihara, Kato, Reverger, Tirta, & Kashima, ; Ran et al, ). All these studies reported that with passing of the years, the condition of untreated patients worsens more, in comparison with treated patients.…”

Section: Discussionmentioning

confidence: 99%

The effect of baseline antipsychotic status on the 12‐month outcome in initially stabilized patients with schizophrenia

Fountoulakis

Panagiotidis

Nimatoudis

2019

Human Psychopharmacology

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Introduction Recently, the usefulness of antipsychotics has been challenged. The aim of the study was to measure the real‐life effect of antipsychotic treatment on remission and recovery rates in already stabilized patients with schizophrenia after 1 year. Material and Methods The study included 133 stabilized patients with schizophrenia (77 males and 56 females; aged 33.55 ± 11.22 years). The assessment included testing at baseline and after 1 year with the Positive and Negative Syndrome Scale, Calgary Depression Scale, State–Trait Anxiety Inventory, UKU, Extrapyramidal Symptom Rating Scale, and General Assessment of Functioning. Results More patients were on antipsychotics after 1 year (increase by 16.45%). There was an increase in the remission by 75% and in the recovery rate by 66%. It was not possible to predict the outcome on the basis of baseline variables. Discussion There is an accumulating beneficial effect of antipsychotic treatment over a 12‐month period; early lack of remission is not prognostic of a poor outcome. There might be different neurobiological mechanisms underlying acute and sustained response. Both remission and recovery are difficult to achieve for patients with schizophrenia and characterize only a minority of patients. Only a very small minority of patients (4.5%) that is impossible to identify a priori would do well without off antipsychotics.

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Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China

Cited by 77 publications

References 42 publications

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

The effect of baseline antipsychotic status on the 12‐month outcome in initially stabilized patients with schizophrenia

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