May 14, 2012
Information sourced from Journal Watch:
Long-Term Antipsychotics in Patients with Schizophrenia
Not every patient needs continuous medication, according to this 20-year study.
Although prolonged use of antipsychotics is the current standard of care for schizophrenia, it is unclear whether all patients require this. These authors address this question by analyzing data from a 20-year follow-up study of 139 patients hospitalized with psychosis (mean age at index hospitalization, 23; 52% men; follow-ups at 2, 4.5, 7.5, 10, 15, and 20 years).
The researchers compared 70 patients with schizophrenia disorders (SZ group; schizophrenia, 61 patients; schizoaffective disorder, 9) with 69 psychotic mood-disorder patients (bipolar disorder, 38; unipolar depression, 31). For 41%, this was the first hospitalization, and for 25% the second.
Of the SZ group, approximately 35% were not taking antipsychotic medication at a particular follow-up point, 34% were prescribed antipsychotics at every follow-up, and 21% were not on antipsychotics at any follow-up. Starting at the 4.5-year follow-up, SZ patients not taking antipsychotics were significantly less symptomatic than those on antipsychotics and more likely to have experienced recovery (i.e., no symptoms or rehospitalization and adequate work and social functioning) in the previous year. Unmedicated patients also had better premorbid developmental achievements, less anxiety, and better cognitive functioning. Of SZ patients who were not psychotic at a particular follow-up, those off antipsychotics had a lower relapse rate at the next follow-up. As expected, the mood-disorder group had significantly better outcomes than the SZ group.
Comment: Most SZ patients in this study were not “cured.” However, over 20 years, a significant proportion could stop antipsychotic medication for some time without increased risk for relapse. It is possible some of these unmedicated patients were more resilient and less prone to psychosis. Clinicians should not assume that all patients with schizophrenia require continuous, lifetime antipsychotic treatment, especially if they have good premorbid functioning, less anxiety, and better cognitive skills.
— Deborah Cowley, MD
Published in Journal Watch Psychiatry March 26, 2012
Citation:
Harrow M et al. Do all schizophrenic patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychol Med 2012 Feb 17 [Medline® Abstract]
Copyright© 2012. Massachusetts Medical Society. All rights reserved.
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