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A critical analysis of recent data on the long-term outcome of antipsychotic treatment

Published online by Cambridge University Press:  19 December 2018

Joanna Moncrieff  and
Sandra Steingard
Joanna Moncrieff*
Affiliation:
Department of Mental Health Sciences, Division of Psychiatry, University College London, London, UK
Sandra Steingard
Affiliation:
Howard Centre, Burlington, VT, USA
*
Author for correspondence: Joanna Moncrieff, E-mail: j.moncrieff@ucl.ac.uk
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Abstract

New studies of long-term outcomes claim to show that taking antipsychotics on a continuous and indefinite basis is the best approach for people diagnosed with a first episode of psychosis or schizophrenia. A 10-year follow-up of a trial of quetiapine maintenance, for example, found a higher proportion of people with a poor composite outcome in the group initially randomised to placebo. However, most people classified as showing poor outcome were rated as having a mild score on a single psychotic symptom; there were no differences in overall symptoms, positive or negative symptoms or level of functioning. Moreover, 16% of participants did not have a follow-up interview and data from the end of the original trial were used instead. A study using a Finnish database suggested that mortality and readmission were higher in people who did not start long-term antipsychotic treatment or who discontinued it as compared with long-term continuous users. However, the analysis did not control for important confounders and is likely to reflect the fact that people who do not comply with treatment are at higher risk of death due to underlying health risks and behaviours. The analysis showed a slightly higher risk of readmission among non-users of antipsychotics compared with long-term users and a more substantial increased risk among people who discontinued treatment. However, follow-up ceased at the first readmission and therefore eventual, long-term outcome was not assessed. Speed of reduction and whether it was done with or without clinical support were also not distinguished.

Keywords

Antipsychotic long-term effectsantipsychoticsobservational dataoutcome studiespsychosisschizophrenia
Type
Commentary
Information
Psychological Medicine , Volume 49 , Issue 5 , April 2019 , pp. 750 - 753
Copyright
Copyright © Cambridge University Press 2018 

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References

Chen, EY, Hui, CL, Lam, MM, Chiu, CP, Law, CW, Chung, DW, Tso, S, Pang, EP, Chan, KT, Wong, YC, Mo, FY, Chan, KP, Yao, TJ, Hung, SF and Honer, WG (2010) Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial. British Medical Journal 341, c4024 August 19;341:c4024.Google Scholar
Correll, CU, Rubio, JM and Kane, JM (2018) What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatry 17, 149–160.Google Scholar
Curtis, JR, Larson, JC, Delzell, E, Brookhart, MA, Cadarette, SM, Chlebowski, R, Judd, S, Safford, M, Solomon, DH and Lacroix, AZ (2011) Placebo adherence, clinical outcomes, and mortality in the women's health initiative randomized hormone therapy trials. Medical Care 49, 427–435.Google Scholar
De Hert, M, Correll, CU and Cohen, D (2010) Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study. Schizophrenia Research 117, 68–74.Google Scholar
Freemantle, N, Marston, L, Walters, K, Wood, J, Reynolds, MR and Petersen, I (2013) Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research. British Medical Journal 347, f6409.Google Scholar
Goff, DC, Falkai, P, Fleischhacker, WW, Girgis, RR, Kahn, RM, Uchida, H, Zhao, J and Lieberman, JA (2017) The long-term effects of antipsychotic medication on clinical course in schizophrenia. American Journal of Psychiatry 174, 840–849.Google Scholar
Harrow, M, Jobe, TH and Faull, RN (2012) Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine 42, 2145–2155.Google Scholar
Hui, CLM, Honer, WG, Lee, EHM, Chang, WC, Chan, SKW, Chen, ESM, Pang, EPF, Lui, SSY, Chung, DWS, Yeung, WS, Ng, RMK, Lo, WTL, Jones, PB, Sham, P and Chen, EYH (2018) Long-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial. The Lancet. Psychiatry 5, 432–442.Google Scholar
Moilanen, JM, Haapea, M, Jaaskelainen, E, Veijola, JM, Isohanni, MK, Koponen, HJ and Miettunene, J (2016) Long-term antipsychotic use and its association with outcomes in schizophrenia: the Northern Finland birth cohort 1966. European Psychiatry 36, 7–14.Google Scholar
Morgan, C, Lappin, J, Heslin, M, Donoghue, K, Lomas, B, Reininghaus, U, Onyejiaka, A, Croudace, T, Jones, PB, Murray, RM, Fearon, P, Doody, GA and Dazzan, P (2014) Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychological Medicine 44, 2713–2726.Google Scholar
Murray, RM, Quattrone, D, Natesan, S, van Os, J, Nordentoft, M, Howes, O, Di Forti, M and Taylor, D (2016) Should psychiatrists be more cautious about the long-term use of antipsychotics? British Journal of Psychiatry 209, 361–365.Google Scholar
National Institute for Health and Care Excellence (NICE) (2014) Psychosis and Schizophrenia in Adults: Treatment and Management. London: NICE.Google Scholar
Osborn, DP, Petersen, I, Beckley, N, Walters, K, Nazareth, I and Hayes, J (2018) Weight change over two years in people prescribed olanzapine, quetiapine and risperidone in UK primary care: Cohort study in THIN, a UK primary care database. Journal of Psychopharmacology 32, 1098–1103.Google Scholar
Pies, R (2016) Long-term antipsychotic treatment: effective and often necessary, with caveats. Psychiatric Times 33(4), 5th April 2016. http://www.psychiatrictimes.com/couch-crisis/long-term-antipsychotic-treatment-effective-and-often-necessary-caveats.Google Scholar
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L, Tanskanen, A and Haukka, J (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). The Lancet 374, 620–627.Google Scholar
Tiihonen, J, Tanskanen, A and Taipale, H (2018) 20-year nationwide follow-up study on discontinuation of antipsychotic treatment in first-episode schizophrenia. American Journal of Psychiatry 175, 765–773.Google Scholar
Torniainen, M, Mittendorfer-Rutz, E, Tanskanen, A, Bjorkenstam, C, Suvisaari, J, Alexanderson, K and Tiihonen, J (2015) Antipsychotic treatment and mortality in schizophrenia. Schizophrenia Bulletin 41, 656–663.Google Scholar
Undurraga, J, Murru, A and Vieta, E (2014) Early medication discontinuation on long-term recovery outcome in first-episode psychosis. JAMA Psychiatry 71, 206–207.Google Scholar
Wils, RS, Gotfredsen, DR, Hjorthoj, C, Austin, SF, Albert, N, Secher, RG, Thorup, AA, Mors, O and Nordentoft, M (2017) Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis. Schizophrenia Research 182, 42–48.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S and Nienhuis, FJ (2013) Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. Journal of the American Medical Association: Psychiatry 70, 913–920.Google Scholar