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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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