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Should antipsychotic medications for schizophrenia be given for a lifetime? Replication of a naturalistic, long-term, follow-up study of antipsychotic treatment

Published online by Cambridge University Press:  19 February 2019

Ira D. Glick Open the ORCID record for Ira D. Glick [Opens in a new window] ,
Daisy Zamora ,
Danielle Kamis  and
John M. Davis
Ira D. Glick*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. USA; and Medical Director, Pacific Research Partners, Oakland, California, USA
Daisy Zamora
Affiliation:
Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
Danielle Kamis
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
John M. Davis
Affiliation:
College of Medicine, University of Illinois, Chicago, Illinois, USA
*
*Address for correspondence: Dr. Ira D. Glick, (Email: iraglick@stanford.edu)
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Abstract

Objective

Because ethically and practically a randomized control trial of antipsychotics will never be done, we recently conducted and reported a 8- to 50-year, naturalistic follow-up from an academic clinic of patients with chronic schizophrenia on antipsychotic medication. We found that better medication adherence was a statistically significant predictor of better long-term global outcome and life satisfaction. Because there were important limitations on our findings, we now in this communication, using similar methodology, detail outcomes for a very different sample—inner city patients with chronic schizophrenia with a long past history of antipsychotic treatment, who were enrolled in clinical trials for new medications for schizophrenia.

Methods

This is a retrospective, naturalistic, longitudinal 6- to 49-years antipsychotic treatment (mean average, 20) follow-up of a consecutive series of patients volunteering for screening for studies with schizophrenia. Lifetime data were collected on (1) their medication adherence, (2) long-term global outcome, and (3) life satisfaction. Outcomes were rated by 2 different clinicians, 1 with information on medication adherence (nonblind rater) and 1 without (blind rater). We used linear regression models adjusted for age, family support, substance use disorder, race, marital status, and number of years in treatment to estimate the association between adherence and each outcome.

Results

A total of 34 patients were assessed. Medication adherence was positively associated with the blind clinician’s rating of global outcome (P value=0.03) and the global assessment of functioning (P value=0.05). In the nonblinded clinician rating, medication adherence was unrelated to global outcome (P value=0.26) and to patients’ report of life satisfaction (P value=0.54).

Conclusion

This replication study, like our previous study, is not inconsistent with the recommendation for continuous, long-term treatment for chronic schizophrenia unless medically contraindicated.

Keywords

Antipsychoticsmedication adherencenaturalisticschizophreniasubstance use disorder
Type
Original Research
Information
CNS Spectrums , Volume 24 , Issue 5 , October 2019 , pp. 557 - 563
Copyright
© Cambridge University Press 2019 

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Footnotes

The authors thank Mark Horowitz for statistical programming.

Since this paper was submitted for publication, there have been two other reports on the benefits of long term antipsychotics: Kahn RS. On the continued benefits of antipsychotics after the first episode of schizophrenia. AM J Psychiatry 2018; 175: 712–713. Welte AS, Edlinger, M., et. al. Characteristics of Involuntarily Admitted Patients and Treatment Patterns Over a 21-Year Observation Period. J Clin Psychopharmacology 2018; 4: 376–379.

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