Antipsychotics Have Few Negative Long-term Effects on Schizophrenia Outcomes

The positive effects of antipsychotic medications in patients with schizophrenia and other psychotic disorders outweigh the adverse effects of antipsychotics on long-term outcomes, according to findings from an expert panel published in the American Journal of Psychiatry.

“Currently, there is not compelling evidence from controlled clinical trials that initial antipsychotic treatment worsens the long-term course of the illness,” lead investigator Donald C. Goff, MD, of New York University Langone Medical Center in New York City, said.

“The widely accepted recommendation that all patients with new-onset schizophrenia receive acute and maintenance antipsychotic treatment has been challenged out of concern that the medication might adversely affect long-term outcomes,” the researchers stated, pointing to the association between antipsychotic treatment and brain volume reduction and dopamine receptor sensitization, which might make patients more vulnerable to relapse or progression of psychosis.

While antipsychotics have proven short-term effectiveness, questions linger regarding whether they have a negative effect on clinical course. With no data available from clinical trials, the study’s investigators organized a panel that included experts in antipsychotic pharmacology, neuroimaging, and neuropathology. They analyzed preclinical and clinical evidence that supported the potential adverse effects of antipsychotics.

The panel found little evidence of a negative long-term effect of initial or maintenance antipsychotic treatment on schizophrenia outcomes compared with withholding treatment.

The evidence from randomized controlled trials strongly supports the efficacy of antipsychotics for the acute treatment of psychosis and the prevention of relapse. Correlational evidence also suggests that delaying or withholding treatment could lead to poor long-term outcomes.

“Patients should be made aware of the strong evidence supporting antipsychotic efficacy and of the side effects that vary between drugs,” the researchers said.

“Additional research is needed to help quantify the risk-benefit ratio associated with continuation compared with discontinuation of antipsychotic treatment and to identify predictive biomarkers in order to facilitate shared decision making and a personalized medicine approach,” they added.

Reference

Goff DC, Falkai P, Fleischhacker WW, et al. The long-term effects of antipsychotic medication on clinical course in schizophrenia [published online May 5, 2017]. Am J Psychiatry. doi:10.1176/appi.ajp.2017.16091016