Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics?

TY - JOUR

T1 - Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics?

AU - Murray, Robin M

AU - Quattrone, Diego

AU - Natesan, Sridhar

AU - van Os, Jim

AU - Nordentoft, Merete

AU - Howes, Oliver

AU - Di Forti, Marta

AU - Taylor, David

N1 - © The Royal College of Psychiatrists 2016.

PY - 2016/11

Y1 - 2016/11

N2 - Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2 receptor. Psychiatrists should work with their patients to slowly reduce the antipsychotic to the lowest dose that prevents the return of distressing symptoms. Up to 40% of those whose psychosis remits after a first episode should be able to achieve a good outcome in the long term either with no antipsychotic medication or with a very low dose.

AB - Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2 receptor. Psychiatrists should work with their patients to slowly reduce the antipsychotic to the lowest dose that prevents the return of distressing symptoms. Up to 40% of those whose psychosis remits after a first episode should be able to achieve a good outcome in the long term either with no antipsychotic medication or with a very low dose.

KW - Journal Article

U2 - 10.1192/bjp.bp.116.182683

DO - 10.1192/bjp.bp.116.182683

M3 - Journal article

C2 - 27802977

SN - 0960-5371

VL - 209

SP - 361

EP - 365

JO - The Journal of mental science

JF - The Journal of mental science

IS - 5

ER -