Thursday, 3 September 2015

Antipsychotic Maintenance Treatment: Time to Rethink? @JoannaMoncrieff #PLOS [reblog]

Citation: Moncrieff J (2015) Antipsychotic Maintenance Treatment: Time to Rethink? PLoS Med 12(8): e1001861. doi:10.1371/journal.pmed.1001861

"Summary Points
  • Existing studies of long-term antipsychotic treatment for people with schizophrenia and related conditions are too short and have ignored the impact of discontinuation-related adverse effects.
  • Recent evidence confirms that antipsychotics have a range of serious adverse effects, including reduction of brain volume.
  • The first really long-term follow-up of a randomised trial found that patients with first-episode psychosis who had been allocated to a gradual antipsychotic reduction and discontinuation programme had better functioning at seven-year follow-up than those allocated to maintenance treatment, with no increase in relapse.
  • Further studies with long-term follow-up and a range of outcomes should be conducted on alternatives to antipsychotic maintenance treatment for people with recurrent psychotic conditions.
Schizophrenia and psychotic disorders are estimated to affect 1% of the population and are one of the highest causes of global disability [1]. They place a considerable burden on individuals, families, and society, with costs amounting to US$62.7 billion in the United States in 2002, for example [2]. The highest costs are related to unemployment, and one long-term follow-up study found that more than 80% of people diagnosed with schizophrenia have some ongoing social disability [3].

Long-term antipsychotic treatment has been the norm for people diagnosed with schizophrenia and other recurrent psychotic disorders since the introduction of these drugs in the 1960s [4]. Recent data from the United Kingdom indicate that 97.5% of mental health service patients diagnosed with schizophrenia are prescribed at least one antipsychotic [5]. The practice is based on research believed to have established that continuous antipsychotic treatment reduces the risk of relapse. Interpreting the evidence is not straightforward, though, and other data are beginning to emerge that suggest that long-term treatment may have an adverse impact on levels of social functioning [6,7]. Is it time, therefore, to review the practice of antipsychotic maintenance treatment and question whether it should continue to be the default treatment strategy in people diagnosed with schizophrenia or similar psychotic disorders? ...." read complete essay


blog post: 'More Harm Than Good: Confronting the Psychiatric Medication Epidemic' Conference 18 September 2015 London

Conference Programme 18 September 2015 London