Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study

Abstract

<jats:sec id="S0033291712000220_sec_a001"><jats:title>Background</jats:title><jats:p>The prevailing standard of care in the field involves background assumptions about the importance of prolonged use of antipsychotic medications for all schizophrenia (SZ) patients. However, do all SZ patients need antipsychotics indefinitely? Are there factors that help to identify which SZ patients can enter into prolonged periods of recovery without antipsychotics? This 20-year longitudinal research studied these issues.</jats:p></jats:sec><jats:sec id="S0033291712000220_sec_a002"><jats:title>Method</jats:title><jats:p>A total of 139 early young psychotic patients from the Chicago Follow-up Study, including 70 patients with SZ syndromes and 69 with mood disorders, were assessed, prospectively, at the acute phase and then followed up six times over the next 20 years. Patients were assessed with standardized instruments for major symptoms, psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.</jats:p></jats:sec><jats:sec id="S0033291712000220_sec_a003" sec-type="results"><jats:title>Results</jats:title><jats:p>At each follow-up, 30–40% of SZ patients were no longer on antipsychotics. Starting at the 4.5-year follow-ups and continuing thereafter, SZ patients not on antipsychotics for prolonged periods were significantly less likely to be psychotic and experienced more periods of recovery; they also had more favorable risk and protective factors. SZ patients off antipsychotics for prolonged periods did not relapse more frequently.</jats:p></jats:sec><jats:sec id="S0033291712000220_sec_a004" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>The data indicate that not all SZ patients need treatment with antipsychotics continuously throughout their lives. SZ patients not on antipsychotics for prolonged periods are a self-selected group with better internal resources associated with greater resiliency. They have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery.</jats:p></jats:sec>

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

“…These authors published several papers [45,46,48,49] that examined patients with schizophrenia who were either on or off antipsychotic medications over a 15-to 20-year study period, and found that those who got off antipsychotics, as a group, had much better outcomes. More specifically, over the long term, patients with schizophrenia not prescribed antipsychotics had statistically significantly less psychotic symptoms (p \ 0.05) [45,46], more periods of remission [47] or recovery (p \ 0.05) [45,48,49], and a better global functioning (p \ 0.001) [46] than those prescribed antipsychotics. This surprising finding led these authors to suggest a 'recovery paradox' in which antipsychotics help in the short term, but may lose efficacy in the long term.…”

“…One author [33] even states that an estimated 25-40 % of acute psychoses remit without antipsychotic treatment, referring to recovery rates reported by several long-term follow-up studies [19,[41][42][43][44], in most cases conducted prior to the widespread use of antipsychotic drugs. Several more recent long-term (C10 years) naturalistic or observational follow-up studies [45][46][47][48][49] suggest that, longitudinally, patients with schizophrenia not prescribed antipsychotics experience more periods of remission or recovery and better global functioning than those prescribed continuous antipsychotic treatment. The buildup of dopamine supersensitivity and tolerance to antipsychotics [50][51][52][53] would lead to treatment failure over time [54].…”

Clinical Factor 2012

“…Harrow et al [8] examined this assumed paradigm in a 20-year longitudinal study of 70 patients with schizophrenia and 69 patients with mood disorders. These patients were prospectively assessed at baseline and then 6 times over the next 20 years for major symptoms, psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.…”

The Need-Adapted Approach in Psychosis: The Impact of Psychosis on the Treatment and the Professionals

“…There also seem to be major contradictions between the principles of CCGS and those of NAA, which was the focus of this research. In the paragraphs below I shall present a critical evaluation of CCGS.Scientific discussion has indicated a need to reconsider the role of antipsychotic medication -and indeed the entire biogenetic paradigm of psychiatry (Bracken et al, 2012;Harrow, Jobe, & Faull, 2012;Lepping et al, 2011;Morrison et al, 2012;Priebe, Burns, & Craig, 2013). This is not reflected in CCGS, with the updates moving rather in the opposite direction.…”