Maintenance treatment with antipsychotic drugs for schizophrenia

Abstract

BackgroundThe symptoms and signs of schizophrenia have been firmly linked to high levels of dopamine in specific areas of the brain (limbic system). Antipsychotic drugs block the transmission of dopamine in the brain and reduce the acute symptoms of the disorder. This review examined whether antipsychotic drugs are also effective for relapse prevention. ObjectivesTo review the effects of maintaining antipsychotic drugs for people with schizophrenia compared to withdrawing these agents. Search methodsWe searched the Cochrane Schizophrenia Group's Specialised Register (November 2008), with additional searches of MEDLINE, EMBASE and clinicaltrials.gov (June 2011). Selection criteriaWe included all randomised trials comparing maintenance treatment with antipsychotic drugs and placebo for people with schizophrenia or schizophrenia-like psychoses. Data collection and analysisWe extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD) or standardised mean differences (SMD) again based on a random-effects model. Main resultsThe review currently includes 65 randomised controlled trials (RCTs) and 6493 participants comparing antipsychotic medication with placebo. The trials were published from 1959 to 2011 and their size ranged between 14 and 420 participants. In many studies the methods of randomisation, allocation and blinding were poorly reported. Although this and other potential sources of bias limited 1 Maintenance treatment with antipsychotic drugs for schizophrenia (Review)

‘Responsible, but Still not a Real Treatment Partner’: A Qualitative Study of the Experiences of Relatives of Patients on Outpatient Commitment Orders

“…Their experiences with the patient's medication were both positive and negative, and they often felt challenged by the patient's negative experiences. Relatives' experience finds support in studies showing that the long-term effects of psychosis medications may be overstated (Leucht et al, 2012). Some studies explain relapses as a consequence of long-term medication (Harrow & Jobe, 2013;Wunderink, Nieboer, Wiersma, Sytema, & Nienhuis, 2013).…”

The Effects of Modafinil in People with a Diagnosis of Schizophrenia

“…delusions and hallucinations) [8], but they have limited effect in managing negative symptoms [9]. However, negative symptoms (e.g.…”

Antipsychotic maintenance treatment in schizophrenia and the importance of preventing relapse

“…Treatment failure occurs irrespective of whether it is the first or a subsequent relapse, and even when treatment is re-introduced immediately after the first signs of illness recurrence 8 . Given all of these potential hazards associated with illness recurrence, together with the clear-cut evidence for efficacy of antipsychotics in relapse prevention studies 9 , it is understandable that clinicians continue to prioritize relapse prevention via continuous antipsychotic treatment as a treatment goal. This is despite the substantial adverse effect burden associated with antipsychotic medication.…”