Recovery in schizophrenia: the role of antipsychotic treatment

TL;DR

The paper explores how long-term antipsychotic treatment, when optimized and used in early intervention programs, can improve recovery and outcomes in schizophrenia.

Contribution

The paper highlights the importance of low-dose antipsychotic treatment and reevaluates the role of polypharmacy in schizophrenia management.

Findings

Adequate (low-dose) antipsychotic treatment is associated with better recovery and outcomes in schizophrenia.

Polypharmacy (combination of two antipsychotics) may benefit a significant proportion of patients.

Higher doses of antipsychotics are linked to poorer outcomes and potential brain changes.

Abstract

Comprehensive care programs, which include individually planned pharmacotherapy are associated with higher rates of recovery1 and better long-term prognosis2. However, there are barriers to individually optimised antipsychotic treatment both from both the patients and treatment teams perspectives.

To summarize the potential contribution of adequate long-term antipsychotic treatment to recovery or better outcomes in schizophrenia.

Review of research data.

Results A shorter duration of untreated psychosis, a lower number of relapses, and the absence of a chronic course of psychosis are associated with higher rates of recovery and a better prognosis. The OPUS early intervention program was associated with better outcomes for up to 10 years, but not for more than 20 years3. Second generation antipsychotics are associated with lower mortality rates, including suicides in young people with schizophrenia.4

Higher doses of antipsychotics are associated with poorer outcomes and with potential structural brain changes, while adequate (lower) doses of antipsychotics are associated with lower side effect burden and better overall outcomes5. A significant proportion of patient may benefit from polypharmacy (combination of 2 antipsychotics)6. Antipsychotic treatment discontinuation strategies are associated with the development of treatment resistance.7

Adequate (low dose) antipsychotic treatment is part of the complex early intervention programs and long term treatment of schizophrenia, which are associated with higher rates of recovery and good outcomes. The role of polypharmacy (combination of 2 antipsychotics) may need a reconsideration in the treatment guidelines of schizophrenia.Kane JM et al. The Journal of clinical psychiatry. 2015 Mar 25;76(3):16590.Posselt CM et al. 2021. American Journal of Psychiatry, 2021, 178(10):941-951Hansen HG et al. 2023. JAMA Psychiatry, 2023, 80(4): 371-379.Correll CU et al. World Psychiatry. 2022 Jun;21(2):248-71.Andreasen NC et al. 2013 Jun;170(6):609-15.Katona L et al. 2014 Jan 1;152(1):246-54.Emsley R et al2013 Feb 1;33(1):80-3.

Kane JM et al. The Journal of clinical psychiatry. 2015 Mar 25;76(3):16590.

Posselt CM et al. 2021. American Journal of Psychiatry, 2021, 178(10):941-951

Hansen HG et al. 2023. JAMA Psychiatry, 2023, 80(4): 371-379.

Correll CU et al. World Psychiatry. 2022 Jun;21(2):248-71.

Andreasen NC et al. 2013 Jun;170(6):609-15.

Katona L et al. 2014 Jan 1;152(1):246-54.

Emsley R et al2013 Feb 1;33(1):80-3.

None Declared