The long-term effects of antipsychotic medication on clinical course in schizophrenia

Donald C. Goff, Peter Falkai, W. Wolfgang Fleischhacker, Ragy R. Girgis, Rene M. Kahn, Hiroyuki Uchida, Jingping Zhao, Jeffrey A. Lieberman

Research output: Contribution to journalReview article

62 Citations (Scopus)

Abstract

Concerns have been raised that treatment with antipsychotic medication might adversely affect long-term outcomes for people with schizophrenia. The evidence cited for these concerns includes the association of antipsychotic treatment with brain volume reduction and with dopamine receptor sensitization, which might make patients vulnerable to relapse and illness progression. An international group of experts was convened to examine findings from clinical and basic research relevant to these concerns. Little evidence was found to support a negative long-term effect of initial or maintenance antipsychotic treatment on outcomes, compared with withholding treatment. Randomized controlled trials strongly support the efficacy of antipsychotics for the acute treatment of psychosis and prevention of relapse; correlational evidence suggests that early intervention and reduced duration of untreated psychosis might improve longer-term outcomes. Strategies for treatment discontinuation or alternative non-pharmacologic treatment approaches maybenefit a subgroup of patients but may be associated with incremental risk of relapse and require further study, including the development of biomarkers that will enable a precision medicine approach to individualized treatment.

Original languageEnglish
Pages (from-to)840-849
Number of pages10
JournalAmerican Journal of Psychiatry
Volume174
Issue number9
DOIs
Publication statusPublished - 2017 Sep 1

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Antipsychotic Agents
Schizophrenia
Psychotic Disorders
Therapeutics
Recurrence
Precision Medicine
Withholding Treatment
Dopamine Receptors
Secondary Prevention
Randomized Controlled Trials
Biomarkers
Maintenance
Brain
Research

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Goff, D. C., Falkai, P., Fleischhacker, W. W., Girgis, R. R., Kahn, R. M., Uchida, H., ... Lieberman, J. A. (2017). The long-term effects of antipsychotic medication on clinical course in schizophrenia. American Journal of Psychiatry, 174(9), 840-849. https://doi.org/10.1176/appi.ajp.2017.16091016

The long-term effects of antipsychotic medication on clinical course in schizophrenia. / Goff, Donald C.; Falkai, Peter; Fleischhacker, W. Wolfgang; Girgis, Ragy R.; Kahn, Rene M.; Uchida, Hiroyuki; Zhao, Jingping; Lieberman, Jeffrey A.

In: American Journal of Psychiatry, Vol. 174, No. 9, 01.09.2017, p. 840-849.

Research output: Contribution to journalReview article

Goff, DC, Falkai, P, Fleischhacker, WW, Girgis, RR, Kahn, RM, Uchida, H, Zhao, J & Lieberman, JA 2017, 'The long-term effects of antipsychotic medication on clinical course in schizophrenia', American Journal of Psychiatry, vol. 174, no. 9, pp. 840-849. https://doi.org/10.1176/appi.ajp.2017.16091016
Goff, Donald C. ; Falkai, Peter ; Fleischhacker, W. Wolfgang ; Girgis, Ragy R. ; Kahn, Rene M. ; Uchida, Hiroyuki ; Zhao, Jingping ; Lieberman, Jeffrey A. / The long-term effects of antipsychotic medication on clinical course in schizophrenia. In: American Journal of Psychiatry. 2017 ; Vol. 174, No. 9. pp. 840-849.
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