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

• Published in: Psychological medicine 2012-10, Vol.42 (10), p.2145-2155
• Main Authors: Harrow, M., Jobe, T. H., Faull, R. N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Antipsychotic Agents - therapeutic use; Antipsychotic drugs; Anxiety; Biological and medical sciences; Chicago; Drug therapy; Female; Follow-Up Studies; Humans; Interview, Psychological - methods; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Prospective Studies; Psychiatry; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Psychosocial functioning; Psychotropic drugs; Recovery; Remission Induction - methods; Schizophrenia; Schizophrenia - drug therapy; Secondary Prevention; Treatment Outcome; Vulnerability; Young Adult
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291712000220

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. 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. 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. 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.