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Should antipsychotic medications for schizophrenia be given for a lifetime? Replication of a naturalistic, long-term, follow-up study of antipsychotic treatment

Published online by Cambridge University Press:  19 February 2019

Ira D. Glick
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. USA; and Medical Director, Pacific Research Partners, Oakland, California, USA
Daisy Zamora
Affiliation:
Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
Danielle Kamis
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
John M. Davis
Affiliation:
College of Medicine, University of Illinois, Chicago, Illinois, USA
Corresponding
E-mail address:

Abstract

Objective

Because ethically and practically a randomized control trial of antipsychotics will never be done, we recently conducted and reported a 8- to 50-year, naturalistic follow-up from an academic clinic of patients with chronic schizophrenia on antipsychotic medication. We found that better medication adherence was a statistically significant predictor of better long-term global outcome and life satisfaction. Because there were important limitations on our findings, we now in this communication, using similar methodology, detail outcomes for a very different sample—inner city patients with chronic schizophrenia with a long past history of antipsychotic treatment, who were enrolled in clinical trials for new medications for schizophrenia.

Methods

This is a retrospective, naturalistic, longitudinal 6- to 49-years antipsychotic treatment (mean average, 20) follow-up of a consecutive series of patients volunteering for screening for studies with schizophrenia. Lifetime data were collected on (1) their medication adherence, (2) long-term global outcome, and (3) life satisfaction. Outcomes were rated by 2 different clinicians, 1 with information on medication adherence (nonblind rater) and 1 without (blind rater). We used linear regression models adjusted for age, family support, substance use disorder, race, marital status, and number of years in treatment to estimate the association between adherence and each outcome.

Results

A total of 34 patients were assessed. Medication adherence was positively associated with the blind clinician’s rating of global outcome (P value=0.03) and the global assessment of functioning (P value=0.05). In the nonblinded clinician rating, medication adherence was unrelated to global outcome (P value=0.26) and to patients’ report of life satisfaction (P value=0.54).

Conclusion

This replication study, like our previous study, is not inconsistent with the recommendation for continuous, long-term treatment for chronic schizophrenia unless medically contraindicated.

Type
Original Research
Copyright
© Cambridge University Press 2019 

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Footnotes

The authors thank Mark Horowitz for statistical programming.

Since this paper was submitted for publication, there have been two other reports on the benefits of long term antipsychotics: Kahn RS. On the continued benefits of antipsychotics after the first episode of schizophrenia. AM J Psychiatry 2018; 175: 712–713. Welte AS, Edlinger, M., et. al. Characteristics of Involuntarily Admitted Patients and Treatment Patterns Over a 21-Year Observation Period. J Clin Psychopharmacology 2018; 4: 376–379.

References

Glick, ID, Davis, JM, Zamora, D, et al. Should antipsychotic medications for schizophrenia be given for a lifetime? A naturalistic, long-term follow-up study. J Clin Psychopharmacol. 2017; 37(2): 125130.CrossRefGoogle ScholarPubMed
Leucht, S, Tardy, M, Komossa, K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet. 2012; 379(9831): 20632071.CrossRefGoogle ScholarPubMed
Murray, RM, Quattrone, D, Natesan, S, et al. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? Br J Psychiatry. 2016; 209(5): 361365.CrossRefGoogle ScholarPubMed
Bleuler, M. Die Schizophrenen Geistesstorungen Im Lichte. NewYork, NY: Intercontinental Medical Book Corp; 1972.Google Scholar
Ciompi, L, Müller, C. Lifestyle and age of schizophrenics. A catamnestic long-term study into old age [in German]. Monogr Gesamtgeb Psychiatr Psychiatry Ser. 1976; 12:1242.Google Scholar
Harding, CM, Brooks, GW, Ashikaga, T, et al. The Vermont longitudinal study of persons with severe mental illness, I: methodology, study sample, and overall status 32 years later. Am J Psychiatry. 1987; 144(6): 718726.Google ScholarPubMed
Levenstein, S, Klein, DF, Pollack, M. Follow-up study of formerly hospitalized voluntary psychiatric patients: the first two years. Am J Psychiatry. 1966; 122(10): 11021109.CrossRefGoogle ScholarPubMed
Goldberg, SC, Schooler, NR, Hogarty, GE, et al. Prediction of relapse in schizophrenic outpatients treated by drug and sociotherapy. Arch Gen Psychiatry. 1977; 34(2): 171184.CrossRefGoogle ScholarPubMed
Hegarty, JD, Baldesserini, RJ, Tohen, M, et al. One hundred years of schizophrenia: a meta-analysis of the outcome literature. Am J Psychiatry. 1994; 151(10): 14091416.Google ScholarPubMed
Goff, DC, Falkai, P, Fleischhacker, WW, et al. The long-term effects of antipsychotic medication on clinical course in schizophrenia. Am J Psychiatry. 2017; 174(9): 840849.CrossRefGoogle Scholar
Tiihonen, J, Tanskanen, A, Taipale, H. 20-Year nationwide follow-up study on antipsychotic treatment, re-hospitalization, and mortality in first-episode schizophrenia (FIN20 Study). Poster presented at: American College of Neuropsychopharmacology 56th Annual Meeting; December 3–7, 2017; Palm Springs, CA.Google Scholar
Wunderlink, L, Nieboer, RM, Wiersma, D, et al. Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry. 2013; 70(9): 913920.CrossRefGoogle Scholar
Kane, JM, Robinson, DG, Schooler, NR. Comprehensive versus usual community care for first episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. Am J Psychiatry. 2016; 173(4): 362372.CrossRefGoogle ScholarPubMed
Weibell, MA, Hegelstad, WTV, Auestad, B, et al. The effect of substance use on 10-year outcome in first-episode psychosis. Schizophr Bull. 2017; 43(4): 843851.CrossRefGoogle ScholarPubMed
Katschnig, H. How useful is the concept of quality of life in psychiatry? In: Katschnig H, Freeman H, Sartorius N, eds. Quality of Life in Mental Disorders. 2nd ed. Chichester, UK: Wiley; 2006:317.Google ScholarPubMed
Niv, N, Cohen, AN, Sull ivan, G, et al. The MIRECC version of the Global Assessment of Functioning scale: reliability and validity. Psychiatr Serv. 2007; 58(4): 529535.CrossRefGoogle ScholarPubMed
Tungström, S, Söderberg, P, Armelius, BA. Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work. Psychiatr Serv. 2005; 56(4): 439443.CrossRefGoogle ScholarPubMed
Fervaha, G, Agid, O, Takeuchi, H, et al. Life satisfaction among individuals with schizophrenia in the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study. Am J Psychiatry. 2013; 170(9): 10611062.CrossRefGoogle ScholarPubMed

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