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The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia

Published online by Cambridge University Press:  29 June 2020

Konstantinos N. Fountoulakis Open the ORCID record for Konstantinos N. Fountoulakis [Opens in a new window] ,
Hans-Jurgen Moeller ,
Siegfried Kasper ,
Carol Tamminga ,
Shigeto Yamawaki ,
Rene Kahn ,
Rajiv Tandon ,
Christoph U. Correll Open the ORCID record for Christoph U. Correll [Opens in a new window]  and
Afzal Javed
Konstantinos N. Fountoulakis*
Affiliation:
3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Hans-Jurgen Moeller
Affiliation:
Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany
Siegfried Kasper
Affiliation:
Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Vienna, Austria
Carol Tamminga
Affiliation:
Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
Shigeto Yamawaki
Affiliation:
Center for Brain, Mind and KANSEI Sciences Research, Hiroshima University, Hiroshima, Japan
Rene Kahn
Affiliation:
Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Rajiv Tandon
Affiliation:
Department of Psychiatry, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
Christoph U. Correll
Affiliation:
Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
Afzal Javed
Affiliation:
Warwick Medical School, University of Warwick, Coventry, United Kingdom Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
*
*Author for correspondence: Konstantinos N. Fountoulakis, Email: [email protected]
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Abstract

This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup’s conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.

Keywords

Antipsychoticsusefulnessoutcomeschizophrenia
Type
Review
Information
CNS Spectrums , Volume 26 , Issue 6: Special Issue: Functional Neurological Disorder , December 2021 , pp. 562 - 586
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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