Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T15:15:48.654Z Has data issue: false hasContentIssue false
  • English
  • Français

Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study

Published online by Cambridge University Press:  24 March 2014

M. Harrow ,
T. H. Jobe  and
R. N. Faull
M. Harrow*
Affiliation:
Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
T. H. Jobe
Affiliation:
Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
R. N. Faull
Affiliation:
Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
*
* Address for correspondence: M. Harrow, Ph.D., Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Street (M/C 912), Chicago, IL 60612, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This research assesses whether multi-year treatment with antipsychotic medications reduces or eliminates psychosis in schizophrenia. It provides 20 years of longitudinal data on the frequency and severity of psychotic activity in samples of schizophrenia patients (SZ) treated versus those not treated with antipsychotic medications.

Method

A total of 139 early young schizophrenia and mood-disordered patients were assessed at index hospitalization and then reassessed six times over 20 years for psychosis and other major variables.

Results

At each follow-up assessment over the 20 years, a surprisingly high percentage of SZ treated with antipsychotics longitudinally had psychotic activity. More than 70% of SZ continuously prescribed antipsychotics experienced psychotic activity at four or more of six follow-up assessments over 20 years. Longitudinally, SZ not prescribed antipsychotics showed significantly less psychotic activity than those prescribed antipsychotics (p < 0.05).

Conclusions

The 20-year data indicate that, longitudinally, after the first few years, antipsychotic medications do not eliminate or reduce the frequency of psychosis in schizophrenia, or reduce the severity of post-acute psychosis, although it is difficult to reach unambiguous conclusions about the efficacy of treatment in purely naturalistic or observational research. Longitudinally, on the basis of their psychotic activity and the disruption of functioning, the condition of the majority of SZ prescribed antipsychotics for multiple years would raise questions as to how many of them are truly in remission.

Keywords

Antipsychotic medicationslongitudinalpsychosisschizophreniatreatment
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 14 , October 2014 , pp. 3007 - 3016
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

ADA (2004). Consensus development conference on antipsychotic drugs and obesity and diabetes. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Diabetes Care 27, 596–601.Google Scholar
Andreasen, N, Carpenter, W, Kane, J, Lasser, R, Marder, S, Weinberger, M (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.Google Scholar
Bleuler, M (1978). The Schizophrenic Disorders: Long-Term Patient and Family Studies. Yale University Press: New Haven, CT. Google Scholar
Bola, JR, Lehtinen, K, Cullberg, J, Ciompi, L (2009). Psychosocial treatment, antipsychotic postponement, and low-dose medication strategies in first-episode psychosis: a review of the literature. Psychosis 1, 4–18.Google Scholar
Buchanan, R, Kreyenbuhl, J, Kelly, D, Noel, J, Boggs, D, Fischer, B, Himelhoch, S, Fang, B, Peterson, E, Aquino, P, Keller, W (2010). The 2009 Schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophrenia Bulletin 36, 71–93.Google Scholar
Chouinard, G, Jones, BD (1980). Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics. American Journal of Psychiatry 137, 16–21.Google Scholar
Ciompi, L, Hoffmann, H (2004). Soteria Berne: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic. World Psychiatry 3, 140–146.Google Scholar
Cohen, P, Cohen, J (1984). The clinician's illusions. Archive of General Psychiatry 41, 1178–1182.Google Scholar
Cornblatt, BA, Carrión, RE, Addington, J, Seidman, L, Walker, EF, Cannon, TD, Cadenhead, KS, McGlashan, TH, Perkins, DO, Tsuang, MT (2012). Risk factors for psychosis: impaired social and role functioning. Schizophrenia Bulletin 36, 1247–1257.Google Scholar
Cramer, JA, Rosenheck, R (1998). Compliance with medication regimens for mental and physical disorders. Psychiatric Services 49, 196–201.Google Scholar
Davis, J, Chen, N, Glick, I (2003). A meta-analysis of the efficacy of second-generation antipsychotics. Archives of General Psychiatry 60, 553–564.CrossRefGoogle ScholarPubMed
Docherty, NM, St-Hilaire, A, Aakre, JM, Seghers, JP (2009). Life events and high-trait reactivity together predict psychotic symptom increases in schizophrenia. Schizophrenia Bulletin 35, 638–645.Google Scholar
Endicott, J, Spitzer, R (1978). A diagnostic interview. Archives of General Psychiatry 35, 837–844.Google Scholar
Fallon, P, Dursun, S, Deakin, B (2012). Drug-induced supersensitivity psychosis revisited: characteristics of relapse in treatment-compliant patients. Therapeutic Advances in Psychopharmacology 2, 13–22.Google Scholar
Fenton, W, McGlashan, T (1987). Sustained remission in drug-free schizophrenic patients. American Journal of Psychiatry 144, 1306–1309.Google Scholar
Gardner, DM, Murphy, AL, O'Donnell, H, Centorrino, F, Baldessarini, RJ (2010). International consensus study of antipsychotic dosing. American Journal of Psychiatry 167, 686–693.Google Scholar
Gilbert, PL, Harris, MJ, McAdams, LA, Jeste, DV (1995). Neuroleptic withdrawal in schizophrenic patients: a review of the literature. Archives of General Psychiatry 52, 173–188.CrossRefGoogle ScholarPubMed
Goghari, V, Harrow, M, Grossman, L, Rosen, C (2013). A 20-year multi-follow-up of hallucinations in schizophrenia, other psychotic, and mood disorders. Psychological Medicine 43, 1151–1160.Google Scholar
Harding, C, Brooks, G, Ashikiga, T, Strauss, J, Breier, A (1987). The Vermont longitudinal study of persons with severe mental illness: II. Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry 144, 727–735.Google Scholar
Harrow, M, Goldberg, J, Grossman, L, Meltzer, H (1990). Outcome in manic disorders. A naturalistic follow-up study. Archives of General Psychiatry 47, 665–671.Google Scholar
Harrow, M, Grossman, L, Jobe, T, Herbener, E (2005). Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study. Schizophrenia Bulletin 31, 723–734.Google Scholar
Harrow, M, Jobe, TH (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multi-follow-up study. Journal of Nervous and Mental Disease 195, 406–414.Google Scholar
Harrow, M, Jobe, TH (2010). How frequent is chronic multiyear delusional activity and recovery in schizophrenia: a 20-year multi-follow-up. Schizophrenia Bulletin 36, 192–204.CrossRefGoogle ScholarPubMed
Harrow, M, Jobe, TH (2013). Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Schizophrenia Bulletin 39, 962–965.CrossRefGoogle ScholarPubMed
Harrow, M, Jobe, TH, Faull, RN (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine 42, 2145–2155.Google Scholar
Harrow, M, Jobe, TH, Herbener, ES, Goldberg, JF, Kaplan, KJ (2004). Thought disorder in schizophrenia: working memory and impaired context. Journal of Nervous and Mental Disease 192, 3–11.Google Scholar
Harrow, M, Quinlan, D (1985). Disordered Thinking and Schizophrenic Psychopathology. Gardner Press: New York, NY.Google Scholar
Harrow, M, Yonan, C, Sands, J, Marengo, J (1994). Depression in schizophrenia: are neuroleptics, akinesia, or anhedonia involved? Schizophrenia Bulletin 20, 327–338.Google Scholar
Healy, D (2002). The Creation of Psychopharmacology. Harvard University Press: Cambridge, MA.Google Scholar
Hegarty, J, Baldessarini, R, Tohen, M, Waternaux, C (1994). One hundred years of schizophrenia: a meta-analysis of the outcome literature. American Journal of Psychiatry 151, 1409–1416.Google Scholar
Ho, BC, Andreasen, NC, Ziebell, S, Pierson, R, Magnotta, V (2011). Long-term antipsychotic treatment and brain volumes: a longitudinal study of first-episode schizophrenia. Archives of General Psychiatry 68, 128–137.Google Scholar
Holinger, D, Shenton, M, Wible, C, Donnino, R, Kikinis, R, Jolesz, F, McCarley, R (1999). Superior temporal gyrus volume abnormalities and thought disorder in left-handed schizophrenic men. American Journal of Psychiatry 156, 1730–1735.Google Scholar
Hollingshead, A, Redlich, F (1958). Social Class and Mental Illness. John Wiley & Sons: New York, NY.Google Scholar
Jääskeläinen, E, Juola, P, Hirvonen, N, McGrath, JJ, Saha, S, Isohanni, M, Veijola, J, Miettunen, J (2013). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bulletin 39, 1296–1306.Google Scholar
Jablensky, A, Sartorius, N (2008). What did the WHO studies really find? Schizophrenia Bulletin 34, 253–255.Google Scholar
Jobe, TH, Harrow, M (2010). Schizophrenia course, long-term outcome, recovery, and prognosis. Current Directions in Psychological Science 19, 220–225.Google Scholar
Kendler, KS, Schaffner, KF (2011). The dopamine hypothesis of schizophrenia: an historical and philosophical analysis. Philosophy, Psychiatry, and Psychology 18, 41–63.Google Scholar
Kurita, M, Holloway, T, García-Bea, A, Kozlenkov, A, Friedman, AK, Moreno, JL, Takahashi, N (2012). HDAC2 regulates atypical antipsychotic responses through the modulation of mGlu2 promoter activity. Nature Neuroscience 15, 1245–1254.Google Scholar
Lehman, AF, Lieberman, J, Dixon, L, McGlashan, T, Miller, A, Perkins, D, Kreyenbuhl, J (2004). Practice guideline for the treatment of patients with schizophrenia, second edition. American Journal of Psychiatry 161, 1–56.Google ScholarPubMed
Leucht, S, Tardy, M, Komossa, K, Heres, S, Kissling, W, Davis, JM (2012). Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews. Issue 5. Art. No. CD008016.Google Scholar
McGorry, P, Alvarez-Jimenez, M, Killackey, E (2013). Antipsychotic medication during the critical period following remission from first-episode psychosis: less is more. Journal of the American Medical Association. Psychiatry 70, 898–900.Google Scholar
McGurk, SR, Mueser, KT, Covell, NH, Cicerone, KD, Drake, RE, Silverstein, SM, Medialia, A, Myers, R, Bellack, AS, Bell, MD (2013). Mental health system funding of cognitive enhancement interventions for schizophrenia: summary and update of the New York Office of Mental Health expert panel and stakeholder meeting. Psychiatric Rehabilitation Journal 36, 133–145.Google Scholar
Moncrieff, J (2009 a). A critique of the dopamine hypothesis of schizophrenia and psychosis. Harvard Review of Psychiatry 17, 214–225.Google Scholar
Moncrieff, J (2009 b). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Palgrave Macmillan: Basingstoke, UK.Google Scholar
Morrison, AP, Hutton, P, Shiers, D, Turkington, D (2012). Antipsychotics: is it time to introduce patient choice? British Journal of Psychiatry 201, 83–84.CrossRefGoogle ScholarPubMed
Mueser, KT, Deavers, F, Penn, DL, Cassisi, JE (2013). Psychosocial treatments for schizophrenia. Annual Review of Clinical Psychology 9, 465–497.Google Scholar
Murray, RM, Lappin, J, Di Forti, M (2008). Schizophrenia: from developmental deviance to dopamine dysregulation. European Neuropsychopharmacology 18, S129–S134.Google Scholar
Osterberg, L, Blaschke, T (2005). Adherence to medication. New England Journal of Medicine 353, 487–497.CrossRefGoogle ScholarPubMed
Sands, J, Harrow, M (1994). Psychotic unipolar depression at follow-up: factors related to psychosis in the affective disorders. American Journal of Psychiatry 151, 995–1000.Google Scholar
Seeman, MV, Seeman, P (2014). Is schizophrenia a dopamine supersensitivity psychotic reaction? Progress in Neuro-Psychopharmacology and Biological Psychiatry 48, 155–160.CrossRefGoogle ScholarPubMed
Seeman, P, Schwarz, J, Chen, JF, Szechtman, H, Perreault, M, McKnight, GS, Roder, JC, Quirion, R, Boksa, P, Srivastava, LK (2006). Psychosis pathways converge via D2high dopamine receptors. Synapse 60, 319–346.Google Scholar
Seikkula, J, Alakare, B, Aaltonen, J (2011). The comprehensive open-dialogue approach in Western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis 3, 192–204.CrossRefGoogle Scholar
Silverstein, S, Bellack, A (2008). A scientific agenda for the concept of recovery as it applies to schizophrenia. Clinical Psychology Review 28, 1108–1124.Google Scholar
Stephens, J, Pascal, R, McHugh, P (1997). Long-term follow-up of patients hospitalized for schizophrenia, 1913 to 1940. Journal of Nervous and Mental Disorders 185, 715–721.Google Scholar
Subotnik, K, Nuechterlein, K, Green, M, Horan, W, Nienow, T, Ventura, J, Nguyen, A (2006). Neurocognitive and social cognitive correlates of formal thought disorder in schizophrenia patients. Schizophrenia Research 85, 84–95.Google Scholar
Tandon, R, Belmaker, R, Gattaz, WF (2008). World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophrenia Research 100, 20–38.Google Scholar
Tranter, R, Healy, D (1998). Neuroleptic discontinuation syndromes. Journal of Psychopharmacology 12, 401–406.Google Scholar
Vaillant, G (1978). A 10-year followup of remitting schizophrenics. Schizophrenia Bulletin 4, 78–85.CrossRefGoogle ScholarPubMed
Whitaker, R (2011). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Broadway Books: New York, NY.Google Scholar
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S, Nienhuis, FJ (2013). 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 recovery in remitted first-episode psychosis. Journal of the American Medical Association. Psychiatry 70, 913–920.Google Scholar
Wunderink, L, Nienhuis, FJ, Sytema, S, Slooff, CJ, Knegtering, R, Wiersma, D (2007). Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. Journal of Clinical Psychiatry 68, 654–661.Google Scholar
Zigler, E, Glick, M (2001). The developmental approach to adult psychopathology. The Clinical Psychologist 54, 2–11.Google Scholar
Zipursky, RB, Reilly, TJ, Murray, RM (2013). The myth of schizophrenia as a progressive brain disease. Schizophrenia Bulletin 39, 1363–1372.Google Scholar