Continuous use of antipsychotic medications called into question

Unmedicated patients with schizophrenia and affective psychosis fare better than their peers on maintenance antipsychotic therapy, a study reports.

The study was part of the Chicago follow-up study designed as a naturalistic prospective longitudinal research study. The goal was to evaluate the course, outcome, symptomatology, and effects of antipsychotic medication in relation to recovery and rehospitalization in patient with serious mental illness disorders.

The analysis included a total of 139 participants with 734 observations. Generalized estimating equation for logistic regression facilitated adjustment for confounding factors measured at index hospitalization and follow-ups.

Most participants with schizophrenia or affective psychosis experienced future episodes of psychosis at some point during the 20-year follow-up. Those with schizophrenia saw a significant increase in the number of future episodes of psychosis.

Outcomes were better for patients with schizophrenia not on antipsychotics after the first 2 years than for those prescribed antipsychotics. The adjusted odds ratios associated with not being on antipsychotic medication were 5.989 (95 percent confidence interval [CI], 3.588–9.993) for recovery and 0.134 (95 percent CI, 0.070–0.259) for rehospitalization.

Regardless of diagnosis, after the second year, not being on antipsychotics was predictive of a higher probability of recovery and lower probability of rehospitalization at subsequent follow-ups.

The findings bring into question the use of continuous antipsychotic medications, regardless of diagnosis, and highlight the importance of exposing the role of antipsychotic-induced dopamine supersensitivity psychosis and drug resistance.