Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics?
Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2receptor. Psychiatrists should work with their patients to slowly reduce the antipsychotic to the lowest dose that prevents the return of distressing symptoms. Up to 40% of those whose psychosis remits after a first episode should be able to achieve a good outcome in the long term either with no antipsychotic medication or with a very low dose.
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK robin.murray@kcl.ac.uk.
Robin M
RM
Murray
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Diego
D
Quattrone
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Sridhar
S
Natesan
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Jim
J
van Os
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Merete
M
Nordentoft
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Oliver
O
Howes
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
Marta
M
Di Forti
Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK.
David
D
Taylor
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D011618:Psychotic Disorders / Q000517:prevention & control*; D012559:Schizophrenia / Q000517:prevention & control*; D055502:Secondary Prevention / Q000592:standards*
D014150:Antipsychotic Agents