Findings Challenge Schizophrenia Treatment Guideline

Long-term antipsychotic treatment is linked with increased survival in patients stabilized after first-episode schizophrenia, according to a study in The American Journal of Psychiatry.

“It is generally believed that after the first episode of schizophrenia, the risk of relapse decreases with time in patients who are stabilized,” researchers wrote. “Many treatment guidelines recommend that after stabilization, antipsychotic treatment should be continued for 1–5 years, and longer exposure should be avoided if possible. However, there is no published evidence to substantiate this view.”

Researchers looked into the reality behind the recommendation using prospectively gathered outcome data for 8719 patients in Finland hospitalized for first-episode schizophrenia between 1996 and 2014.

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The lowest risk of rehospitalization or death, researchers found, was among patients who received continuous antipsychotic treatment. Compared with patients who received antipsychotics for as many as 16 years or more, the risk of death was 174%–214% higher among patients who did not use antipsychotics or discontinued them early, according to the study.

“Whatever the underlying mechanisms, these results provide evidence that, contrary to general belief, the risk of treatment failure or relapse after discontinuation of antipsychotic use does not decrease as a function of time during the first 8 years of illness,” researchers wrote.

—Jolynn Tumolo

Reference:

Tiihonen J, Tanskanen A, Taipale H. 20-year nationwide follow-up study on discontinuation of antipsychotic treatment in first-episode schizophrenia. The American Journal of Psychiatry. 2018;175(8): 765-773.