TY - JOUR
T1 - The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia
AU - Fountoulakis, Konstantinos N.
AU - Moeller, Hans Jurgen
AU - Kasper, Siegfried
AU - Tamminga, Carol
AU - Yamawaki, Shigeto
AU - Kahn, Rene
AU - Tandon, Rajiv
AU - Correll, Christoph U.
AU - Javed, Afzal
N1 - Funding Information:
Disclosures. Dr. Fountoulakis has received grants and served as consultant, advisor, or CME speaker for the following entities: AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Ferrer, Gedeon Richter, Janssen, Lundbeck, Otsuka, Pfizer, the Pfizer Foundation, Sanofi-Aventis, Servier, Shire, and others. Dr. Moeller received honoraria for lectures or for advisory activities or received grants by the following pharmaceutical companies: Lundbeck, Servier, Schwabe, and Bayer. He was president or in the Executive Board of the following organizations: CINP, ECNP, WFSBP, EPA, and chairman of the WPA section on Pharmacopsychiatry. Dr. Kasper within the last 3 years received grants/research support, consulting fees, and honoraria from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Eli Lilly, Janssen, KRKA-Pharma, Lundbeck, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe, and Servier. Dr. Tamminga received an investigator-initiated grant by Suno-vion, has acted as AdHoc advisor to Astellas, and participated as member to advisory boards for Karuna and Kynexis. Dr. Yamawaki has no conflict of interest pertaining to the current paper. Dr. Kahn acts as consultant for Alkermes, Luye Pharma, Otsuka, Merck, and Sunovion. Dr. Tandon has no conflict of interest pertaining to the current paper. Dr. Correll has been a consultant and/or advisor to or has received honoraria from Acadia, Alkermes, Allergan, Angel-ini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recor-dati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. Dr. Javed has no conflict of interest pertaining to the current paper.
Publisher Copyright:
© The Author(s), 2020. Published by Cambridge University Press.
PY - 2021/12/29
Y1 - 2021/12/29
N2 - 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.
AB - 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.
KW - Antipsychotics
KW - outcome
KW - schizophrenia
KW - usefulness
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U2 - 10.1017/S1092852920001546
DO - 10.1017/S1092852920001546
M3 - Review article
C2 - 32594935
AN - SCOPUS:85089785012
VL - 26
SP - 562
EP - 586
JO - CNS Spectrums
JF - CNS Spectrums
SN - 1092-8529
IS - 6
ER -