Content area
Full Text
(ProQuest: ... denotes non-US-ASCII text omitted.)
Original Articles
Introduction
Does continuous multi-year treatment with antipsychotic medications reduce or eliminate psychosis and are the results superior to a non-medicated sample? Despite these medications being viewed as 'antipsychotics', their long-term effectiveness in eliminating psychosis in schizophrenia patients (SZ) is still unknown. Antipsychotic medications are seen as the cornerstone for the short- and long-term treatment of SZ, based on their action reducing the period of intense psychosis during acute hospitalization, and on the numerous 6-month to 2-year double-blind studies of schizophrenia out-patients (Gilbert et al. 1995; Davis et al. 2003; Buchanan et al. 2010). American Psychiatric Association (APA) guidelines (Lehman et al. 2004) indicate clinicians should consider discontinuing antipsychotics for SZ who are symptom free for a year or longer. However, many clinicians assume that antipsychotics are important for continued stability and keep SZ on antipsychotics indefinitely.
A major issue is the lack of evidence of long-term (>3 years) treatment with antipsychotic medications and whether, as 'antipsychotics', they reduce or eliminate psychosis. Optimistic views by the World Psychiatric Association (WPA) Pharmacopsychiatry Section note that: 'Antipsychotic treatment has a significant impact on the long-term course of schizophrenic illness and can significantly facilitate recovery' (Tandon et al. 2008, p. 31). However, in a comprehensive review of the very many double-blind studies, Leucht et al. (2012) noted that 'nothing is known about the effects of antipsychotic drugs compared to placebo after three years'.
Research by us and other investigators has begun to question the long-term effectiveness of antipsychotics. This research has produced clear evidence of subsamples of SZ who, on a long-term basis, show favorable outcomes without prolonged antipsychotic treatment (Bleuler, 1978; Fenton & McGlashan, 1987; Harding et al. 1987; Harrow et al. 2005, 2012; Harrow & Jobe, 2007, 2013; Jablensky & Sartorius, 2008).
The current multi-follow-up research used 20-year longitudinal data, collected prospectively, at multiple times, at systematic intervals for treated and untreated SZ, and focused on psychosis, assessing: (1) How frequently over a 20-year period do SZ treated with antipsychotics experience psychosis? (2) For those SZ experiencing psychosis while being treated with antipsychotics, how severe are the psychotic symptoms? (3) Is the psychosis less severe than that of SZ not in treatment? (4) How effective is antipsychotic treatment over...