Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics?

Robin M. Murray*, Diego Quattrone, Sridhar Natesan, Jim van Os, Merete Nordentoft, Oliver Howes, Marta Di Forti, David Taylor

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

135 Citations (Web of Science)

Abstract

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 D-2 receptor. 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. (C) The Royal College of Psychiatrists 2016.
Original languageEnglish
Pages (from-to)361-365
JournalBritish Journal of Psychiatry
Volume209
Issue number5
DOIs
Publication statusPublished - Nov 2016

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