Antipsychotic medications help prevent relapses in schizophrenia, but increase side effects too

Taking another step in the discussion about the benefits of antipsychotic medications vs side effects such as weight gain, a recently published meta-analysis examined 116 reports involving 65 trials and data for 5,493 patients. Using a primary outcome of relapse between 7 and 12 months, the researchers found that use of antipsychotic drugs significantly reduced relapse rates; 64% of patients assigned to placebo relapsed within a year, compared with 27% of patients prescribed antipsychotic drugs.


“The key is to discuss treatment options with each and every patient and make informed choices accordingly.”
-Saddichha Sahoo, MD, Indian physician and current fellow with the Department of Psychiatry at the University of British Columbia in Vancouver, BC, Canada


The analysis found that 10% of patients taking antipsychotic drugs were[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] readmitted, compared with 26% of patients receiving placebo. Only one-third of the patients who relapsed required readmission. The evidence was less strong, but still suggestive, that antipsychotics resulted in better quality of life and fewer aggressive acts.

Key Point: Antipsychotic drugs compared to placebo significantly reduced relapse in this meta-analysis. Side effects were increased as well, however. Physicians should balance the benefits and risks and make treatment decisions individually, with monitoring for side effects.

On the other hand, patients taking antipsychotic drugs were more likely than patients assigned to placebo to gain weight (10% compared with 6%), have movement disorders (16% compared with 9%), and experience sedation (13% compared with 9%).

Depot preparations were more effective at reducing relapse than oral formulations, with depot haloperidol and depot fluphenazine having the strongest effects.

The effects of antipsychotics were greater in unblinded than blinded trials, and the outcome differences between drug and placebo decreased over time.

The authors concluded that while antipsychotic drugs do benefit patients with schizophrenia, these benefits should be balanced against side effects, with a closer look in future studies at long-term adverse effects of the drugs.

The age-corrected prevalence of schizophrenia in India is between 2.6 and 4.0 per 1,000 population, said Saddichha Sahoo, MD, who is on a 2-year assignment as clinical fellow with the Department of Psychiatry at the University of British Columbia in Vancouver, BC, Canada. “This puts a huge burden on the health system in our country,” Sahoo told mdCurrent-India. Antipsychotics are available that can help the patient become “fully functional,” he said.

As for the distinction between first- and second-generation antipsychotic medications, both are equally associated with fewer admissions, better quality of life, and better adjustment, Sahoo said. Long-acting depot preparations improve compliance, and therefore reduce relapses, he said.

Physicians in India should carefully balance the risks and benefits of these medications, by regular monitoring for effectiveness and side effects, Sahoo said. “The key is to discuss treatment options with each and every patient and make informed choices accordingly.”

Source: Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet. 2012 June 2;379(9381):2063-2071.

Access the original journal information here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960239-6/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3
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This entry was posted in Neurology, Pharmacology, Primary Care, Psychiatry and tagged , , , , , , , , . Volume: .

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