Schizophrenia - Antipsychotic drugs significantly reduce relapse risk

Five decades worth of evidence demonstrates that antipsychotic drugs can decrease the risk of relapse in patients with schizophrenia by 60% The study, published Online First in The Lancet, shows that patijdents taking antipsychotics also have a considerably lower chance of needing to be hospitalized, behave aggressively, and may enjoy a better quality of life, compared with those who do not take medication. Schizophrenia is a debilitating condition that often affects individuals throughout their entire lives, and has a lifetime prevalence of about 1%. The gold-standard treatment for schizophrenia are antipsychotic drugs that are not just extremely expensive being estimated of costing $18.5 billion in 2010 worldwide, but they may also cause serious side effects. It is therefore vital to monitor patients in order to ensure they still benefit from ongoing drug treatment. Furthermore, given that the main cost for schizophrenia is hospitalization due to relapse, which is very common amongst schizophrenic patients, preventing a relapse has significant effects. Stefan Leucht, from the Technische Universität München in Munich, Germany, and his team conducted a systematic review and meta-analysis of 116 reports, from 65 trials involving almost 6,500 schizophrenics. that were published between 1959 and 2011. They discovered that only 27% of patients on antipsychotic drugs suffered from relapses, as compared with 64% on placebo. Their findings furthermore demonstrated that only 10% of patients on antipsychotic drugs were readmitted to hospital in comparison with 26% on placebo, even though less than a third of relapsed patients had to be admitted. Five studies indicated that those on antipsychotic drugs behaved less aggressively, whilst three studies suggested that those on antipsychotic maintenance treatment enjoyed a better quality of life. The results were as follows: Antipsychotic Group Percentage of relapses 27% Readmission to the hospital 10% More side effects 16% Sedation 13% Weight gain 10% Placebo Group Percentage of relapses 64% Readmission to the hospital 26% More side effects 9% Sedation 9% Weight gain 6% The researchers concluded: "We have established that antipsychotic maintenance treatment substantially reduces relapse risk in all patients with schizophrenia for up to 2 years of follow-up. The effect was robust in important subgroups such as patients who had only one episode, those in remission, and irrespective of abrupt or gradual withdrawal of treatment or between first-generation or second-generation drugs, but the drugs seemed to lose their effectiveness with time. Future studies should focus on outcomes of social participation and long-term morbidity and mortality of these drugs." Jim van Os from the Maastricht University Medical Centre in The Netherlands and Oliver Howes from King's College in London say in a linked comment: "Although the evidence for antipsychotic drugs seems robust, several important issues remain. We do not know whether patients prefer drugs to placebo, and to what degree treatment affects social participation. Although antipsychotic drugs might reduce relapse of psychosis, the cost-benefit analysis for long-term use is imprecise at best, and no evidence that other, more disabling, domains of psychopathology such as cognitive alterations or motivational impairment are similarly alleviated is available."