Antipsychotics: Clinical Effectiveness
In the last decades, psychiatry has made significant progress in clinical psychopharmacology. While it has been disappointing that no medication has been developed to treat negative symptoms and cognition, clinicians today have a large evidence base from clinical trials with regard to antipsychotic efficacy and side effects but, importantly, also about the real-world effectiveness of antipsychotics outside of typical clinical drug trials. In this chapter, I illustrate how knowing the literature informs treatment, particularly with regard to antipsychotic choice to optimize symptom control, achieve the best possible quality of life, and minimize iatrogenic morbidity. Included in this chapter is a discussion of shared decision-making as the practical aspects of prescribing are more than just knowing an antipsychotic’s receptor profile.
KeywordsLarge pragmatic trials CATIE Evidence-based psychiatry Clinical guidelines Symptomatic remission Antipsychotic selection Antipsychotic switch Antipsychotic discontinuation Antipsychotic withdrawal Shared decision-making Quality of life Morbidity and mortality
- 1.Wiktionary. Plus ça change, plus c’est la même chose. Available from: https://en.wiktionary.org/wiki/plus_%C3%A7a_change,_plus_c%27est_la_m%C3%AAme_chose. Accessed on 7/1/2019.
- 7.McEvoy JP, Lieberman JA, Stroup TS, Davis SM, Meltzer HY, Rosenheck RA, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry. 2006;163:600–10.CrossRefGoogle Scholar
- 8.Jones PB, Barnes TR, Davies L, Dunn G, Lloyd H, Hayhurst KP, et al. Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia: cost utility of the latest antipsychotic drugs in schizophrenia study (CUtLASS 1). Arch Gen Psychiatry. 2006;63:1079–87.PubMedCrossRefGoogle Scholar
- 12.Stroup TS, McEvoy JP, Ring KD, Hamer RH, LaVange LM, Swartz MS, et al. A randomized trial examining the effectiveness of switching from olanzapine, quetiapine, or risperidone to aripiprazole to reduce metabolic risk: comparison of antipsychotics for metabolic problems (CAMP). Am J Psychiatry. 2011;168:947–56.PubMedPubMedCentralCrossRefGoogle Scholar
- 37.Dong M, Lu L, Zhang L, Zhang YS, Ng CH, Ungvari GS, et al. Quality of life in schizophrenia: a meta-analysis of comparative studies. In: Psychiatr Q, vol. 90; 2019. p. 519–32.Google Scholar
- https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines – The link to the practice guidelines for the American Psychiatric Association, including the updated schizophrenia guideline.
- https://www.nice.org.uk/guidance – The link to NICE guidance, including various guidelines related to schizophrenia care. NICE which stands for National Institute for Health and Care Excellence is an independent organization in the UK that was established in 1999 to provide unbiased summaries of the literature to guide clinicians but also systems regarding healthcare funding. So-called NICE recommendations are often considered authoritative. Incidentally, their first clinical guideline was the schizophrenia guideline.