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Antipsychotics: Clinical Effectiveness

  • Oliver Freudenreich
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

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.

Keywords

Large 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 

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Additional Resources

    Web Site

    1. 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.
    2. 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.

    Article

    1. Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the pharmacotherapy of schizophrenia in adults. Can J Psychiatry. 2017;62:604–16. – A very well organized and readable guideline from our colleagues and neighbors in Canada.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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