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

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)361
Number of pages365
JournalBritish Journal of Psychiatry
Volume209
Issue number5
DOIs
StatePublished - 1 Nov 2016

Documents

  • Should psychiatrists be more cautious_MURRAY_ACCEPTED30July2016_GREEN AAM

    Murray_BJPsych_Final_Should_psychiatrists_be_more_cautious_about_the_long_term_prophylactic_use_of_antipsychotics.pdf, 170 KB, application/pdf

    1/11/2017

    Accepted author manuscript

    This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.org.

King's Authors

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 D2 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.

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