Cochrane for Clinicians

Putting Evidence into Practice

Schizophrenia: Use of Antipsychotic Drugs for Maintenance Therapy

 

Am Fam Physician. 2021 Oct ;104(4):355-356.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does maintenance therapy with antipsychotic drugs prevent symptom relapse in patients with schizophrenia?

Evidence-Based Answer

Compared with placebo, using antipsychotic drugs for maintenance therapy in patients with schizophrenia is associated with relapse prevention at seven to 12 months (number needed to treat [NNT] = 3; 95% CI, 2 to 3). (Strength of Recommendation [SOR]: A, based on consistent, good-quality patient-oriented evidence.) Hospitalizations are less likely among individuals receiving maintenance therapy with antipsychotics (NNT = 8; 95% CI, 6 to 14). (SOR: A, based on consistent, good-quality patient-oriented evidence.) People taking antipsychotic drugs are more likely to experience adverse effects, including movement disorders (number needed to harm [NNH] = 20; 95% CI, 14 to 50) and weight gain (NNH = 25; 95% CI, 20 to 50).1 (SOR: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Schizophrenia is the most common psychotic disease, with an estimated prevalence of 0.25% to 0.64% in the U.S. population.2 Given the limited access to psychiatrists in many parts of the country, family physicians are often called on to screen, diagnose, and treat a variety of psychiatric conditions, including schizophrenia.3,4 In particular, family physicians may be in a position to counsel patients and families on the benefits and risks of continuing antipsychotic medications for the treatment of schizophrenia. This Cochrane review aimed to answer questions about whether maintaining antipsychotic therapy prevented relapse of schizophrenia symptoms, reduced hospitalizations, improved quality of life and social functioning, or was associated with adverse effects.

The Cochrane review included 75 randomized controlled trials involving 9,145 patients with schizophrenia or schizophrenia-like illness and compared those taking antipsychotic medications with those taking placebo.1 The included trials were published between 1959 and 2017.

The primary

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References

show all references

1. Ceraso A, Lin JJ, Schneider-Thoma J, et al. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2020;(8):CD008016....

2. National Institute of Mental Health. Schizophrenia. Accessed December 14, 2020. https://www.nimh.nih.gov/health/statistics/schizophrenia.shtml

3. National Council Medical Director Institute. The psychiatric shortage: causes and solutions. March 28, 2017. Accessed December 14, 2020. https://www.thenationalcouncil.org/wp-content/uploads/2017/03/Psychiatric-Shortage_National-Council-.pdf?daf=375ateTbd56

4. Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. 3rd ed. Published online September 2020. Accessed February 20, 2021. https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890424841

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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