Fountoulakis Konstantinos N, Moeller Hans-Jurgen, Kasper Siegfried, Tamminga Carol, Yamawaki Shigeto, Kahn Rene, Tandon Rajiv, Correll Christoph U, Javed Afzal
3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Psychiatry, Ludwig Maximilian University of Munich, Munich, Germany.
CNS Spectr. 2020 Jun 29:1-25. doi: 10.1017/S1092852920001546.
This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup's conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.
这是一份世界精神病学协会/国际神经精神药理学学院（WPA/CINP）联合工作组关于抗精神病药物治疗精神分裂症的风险/效益比的报告。该报告对文献进行了有选择性但在主题范围内全面的综述，考虑了近期关于该问题的所有讨论观点，当文献结果不明确时避免偏袒任何一方。工作组的结论表明，抗精神病药物在急性期和维持期均有效，且目前的数据不支持超敏反应性反弹精神病的存在。长期接受治疗的患者比未服用抗精神病药物的患者总体预后更好，死亡率更低。未治疗精神病的持续时间延长和复发与较差的预后有一定关联。脑容量损失在首次发作时就已明显，且涉及神经毡体积的损失而非细胞损失。体积损失的进展可能发生在预后较差的亚组患者中。在人类中，抗精神病药物治疗既不会导致也不会加重体积损失，同时有一些数据支持其具有保护作用。精神分裂症患者的死亡率比普通人群高2至3倍，抗精神病药物治疗存在一些风险，包括迟发性运动障碍和代谢综合征；然而，抗精神病药物治疗与较低的死亡率相关，包括心血管死亡率。总之，文献有力地支持在急性期和维持期使用抗精神病药物，并未表明在一段时间后停用抗精神病药物是明智之举。抗精神病药物治疗可改善长期预后并降低总体死亡率和特定病因死亡率。
