Dratcu Luiz, Boland Xavier
Acute Inpatient Psychiatry, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, SE5 8AZ London, UK.
Liaison Psychiatry Service, Lewisham Hospital, South London and Maudsley NHS Foundation Trust, SE5 8AZ London, UK.
Actas Esp Psiquiatr. 2025 May;53(3):616-620. doi: 10.62641/aep.v53i3.1813.
Poor adherence to antipsychotic treatment is the main reason for relapse and admission in patients with severe mental illness (SMI). In addition to apprehensions about side effects, factors for non-adherence include the stigma of mental illness, which also extends to its treatment and which is further compounded by negative perceptions of antipsychotics within the medical profession itself. By reinforcing misconceptions around antipsychotics, warnings at the outbreak of pandemic associating antipsychotic use with coronavirus disease 2019 (COVID-19) related risks could have discouraged antipsychotic prescribing when it was otherwise indicated and also disrupted adherence of SMI patients to the treatment they need. Several studies on risk of antipsychotic use during the pandemic adopted inappropriate inclusion criteria and reached conclusions that proved misleading, particularly if applied to SMI patients. Methodological flaws included ill-defined cohort groups and not accounting for adherence to treatment or clinical indication for antipsychotic prescribing. Conversely, reports from the clinical setting, which were later corroborated in clinical studies, have shown that adherence to antipsychotics may actually protect from COVID-19, thus indicating that the benefits of adhering to antipsychotic treatment extend beyond controlling psychotic symptoms alone. Evidence emerging from the COVID-19 experience adds to the view that adherence to second generation antipsychotics in SMI offers a therapeutic effect to both mental and physical health. This validation of modern antipsychotics as a vital medical asset can prove a turning point in the fight to dispel the stigma of SMI and its treatment.
对抗精神病药物治疗依从性差是重症精神疾病（SMI）患者复发和住院的主要原因。除了对副作用的担忧外，不依从的因素还包括精神疾病的污名化，这也延伸到其治疗，而医学界本身对抗精神病药物的负面看法进一步加剧了这种污名化。在疫情爆发时，将抗精神病药物的使用与2019冠状病毒病（COVID-19）相关风险联系起来的警告，可能会强化围绕抗精神病药物的误解，在其他情况下需要使用抗精神病药物时阻碍其处方开具，还会破坏SMI患者对所需治疗的依从性。关于疫情期间使用抗精神病药物风险的几项研究采用了不恰当的纳入标准，得出了具有误导性的结论，尤其是应用于SMI患者时。方法学缺陷包括队列组定义不明确，以及未考虑治疗依从性或抗精神病药物处方的临床指征。相反，临床环境中的报告（后来在临床研究中得到证实）表明，坚持服用抗精神病药物实际上可能预防COVID-19，因此表明坚持抗精神病药物治疗的益处不仅限于控制精神症状。COVID-19疫情带来的证据进一步支持了这样一种观点，即SMI患者坚持服用第二代抗精神病药物对身心健康都有治疗作用。这种将现代抗精神病药物确认为重要医疗资产的观点，可能成为消除SMI及其治疗污名化斗争中的一个转折点。
