Is the juice worth the squeeze? Reassessing the use of antipsychotics taking into account the evidence of the effects of long-term use

Author/s Giuseppe Tibaldi
Publishing Year 2016 Issue 2016/2 Language Italian
Pages 21 P. 43-63 File size 223 KB
DOI 10.3280/RSF2016-002004
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Short-term efficacy of antipsychotics is known and agreed upon, while, from the 60’s onwards, medium and long-term benefits have been questioned. Recent studies - which compare samples of patients undergoing continuous treatment with patients on reduced, or suspended, antipsychotic medications - highlight that strategies of reduced or suspended antipsychotic medications present significantly higher long-term recovery rates. Recovery consists in regaining high levels of social functioning. Furthermore, there is growing evidence on specific risks caused by antipsychotic treatments: i.e. cognitive decline and mortality. With antidepressants equally alarming evidence has emerged regarding medium and long-term effects. These evidences, little known among Italian mental health professionals, should bring about a reduction in the role played by psychiatric drugs, currently the primary - and often the only - therapeutic offer at onset, or during the subsequent phases of the illness. Nowadays, other therapeutic (or rehabilitative) proposals play a lesser, or subservient role, usually offered later on in the treatment program. Persons who have experienced a psychotic episode and play an active role as "experts by experience" request strongly the use of non-pharmacological interventions, based on the comprehension of the psychotic or depressive experiences, and on shared decision making ("nothing about us without us"). The movements of "experts by experience" require psychotherapeutic proposals, without asking to give up drugs, however they suggest reducing medications: i.e. less often, for less time, at lower doses, accompanied by fewer certainties.

Keywords: Antipsychotic drugs, effectiveness, long-term outcomes

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Giuseppe Tibaldi, Il gioco vale la candela? Riconsiderare l’uso degli antipsicotici alla luce delle evidenze sugli esiti derivanti dal loro utilizzo a lungo termine in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2016, pp 43-63, DOI: 10.3280/RSF2016-002004