Concerns have been raised that treatment with antipsychotic medication might adversely affect long-term outcomes for people with schizophrenia. The evidence cited for these concerns includes the association of antipsychotic treatment with brain volume reduction and with dopamine receptor sensitization, which might make patients vulnerable to relapse and illness progression. An international group of experts was convened to examine findings from clinical and basic research relevant to these concerns. Little evidence was found to support a negative long-term effect of initial or maintenance antipsychotic treatment on outcomes, compared with withholding treatment. Randomized controlled trials strongly support the efficacy of antipsychotics for the acute treatment of psychosis and prevention of relapse; correlational evidence suggests that early intervention and reduced duration of untreated psychosis might improve longer-term outcomes. Strategies for treatment discontinuation or alternative nonpharmacologic treatment approaches may benefit a subgroup of patients but may be associated with incremental risk of relapse and require further study, including the development of biomarkers that will enable a precision medicine approach to individualized treatment.

有人担心使用抗精神病药物治疗可能会对精神分裂症患者的长期结局产生不利影响。针对这些担忧所引用的证据包括抗精神病药物治疗与脑容量减少和多巴胺受体致敏性的关联，这可能会使患者容易复发和疾病发展。召集了一个国际专家小组来研究与这些问题有关的临床和基础研究的发现。与停药治疗相比，几乎没有证据支持初始或维持抗精神病药物治疗对结局产生负面的长期影响。随机对照试验强烈支持抗精神病药对精神病的急性治疗和预防复发的功效；相关证据表明，早期干预和减少未经治疗的精神病的持续时间可能会改善长期结果。中止治疗或替代性非药物治疗方法的策略可能会使亚组患者受益，但可能与复发风险增加相关，需要进一步研究，包括开发生物标志物，以使精密医学方法可用于个体化治疗。