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.

中文翻译：

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WPA/CINP 联合工作组关于抗精神病药物在精神分裂症治疗中的使用和有效性的报告


这是世界精神病学协会/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。它对文献进行了选择性但在主题范围内的全面审查，考虑了最近讨论的有关该问题的所有论点，并在文献中的结果模棱两可时避免偏袒任何一方。该工作组的结论表明，抗精神病药物在急性期和维持期均有效，并且目前的数据不支持超敏性反弹性精神病的存在。长期治疗的患者比不服用抗精神病药物的患者有更好的总体结果和更低的死亡率。未经治疗的精神病和复发的持续时间较长与较差的结果有一定关系。脑容量的损失在第一次发作时就已经很明显，并且涉及神经纤维体积的损失而不是细胞的损失。容量减少的进展可能发生在预后较差的患者亚组中。对于人类来说，抗精神病治疗既不会导致也不会加重容量损失，但有一些数据支持其保护作用。精神分裂症的死亡率比一般人群高 2 至 3 倍，抗精神病药物治疗存在许多危险，包括迟发性运动障碍和代谢综合征；然而，抗精神病药物治疗可降低死亡率，包括心血管死亡率。总之，文献强烈支持在急性期和维持期使用抗精神病药物，但没有建议在一段时间后停用抗精神病药物是明智的。 抗精神病治疗可改善长期结果并降低总体死亡率和特定原因死亡率。