Antipsykotikabruk hos pasienter med en førstegangspsykose. En litteraturstudie med fokus på bivirkninger og langtidseffekter.

Abstract

Objective: Antipsychotics are used by millions of patients worldwide. There is an ongoing discussion whether second generation antipsychotics (SGAs) concerning effects on symptoms and side effects are better than first generation antipsychotics (FGAs). Some researchers and authors have also questioned the long-term effect of antipsychotic drugs and discussed whether they really have a positive positive long-term effect. The last decade some researchers have also looked into whether antipsychotics cause irreversible brain damages. In the present study I wanted to examine to what extent this is supported by the existent research literature. Methods: I conducted searches on various databases such as PubMed, PsychINFO,EMBASE and the Cochrane Library and I used the following words in four combinations: (1)antipsychotics AND first-episode psychosis AND side effects, (2)side effects AND antipsychotics (3)first-episode psychosis AND antipsychotics (4) antipsychotics AND long-term effects. I searched through the referance-lists of several articles and found relevant articles here. I mainly focused on the latest systematic reviews, bacause this is a large topic. Results: The studies regarding the efficacy on positive symptom reduction showed that there is not any significant difference between SGAs and FGAs. SGAs give more weight gain initially than FGAs but with longer follow-up, this difference seems to decrease. The changes in brain structure associated with schizophrenia might be the result of antipsychotic use. There is some evidence that showes that long-term exposure of antipsychotics increases mortality in schizophrenia. Regarding the functional outcome in the long-term, patients that were given dosereduction/discontinuation after remission from the first-episode psychosis(FEP), were doing much better than patients that were given maintainance treatment when evaluated seven years later. Conclusions: There is a need for more research about the side-effects of antipsychotics, with longer follow-up and the use of medium-potent FGAs in moderate doses as comparator. More research is needed regarding the long-term outcomes of antipsychotic treatment including mortality. There is a need for the introduction of patient choice regarding treatment of FEP/psychosis in general with more respect of the patients autonomy and less paternalism from the therapist.