For individuals diagnosed with schizophrenia and schizoaffective disorder, the risk of experiencing repeated episodes of psychosis, known as relapse, is high. Psychosis encompasses a range of symptoms, including delusions, hallucinations, mood disturbances, reduced drive, cognitive impairments, and emotional expressiveness issues. Antipsychotic medications are commonly prescribed to manage psychotic symptoms during an episode and have been shown to be effective in randomized controlled trials (RCTs), the gold standard of evidence-based medicine.
Continuing antipsychotic treatment after an episode has been successful helps delay the return of psychotic symptoms, as demonstrated by research studies. It is crucial to confirm the effectiveness of these medications in preventing relapse in routine clinical practice and to determine which antipsychotics are more effective compared to others. Psychiatrists play a key role in guiding patients on the pros and cons of different antipsychotics based on their efficacy in achieving desired clinical outcomes and their potential side effects.
One common issue that affects medication effectiveness is patient concordance, or adherence to treatment. Patients may fail to take medications due to burdensome side effects, lack of awareness of their condition, or misinformation. Long-acting injections (LAIs) are available for some antipsychotics, providing assurance that the medication has been administered as prescribed.
A recent study compared newer antipsychotics and clozapine with haloperidol in preventing relapse in schizophrenia and schizoaffective disorder. The authors aimed to rank antipsychotics based on their effectiveness in research trials (efficacy) versus real-world clinical practice (effectiveness). Understanding the efficacy-effectiveness gap is essential to ensure that research findings translate into practical outcomes for patients.
The study utilized real-world data from national patient registries in Sweden and Finland, as well as data from RCTs comparing antipsychotics. Meta-analysis and network meta-analysis techniques were applied to provide an average estimate of antipsychotic effectiveness. The main outcome of interest was relapse within 6 or 12 months, defined as hospitalization for psychosis in real-world studies.
Results indicated varying effectiveness among antipsychotics in preventing relapse, with some showing lower relapse risk than others. The study also analyzed effectiveness for RCT-eligible individuals to assess how findings align with research outcomes. Considering these findings can help inform clinical decision-making and improve relapse prevention strategies for individuals with schizophrenia and related disorders.
