The number of concerns and doubts surrounding the use of antipsychotics has been on the rise in recent years. Critics claimed the use of antipsychotics could cause the dopamine receptor to be more sensitive, thereby leading to a progression of psychosis or a greater chance to relapse.

However, a study published in the American Journal of Psychiatry in May questioned the evidence behind such claims, concluding that antipsychotics do not impart negative long-term effect on patient outcomes.

Delaying or withholding antipsychotic treatment might lead to poorer long-term outcomes

The study was carried out by a research group, which consists of experts from the United States, Germany, the Netherlands, Austria, Japan, and China. The study admitted that the preclinical studies in rodents did show the ability of antipsychotic medications in sensitising dopamine receptors. However, researchers noted that such findings do not necessarily imply using antipsychotics in treatment would necessarily increase the risk of relapse.

"The evidence from randomised clinical trials and neuroimaging studies overwhelmingly suggests that the majority of patients with schizophrenia benefit from antipsychotic treatment, both in the initial presentation of the disease and for longer-term maintenance to prevent relapse," said Dr Lieberman, the Chairman of Psychiatry at Colombia University College of Physicians and Surgeons.

While the critics against the use of antipsychotics argued antipsychotics might impose toxic effects on patients, the study suggested otherwise.

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According to the data from the study, only approximately 10%to 20% of the patients could stay away from relapse without the use of antipsychotics after their initial psychotic episode. Psychosis could be harmful to the remaining majority if they are not adhere to the antipsychotics treatment.

“Withholding [antipsychotic] treatment could be detrimental for most patients with schizophrenia," emphasized Lieberman

Such findings highlight the importance of early treatment with antipsychotics and reinforce existing evidence on the efficacy of antipsychotics.

Up to 60% of patients with schizophrenia in Hong Kong were not adherent to their medications

Adherence to antipsychotics is crucial in the treatment of schizophrenia and its related psychotic disorders. An irregular intake of antipsychotics causes patients to be nearly five times more at risk of a relapse and up to four times more at risk of suicide and hospitalisation.

In 2016, International Journal of Psychosocial Rehabilitation published survey findings regarding the adherence issues to antipsychotic medication in patients with schizophrenia. A total of 71 psychiatrists and 143 case managers in Hong Kong took the survey. Surprisingly, the findings revealed a stunning percentage of up to 60 per cent (Psychiatrists: 60%; Case managers: 52%) of patients with schizophrenia were not adherent to their medications.

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The study also highlighted the barriers to recovery from psychiatric illness, with over 90% of the surveyed psychiatrists pointing out non-adherence to treatment as the major obstacle. Other factors might include patients’ loss of insight into their illness, a lack of integrated psychosocial support, as well as stigma and cultural attitudes. Additionally, patients fail to grasp the importance of maintenance doses and stop taking their medications as soon as they ‘feel better’.

Another study in Hong Kong managed to draw links between patient education and medication adherence. They found that over 50% of their sample patients did not know the name of their medications. 40% did not know which class the medications belong to and 30% were not aware of the prescribed dosages. In general, the study found that patients who performed better in medication adherence tend to have better knowledge of their medications. MIMS

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