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Article Index
Conventional Antipsychotic Medications for Schizophrenia
Methods
Maintenance Therapy
Targeted Dose Strategies
Effectiveness of Conventional Antipsychotics
Impacts on Functional Status
Discussion
All Pages

Schizophrenia Bulletin, Vol. 21, No. 4, 1995
National Institute of Mental Health

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Abstract

This article reviews the existing evidence for the efficacy and effectiveness of conventional anti psychotic medications in the treatment of schizophrenia. Among the issues reviewed are their efficacy for acute symptom episodes and for long-term maintenance therapy, differential efficacy among medications, the gap between research-based efficacy rates and effectiveness rates in practice, dosing strategies, and the treatment of first-episode cases. Evidence for efficacy is overwhelming for reduction of positive symptoms but quite limited for other outcomes. Effectiveness in practice may be substantially less than efficacy in clinical trials, perhaps owing to patient heterogeneity, prescribing practices, and noncompliance. First-episode patients should be treated with antipsychotic medication, but perhaps at lower dosages, with consideration of a gradual decrease or discontinuation at 6 months to 1 year.

Schizophrenia Bulletin, 21(4): 567-577, 1995.

Conventional antipsychotic medications refer to those widely used and available in the United States before 1990, including the phenothiazines, butyrophenones, thioxanthenes, dibenzoxazepines, and dihydroindolones. Their common mode of action is to block dopamine D₂ receptors throughout the brain, and their therapeutic activity is presumably related to such blockade in the mesolimbic system. Their widespread use, as well as the anticipated future availability of nonconventional antipsychotic agents, underlines the importance of examining research that supports use of conventional agents. This article reviews evidence for the efficacy and effectiveness of these conventional antipsychotic medications during both the acute and long-term phases of treatment for schizophrenia.

The acute phase refers to the periods during which the patient experiences an acute episode of positive symptoms, with either the onset of symptoms after an asymptomatic period or a marked increase in symptoms over a baseline of less severe symptoms. Operationally, we define this phase as the first 6 to 8 weeks after onset of an episode of positive symptoms. Symptom remission is the central goal in the acute phase.

The phase of long-term maintenance treatment refers to the periods during which the patient is not experiencing an acute episode as defined above. The nature of this phase varies tremendously across individuals. Some individuals are asymptomatic and relatively free of any disability; others experience persistent psychotic symptoms in addition to considerable impairment in their ability to live independently, work, and relate to others. The central goals of antipsychotic drug treatment in the long-term treatment phase are continued suppression of the acute symptoms (continuation therapy) or prevention of the occurrence of another episode of acute symptoms (maintenance or prophylactic therapy).

Review Questions

1. What is the efficacy of conventional antipsychotics for
   1. relief of acute positive symptoms of schizophrenia?
   2. prevention of relapse and recurrence of positive symptoms?
   3. reduction of cognitive impairments and negative symptoms?
2. What is the effectiveness of the conventional antipsychotics for
   1. relief of acute positive symptoms of schizophrenia?
   2. prevention of relapse and recurrence of positive symptoms?
   3. reduction of cognitive impairments and negative symptoms?
3. Is there differential efficacy and effectiveness among the alternative conventional antipsychotics, including depot forms?
4. What effects do conventional antipsychotics have on functional status and other nonclinical outcomes?
5. What strategies can be recommended in the pharmacological treatment of individuals suffering their first acute episode of schizophrenia?

Disorders - Schizophrenia