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Prof. Wolfgang Fleischhacker

 

Wolfgang Fleischhacker Controversias Psiquiatria Barcelona
Talk Debate 2. Long term antipsychotic treatments improve life functional prognosis
Date Friday, April 21st, 2017
Time 15:45 - 16:15

 
BIOGRAPHY

W. Wolfgang Fleischhacker, MD, is Professor and Managing Director in the Department of Psychiatry, Psychotherapy and Psychosomatics at the Medical University Innsbruck, Austria. He is a certified psychiatrist and psychotherapist. After receiving his medical degree from Innsbruck University, Dr. Fleischhacker trained at the Departments of Psychiatry and Neurology of the Medical Faculty there. In 1987 he was awarded a Fulbright Scholarship and spent 18 months at Hillside Hospital in New York.

Dr. Fleischhacker is a member of the editorial boards of several peer reviewed journals, coeditor of the schizophrenia section for Current Opinion in Psychiatry, clinical neuropsychopharmacology field editor for International Journal of Neuropsychopharmacology, deputy editor of Schizophrenia Research and managing editor of the Journal Neuropsychiatrie/Psychiatrie und Psychotherapie.

Research Interests:
Dr. Fleischhacker's main research interests relate to schizophrenia and psychopharmacology. They have led to participation in World Health Organization and World Psychiatric Association programs focusing on schizophrenia. He is also a member of the scientific committee of the Austrian Agency for Health and Food Safety and has served as a consultant for the European Medicines Agency.

Memberships:
Chairman of the European Group for Research in Schizophrenia, Fellow of the International College of Neuropsychopharmacology; Fellow of the American College of Neuropsychopharmacology, Fellow of the European College of Neuropsychopharmacology. He is also a member of the Schizophrenia International Research Society, Austrian Society of Psychiatry and Psychotherapy, Austrian Schizophrenia Society, Austrian Association of Biological Psychiatry.

 
ABSTRACT

The relapse preventive effect of antipsychotic maintenance treatment is one of the best documented outcomes research findings in psychiatry. NNT´s amount to between 4-6. For most patients relapse prevention translates into improved or at least stable psychosocial functioning. Although longer term psychosocial outcomes appear to correlate better with improvement in negative symptoms and cognitive dysfunctions then with positive symptoms, the latter, given their disruptive effects on psychosocial integration are also relevant in this context. More recently, concerns have been raised that the treatment with antipsychotic medication might adversely affect long-term outcomes for schizophrenia patients. These assumptions are based on a few observational studies which have to be interpreted with a note of caution given the methodological challenges inherent in this type of study. Nevertheless, it appears that a small subgroup of patients may stay well after an acute episode despite discontinuing antipsychotics. This is not a novel insight, it has already been described by some of the pioneers of schizophrenia research such as Manfred Bleuler and Gert Huber. Unfortunately, it is as yet impossible to reliably predict such positive outcomes following a first episode of psychosis. Consequently, all available guidelines suggest maintenance treatment for at least a year after a first break of the illness. In reality, the clinical course and patient preference generally drive the decision making process for the maintenance management of schizophrenia. In this context, a few patients will remain relapse free and psychosocially adjusted despite stopping medication, but the great majority will suffer a relapse with negative psychosocial consequences. Whether low dose or intermitted treatment strategies offer viable alternatives to continuing antipsychotics is the subject of ongoing research. In addition, there are first hints from neuroimaging studies that it may be possible to categorize patients with high or low relapse risk via machine learning algorithms in anatomical MR studies or, alternatively, by quantifying dopamine release in PET imaging protocols.

 
REFERENCES

Németh G, et al (2017). Cariprazine versus risperidone monotherapy for the treatment of predominant negative symptoms in patients with schizophrenia: A randomized, double-blind, active-comparator controlled trial. Lancet. 2017 Feb 7. pii: S0140-6736(17)30060-0.

[web] Fleischhacker WW, et al (2014). Schizophrenia--time to commit to policy change. Schizophr Bull. 2014 Apr;40 Suppl 3:S165-94.

[web] Fleischhacker WW, et al (2014). Aripiprazole once-monthly for treatment of schizophrenia: a double-blind, randomised, non-inferiority study. Br J Psychiatry. 2014 Aug;205(2):135-44.