Christoph Correll, MD, on the Risk-benefit Ratio of Long-term Antipsychotics

Three psychiatrists based at academic medical centers in the United States and Germany recently published a literature review on the risk-benefit ratio of long-term antipsychotic treatment

in patients with schizophrenia. Given the many questions that remain regarding the approach to care in this population, they weighed the available evidence on acute, mid-, and long-term

therapy. They also appraised barriers to long-term care, including adherence, dosing adjustments, morbidities, mortality, and offered recommendations on adjunctive therapy. MedPage Today

recently conducted an interview with lead author Christoph Correll, MD, to get further commentary on the paper. Dr. Correll is Professor of Psychiatry and Molecular Medicine, Hofstra

Northwell School of Medicine, Hempstead, NY. This interview has been lightly edited.

MedPage Today: Why was it important for you and Drs. Rubio and Kane to publish this review of the literature?

Dr. Correll: It was important for us to publish this article due to the fact that recently, single study results had called into question the merits of and need for long-term antipsychotic

maintenance treatment of people suffering from schizophrenia. We hope that our review will help clinicians, patients, and families to make clinically meaningful decisions. 

MPT: Your paper mentioned the benefits of a long-acting injectable (LAI) formulation. For the treatment of acute episodes, are you more likely to use an LAI formulation? Why or why not?

CC: For an acute episode, I first start with an oral antipsychotic in order to see whether and to what degree the patient responds and to which doses, and how the medication that is

available as an LAI is tolerated. In patients who respond to and tolerate the oral medication, I then offer and discuss the LAI option and its potential advantages.

MPT: In your own practice, are there any rules of thumb that you use when considering the long-term treatment of patients with schizophrenia?

MPT: What is your typical approach to introducing adjunctive therapies like cognitive behavioral therapy and/or family interventions?

CC: Ideally, mentally ill patients who require medications should also receive psychoeducation and evidence-based psychotherapy (eg, CBT, family therapy, cognitive remediation therapy, 

etc.), tailored to the specific indication and patient needs and preferences. 

MPT: Given what’s in the literature now, what are the top 5 things you would want your colleagues to remember about using antipsychotics in schizophrenia?

MPT: Of the research being conducted in schizophrenia now, what has the greatest potential to impact clinical care in your opinion?

Financial disclosure: Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gerson Lehrman Group, Indivior,

IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, Medavante, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, ROVI, Servier, Sunovion, Supernus, Takeda, and Teva. He has provided

expert testimony for Bristol-Myers Squibb, Janssen, and Otsuka. He served on a Data Safety Monitoring Board for Boehringer-Ingelheim, Lundbeck, ROVI, Supernus, and Teva. He received

royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma.