Schizophrenia is one of the most common of the severe mental illnesses. Drug treatment with antipsychotics forms the mainstay of effective management, but should be used alongside a range of psychosocial interventions.
The newer 'atypical' antipsychotics may be a further refinement, but not a revolution, in the care of those with schizophrenia. They may cause less adverse effects and be more acceptable to those with schizophrenia than other older drugs.
At present, all statements on the effects of 'atypical' antipsychotics must be qualified. The quality of much of the research evidence as measured by clear reporting and clinical applicability, is poor. This often limits the conclusions that can be drawn.
'Atypical' antipsychotics are expensive. Speculation that direct drug costs are offset by decreases in hospitalisation, indirect costs and intangible savings is not based on reliable data, nor is it helpful to those responsible for management of limited drug budgets.
If the NHS is to fully fund 'atypical' antipsychotics their use should be justified by trial data clearly supportive of their use in everyday practice. Large, long-term randomised drug trials with participants, interventions and primary outcomes familiar to health professionals who treat people with schizophrenia are long overdue.
Those involved in the care of people with schizophrenia need to maintain up-to-date knowledge of the research evidence on antipsychotics. Guides to practice should be appraised for bias and day-to-day applicability.
