PLoS Medicine | www.plosmedicine.org 0443 benef t For one more (olanzapine) must be weighed against two harms associated with use oF antipsychotics: (1) a consistent body oF evidence indicates that regular treatment with antipsychotics in the longer run increases mortality [22–26]; and (2) there is evidence that in placebo-controlled trials oF antipsychotics submitted in application For schizophrenia licenses there is a statistically signif cant excess oF completed suicides on active treatment . A range oF problems associated with antipsychotics, From increased mortality to tardive dyskinesia, never show up in the short-term trials aimed at demonstrating treatment eFFects in psychiatry. But aside From these hazards, there are also grounds to question whether the treatment eFFects that some think have been demonstrated in bipolar disorder trials translate into therapeutic eFf cacy. IF use oF these agents based on demonstrated eFFects leads on to eFf cacy, admissions For bipolar disorder might be expected to Fall, but the evidence For this is diFf cult to f nd. In North Wales beFore the advent oF modern pharmacotherapy, patients with bipolar I disorder had on average Four admissions every ten years. In contrast, against a background oF a constant incidence oF bipolar I disorder, and dramatic improvements in service provision, bipolar I patients show a 4-Fold increase in the prevalence oF admissions despite being treated with the very latest psychotropic medications . This is not ordinarily what happens when treatments “work,”
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