O uso de antipsicóticos no manejo de transtornos mentais crônicos graves e persistentes: uma revisão de escopo

Abstract

Chronic severe and persistent mental disorders represent a significant public health challenge due to their high prevalence, prolonged course, substantial functional impairment, and the need for continuous follow-up within health care systems. In this context, antipsychotic medications constitute the main pharmacological class used in the clinical management of these conditions and are widely prescribed in the treatment of schizophrenia, schizoaffective disorder, and severe forms of bipolar disorder, both in psychiatric inpatient settings and in community mental health services. Despite their therapeutic relevance, the long-term use of these medications is marked by challenges related to drug selection, therapeutic regimens, safety, treatment adherence, metabolic and neurological adverse effects, as well as the frequent practice of antipsychotic polypharmacy. The general objective of this scoping review was to map and synthesize the scientific evidence published over the last ten years regarding the use of antipsychotics in the management of chronic severe and persistent mental disorders, with emphasis on psychiatric hospitalization and community-based mental health care settings. This is a qualitative, exploratory, and descriptive scoping review conducted in accordance with the methodological framework proposed by Arksey and O’Malley and the recommendations of the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The literature search was carried out in the PubMed/MEDLINE, Virtual Health Library, Scopus, PsycINFO, Web of Science, and CAPES Journals Portal databases, in addition to grey literature sources, considering studies published between January 2015 and December 2024. Original articles, reviews, clinical guidelines, dissertations, and theses addressing the use of first- and/or second-generation antipsychotics in populations with chronic severe and persistent mental disorders were included. The results revealed substantial heterogeneity in antipsychotic use, both regarding pharmacological classes and therapeutic regimens. A predominance of second-generation antipsychotics was observed, mainly justified by their more favorable tolerability profile, although concerns regarding metabolic adverse effects remain prominent. Antipsychotic polypharmacy emerged as a recurrent practice in contexts of greater clinical severity, despite ongoing controversies surrounding its effectiveness and safety. In community mental health services, antipsychotics were identified as a central component of treatment, frequently associated with challenges related to treatment adherence, insufficient monitoring of adverse effects, and weaknesses in the integration of pharmacological management with psychosocial interventions. It is concluded that, although antipsychotics are essential in the management of chronic severe and persistent mental disorders, the scientific literature highlights relevant gaps concerning rational use, long-term treatment safety, and the integration of pharmacological care with psychosocial approaches. This scoping review allowed for the identification of trends, convergences, and challenges in the field, contributing to the improvement of clinical practice, the organization of mental health services, and the direction of future research.