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- PMID- 33754470
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20220311
- LR - 20220721
- IS - 1751-7893 (Electronic)
- IS - 1751-7885 (Print)
- IS - 1751-7885 (Linking)
- VI - 16
- IP - 2
- DP - 2022 Feb
- TI - Medication strategies in first episode psychosis patients: A survey among
- psychiatrists.
- PG - 139-146
- LID - 10.1111/eip.13138 [doi]
- AB - AIM: There is an ongoing debate regarding the optimal timing of discontinuation
- of antipsychotic drugs for patients with first episode psychosis. Although most
- guidelines recommend maintenance therapy for at least 1 or 2 years after reaching
- remission, study results indicate that early discontinuation may be beneficial
- for at least a subsample of patients. To date, little is known about which
- medication strategies are applied in patients recovering from a first psychotic
- episode. In this study, we examined the beliefs and practices of clinicians on
- medication discontinuation. METHODS: We performed a survey among 50 experienced
- Dutch psychiatrists to assess how often specific treatment strategies have been
- applied in the past 12 months, as well as their knowledge and expectations with
- respect to medication discontinuation. RESULTS: Psychiatrists estimated that,
- after remission, they continued medication at the same dose for at least 12
- months in 51.2% of cases, continued in a reduced dose in 33.8% of cases and
- discontinued medication in 9.1% of cases after 4.4 months of remission on
- average. Although the medication is discontinued in only a relatively small
- proportion of patients, almost half of all clinicians (45.9%) used this strategy
- at least once in the past 12 months. CONCLUSIONS: There is substantial practice
- variation in antipsychotic medication strategies after remission from a first
- psychotic episode. Future research on long-term effects of early medication
- discontinuation can guide clinicians in making evidence-based decisions when
- treating first-episode patients.
- CI - © 2021 The Authors. Early Intervention in Psychiatry published by John Wiley &
- Sons Australia, Ltd.
- FAU - Kikkert, Martijn J
- AU - Kikkert MJ
- AUID- ORCID: 0000-0002-9164-7138
- AD - Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- FAU - Veling, Wim
- AU - Veling W
- AD - Department of Psychiatry, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- FAU - de Haan, Lieuwe
- AU - de Haan L
- AD - Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam,
- The Netherlands.
- FAU - Begemann, Marieke J H
- AU - Begemann MJH
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- FAU - de Koning, Mariken
- AU - de Koning M
- AD - Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- CN - HAMLETT and OPHELIA Consortium
- FAU - Sommer, Iris E
- AU - Sommer IE
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- LA - eng
- PT - Journal Article
- PT - Research Support, Non-U.S. Gov't
- DEP - 20210322
- PL - Australia
- TA - Early Interv Psychiatry
- JT - Early intervention in psychiatry
- JID - 101320027
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - *Antipsychotic Agents/therapeutic use
- MH - Humans
- MH - *Psychiatry
- MH - *Psychotic Disorders/drug therapy
- MH - Remission Induction
- MH - Surveys and Questionnaires
- PMC - PMC9292219
- OTO - NOTNLM
- OT - antipsychotic medication
- OT - discontinuation
- OT - maintenance treatment
- OT - schizophrenia
- COIS- The authors declare no conflicts of interest.
- FIR - Sommer, Iris
- IR - Sommer I
- FIR - de Haan, Lieuwe
- IR - de Haan L
- FIR - Veling, Wim
- IR - Veling W
- FIR - van Os, Jim
- IR - van Os J
- FIR - Smit, Filip
- IR - Smit F
- FIR - Begemann, Marieke
- IR - Begemann M
- FIR - Schuite-Koops, Sanne
- IR - Schuite-Koops S
- FIR - Marcelis, Machteld
- IR - Marcelis M
- FIR - Kikkert, Martijn
- IR - Kikkert M
- FIR - van Beveren, Nico
- IR - van Beveren N
- FIR - Boonstra, Nynke
- IR - Boonstra N
- FIR - Rosema, Bram-Sieben
- IR - Rosema BS
- FIR - Bakker, P Roberto
- IR - Bakker PR
- FIR - Gülöksüz, Sinan
- IR - Gülöksüz S
- FIR - Lokkerbol, Joran
- IR - Lokkerbol J
- FIR - Brand, Bodyl
- IR - Brand B
- FIR - Gangadin, Shiral
- IR - Gangadin S
- FIR - Geraets, Chris
- IR - Geraets C
- FIR - Van't Hag, Erna
- IR - Van't Hag E
- FIR - Oomen, Priscilla
- IR - Oomen P
- FIR - Voppel, Alban
- IR - Voppel A
- FIR - van Amelsvoort, Therese
- IR - van Amelsvoort T
- FIR - Bak, Maarten
- IR - Bak M
- FIR - Been, Agaath
- IR - Been A
- FIR - van den Bosch, Marinte
- IR - van den Bosch M
- FIR - van den Brink, Truus
- IR - van den Brink T
- FIR - Faber, Gunnar
- IR - Faber G
- FIR - Grootens, Koen
- IR - Grootens K
- FIR - de Jonge, Martin
- IR - de Jonge M
- FIR - Knegtering, Henderikus
- IR - Knegtering H
- FIR - Kurkamp, Jörg
- IR - Kurkamp J
- FIR - Mahabir, Amrita
- IR - Mahabir A
- FIR - Pijnenborg, Gerdina Hendrika Maria
- IR - Pijnenborg GHM
- FIR - Staring, Tonnie
- IR - Staring T
- FIR - Vaes, Wiek
- IR - Vaes W
- FIR - Veen, Natalie
- IR - Veen N
- FIR - Veerman, Selene
- IR - Veerman S
- FIR - Wiersma, Sybren
- IR - Wiersma S
- EDAT- 2021/03/24 06:00
- MHDA- 2022/03/12 06:00
- CRDT- 2021/03/23 07:16
- PHST- 2021/02/09 00:00 [revised]
- PHST- 2020/10/23 00:00 [received]
- PHST- 2021/03/06 00:00 [accepted]
- PHST- 2021/03/24 06:00 [pubmed]
- PHST- 2022/03/12 06:00 [medline]
- PHST- 2021/03/23 07:16 [entrez]
- AID - EIP13138 [pii]
- AID - 10.1111/eip.13138 [doi]
- PST - ppublish
- SO - Early Interv Psychiatry. 2022 Feb;16(2):139-146. doi: 10.1111/eip.13138. Epub
- 2021 Mar 22.
- PMID- 23972821
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20140923
- LR - 20220331
- IS - 1573-2509 (Electronic)
- IS - 0920-9964 (Linking)
- VI - 152
- IP - 2-3
- DP - 2014 Feb
- TI - Risk of symptom recurrence with medication discontinuation in first-episode
- psychosis: a systematic review.
- PG - 408-14
- LID - S0920-9964(13)00436-2 [pii]
- LID - 10.1016/j.schres.2013.08.001 [doi]
- AB - The large majority of individuals with a first episode of schizophrenia will
- experience a remission of symptoms within their first year of treatment. It is
- not clear how long treatment with antipsychotic medications should be continued
- in this situation. The possibility that a percentage of patients may not require
- ongoing treatment and may be unnecessarily exposed to the long-term risks of
- antipsychotic medications has led to the development of a number of studies to
- address this question. We carried out a systematic review to determine the risk
- of experiencing a recurrence of psychotic symptoms in individuals who have
- discontinued antipsychotic medications after achieving symptomatic remission from
- a first episode of non-affective psychosis (FEP). Six studies were identified
- that met our criteria and these reported a weighted mean one-year recurrence rate
- of 77% following discontinuation of antipsychotic medication. By two years, the
- risk of recurrence had increased to over 90%. By comparison, we estimated the
- one-year recurrence rate for patients who continued antipsychotic medication to
- be 3%. These findings suggest that in the absence of uncertainty about the
- diagnosis or concerns about the contribution of medication side effects to
- problems with health or functioning, a trial off of antipsychotic medications is
- associated with a very high risk of symptom recurrence and should thus not be
- recommended.
- CI - © 2013 Elsevier B.V. All rights reserved.
- FAU - Zipursky, Robert B
- AU - Zipursky RB
- AD - Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote
- School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100
- West 5th Street, Hamilton, Ontario L8N 3K7, Canada. Electronic address:
- zipursky@mcmaster.ca.
- FAU - Menezes, Natasja M
- AU - Menezes NM
- AD - Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote
- School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100
- West 5th Street, Hamilton, Ontario L8N 3K7, Canada. Electronic address:
- menezes@mcmaster.ca.
- FAU - Streiner, David L
- AU - Streiner DL
- AD - Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote
- School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100
- West 5th Street, Hamilton, Ontario L8N 3K7, Canada; Department of Psychiatry,
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic
- address: streiner@mcmaster.ca.
- LA - eng
- PT - Journal Article
- PT - Review
- PT - Systematic Review
- DEP - 20130821
- PL - Netherlands
- TA - Schizophr Res
- JT - Schizophrenia research
- JID - 8804207
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - Antipsychotic Agents/*therapeutic use
- MH - Humans
- MH - Psychotic Disorders/*diagnosis/*drug therapy
- MH - Recurrence
- OTO - NOTNLM
- OT - Antipsychotic
- OT - Discontinuation
- OT - First episode psychosis
- OT - Recurrence
- OT - Relapse
- OT - Schizophrenia
- OT - Withdrawal
- EDAT- 2013/08/27 06:00
- MHDA- 2014/09/24 06:00
- CRDT- 2013/08/27 06:00
- PHST- 2012/12/19 00:00 [received]
- PHST- 2013/07/29 00:00 [revised]
- PHST- 2013/08/01 00:00 [accepted]
- PHST- 2013/08/27 06:00 [entrez]
- PHST- 2013/08/27 06:00 [pubmed]
- PHST- 2014/09/24 06:00 [medline]
- AID - S0920-9964(13)00436-2 [pii]
- AID - 10.1016/j.schres.2013.08.001 [doi]
- PST - ppublish
- SO - Schizophr Res. 2014 Feb;152(2-3):408-14. doi: 10.1016/j.schres.2013.08.001. Epub
- 2013 Aug 21.
- PMID- 35041015
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20220704
- LR - 20220705
- IS - 1433-9285 (Electronic)
- IS - 0933-7954 (Linking)
- VI - 57
- IP - 7
- DP - 2022 Jul
- TI - An observational study of antipsychotic medication discontinuation in
- first-episode psychosis: clinical and functional outcomes.
- PG - 1329-1340
- LID - 10.1007/s00127-022-02230-0 [doi]
- AB - PURPOSE: To study the impact of supervised antipsychotic medication
- discontinuation on clinical and functional outcomes in first-episode psychosis
- (FEP) in two different cultural environments. METHOD: FEP patients(N = 253),
- treated in two early intervention services (Montreal, Canada and Chennai, India)
- for 2 years, were assessed for medication use, positive and negative symptom
- remission and social-occupational functioning at regular intervals. RESULTS:
- Between months 4 and 24 of treatment, 107 patients discontinued medication
- ('Off'group) as compared to 146 who stayed on medication ('On'group). Medication
- discontinuation was higher in Chennai as compared to Montreal (n = 80, 49.07% vs
- n = 27, 16.87%; χ(2) 37.80, p < 0.001), with no difference in time to
- discontinuation [Means(SDs) = 10.64(6.82) and 10.04(5.43), respectively,
- p = 0.71). At month 24 (N = 235), there were no differences in the rate of
- positive symptom remission between the on and Off groups (81.5 vs 88.0%,
- respectively) at both sites. The rate of negative symptom remission was lower
- among patients in the On compared to the Off group (63.2 vs 87.9%, respectively,
- χ(2) = 17.91, p < 0.001), but only in Montreal (55.4% vs 80.0%, respectively,
- χ(2) = 4.12, p < 0.05). Social and Occupational Functioning Assessment Scale
- scores were equally high in both Off and On medication groups in Chennai [Means
- (SDs) = 79.43(12.95) and 73.59(17.63), respectively] but higher in the Off
- compared to the On group in Montreal Means (SDs) = 77.47(14.97) and 64.94(19.02),
- respectively; Time × site interaction F = 3.96(1,217), p < 0.05]. Medication
- status (On-Off) had no impact on the outcomes, independent of other variables
- known to influence outcomes. CONCLUSION: Certain cultural environments and
- patient characteristics may facilitate supervised discontinuation of
- antipsychotic medication following treatment of an FEP without negative
- consequences.
- CI - © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
- FAU - Malla, Ashok
- AU - Malla A
- AUID- ORCID: 0000-0002-5863-4191
- AD - Department of Psychiatry, McGill University, Office: 29-1110, ACCESS Pavilion,
- 6625 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada. ashok.malla@mcgill.ca.
- FAU - Iyer, Srividya N
- AU - Iyer SN
- AUID- ORCID: 0000-0001-5367-9086
- AD - Department of Psychiatry, McGill University, Office: 29-1110, ACCESS Pavilion,
- 6625 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- AD - Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas
- Mental Health University Institute, Montreal, Canada.
- FAU - Joober, Ridha
- AU - Joober R
- AUID- ORCID: 0000-0003-3492-807X
- AD - Department of Psychiatry, McGill University, Office: 29-1110, ACCESS Pavilion,
- 6625 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- AD - Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas
- Mental Health University Institute, Montreal, Canada.
- FAU - Rangaswamy, Thara
- AU - Rangaswamy T
- AUID- ORCID: 0000-0001-6813-066X
- AD - Schizophrenia Research Foundation (SCARF), Chennai, India.
- FAU - Ramachandran, Padmavati
- AU - Ramachandran P
- AUID- ORCID: 0000-0002-0380-8617
- AD - Schizophrenia Research Foundation (SCARF), Chennai, India.
- FAU - Schmitz, Norbert
- AU - Schmitz N
- AUID- ORCID: 0000-0001-7777-6323
- AD - Department of Psychiatry, McGill University, Office: 29-1110, ACCESS Pavilion,
- 6625 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- FAU - Taksal, Aarati
- AU - Taksal A
- AUID- ORCID: 0000-0003-4125-7585
- AD - Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas
- Mental Health University Institute, Montreal, Canada.
- FAU - Mohan, Greeshma
- AU - Mohan G
- AUID- ORCID: 0000-0002-6322-5413
- AD - Schizophrenia Research Foundation (SCARF), Chennai, India.
- FAU - Margolese, Howard C
- AU - Margolese HC
- AD - Department of Psychiatry, McGill University, Office: 29-1110, ACCESS Pavilion,
- 6625 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada.
- AD - Prevention and Early Intervention Program for Psychosis, McGill University Health
- Centre, Montreal, Canada.
- LA - eng
- GR - 5R01MH093303-05/foundation for the national institutes of health/
- PT - Journal Article
- PT - Observational Study
- DEP - 20220118
- PL - Germany
- TA - Soc Psychiatry Psychiatr Epidemiol
- JT - Social psychiatry and psychiatric epidemiology
- JID - 8804358
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - *Antipsychotic Agents/therapeutic use
- MH - Humans
- MH - India
- MH - *Psychotic Disorders/therapy
- MH - Remission Induction
- MH - Social Adjustment
- OTO - NOTNLM
- OT - Adherence
- OT - Canada
- OT - Early intervention in psychosis
- OT - FEP
- OT - India
- OT - Medication discontinuation
- OT - Remission
- EDAT- 2022/01/19 06:00
- MHDA- 2022/07/06 06:00
- CRDT- 2022/01/18 12:34
- PHST- 2021/07/28 00:00 [received]
- PHST- 2022/01/06 00:00 [accepted]
- PHST- 2022/01/19 06:00 [pubmed]
- PHST- 2022/07/06 06:00 [medline]
- PHST- 2022/01/18 12:34 [entrez]
- AID - 10.1007/s00127-022-02230-0 [pii]
- AID - 10.1007/s00127-022-02230-0 [doi]
- PST - ppublish
- SO - Soc Psychiatry Psychiatr Epidemiol. 2022 Jul;57(7):1329-1340. doi:
- 10.1007/s00127-022-02230-0. Epub 2022 Jan 18.
- PMID- 30058834
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20191014
- LR - 20191014
- IS - 1440-1614 (Electronic)
- IS - 0004-8674 (Linking)
- VI - 52
- IP - 9
- DP - 2018 Sep
- TI - Medication discontinuation in first episode psychosis: thinking about the offset
- of psychotic disorders.
- PG - 819-821
- LID - 10.1177/0004867418790087 [doi]
- FAU - Galletly, Cherrie
- AU - Galletly C
- AD - 1 Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.
- AD - 2 Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia.
- AD - 3 Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.
- FAU - Suetani, Shuichi
- AU - Suetani S
- AD - 4 Queensland Centre for Mental Health Research and The Park Centre for Mental
- Health, Wacol, QLD, Australia.
- AD - 5 Queensland Brain Institute, The University of Queensland, St Lucia, QLD,
- Australia.
- AD - 6 Psychosis Academic Clinical Unit, Metro South Addiction and Mental Health
- Services, Brisbane, QLD, Australia.
- FAU - Dark, Frances
- AU - Dark F
- AD - 6 Psychosis Academic Clinical Unit, Metro South Addiction and Mental Health
- Services, Brisbane, QLD, Australia.
- AD - 7 Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health
- Services, Brisbane, QLD, Australia.
- LA - eng
- PT - Editorial
- DEP - 20180730
- PL - England
- TA - Aust N Z J Psychiatry
- JT - The Australian and New Zealand journal of psychiatry
- JID - 0111052
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - Antipsychotic Agents/*therapeutic use
- MH - Humans
- MH - Practice Guidelines as Topic
- MH - Psychotic Disorders/*drug therapy
- MH - Time Factors
- MH - *Withholding Treatment
- EDAT- 2018/07/31 06:00
- MHDA- 2019/10/15 06:00
- CRDT- 2018/07/31 06:00
- PHST- 2018/07/31 06:00 [pubmed]
- PHST- 2019/10/15 06:00 [medline]
- PHST- 2018/07/31 06:00 [entrez]
- AID - 10.1177/0004867418790087 [doi]
- PST - ppublish
- SO - Aust N Z J Psychiatry. 2018 Sep;52(9):819-821. doi: 10.1177/0004867418790087.
- Epub 2018 Jul 30.
- PMID- 32115314
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20210617
- LR - 20210617
- IS - 1573-2509 (Electronic)
- IS - 0920-9964 (Linking)
- VI - 225
- DP - 2020 Nov
- TI - Perspective on medication decisions following remission from first-episode
- psychosis.
- PG - 82-89
- LID - S0920-9964(20)30083-9 [pii]
- LID - 10.1016/j.schres.2020.02.007 [doi]
- AB - While antipsychotics (APs) could provide rapid relief of positive symptoms in
- psychotic disorders, their usage is often associated with side effects, stigma
- and inconveniences. For these and other reasons, many psychosis patients,
- particularly those of first-episode psychosis (FEP) in remission, wish to
- discontinue maintenance treatment. The current review aims to discuss the
- strategies of AP treatment following remission from FEP, with particular emphasis
- on the evaluation of outcomes following AP discontinuation. Upon review of
- relevant literature, three potential strategies are put forth for
- treatment-responsive, remitted FEP patients: a) life-long maintenance treatment,
- b) AP discontinuation during second year of treatment, or c) AP discontinuation
- after three years of treatment. In theory, the first strategy presents the safest
- option for maximal symptom control. However, a rigorous RCT indicates that if AP
- discontinuation is to be attempted, the third strategy best prevents poor
- long-term clinical outcomes. Further data is needed to address the costs and
- benefits of each treatment strategy, compare AP-free patients with those on
- different types of APs, as well as explore even longer-term outcomes.
- CI - Copyright © 2020 Elsevier B.V. All rights reserved.
- FAU - Hui, Christy L M
- AU - Hui CLM
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China. Electronic
- address: christy@lmhui.com.
- FAU - Lam, Bertha S T
- AU - Lam BST
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China.
- FAU - Lee, Edwin H M
- AU - Lee EHM
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China.
- FAU - Chan, Sherry K W
- AU - Chan SKW
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China; State Key
- Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong,
- China.
- FAU - Chang, W C
- AU - Chang WC
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China; State Key
- Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong,
- China.
- FAU - Suen, Y N
- AU - Suen YN
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China.
- FAU - Chen, Eric Y H
- AU - Chen EYH
- AD - Department of Psychiatry, University of Hong Kong, Hong Kong, China; State Key
- Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong,
- China.
- LA - eng
- PT - Journal Article
- PT - Research Support, Non-U.S. Gov't
- PT - Review
- DEP - 20200227
- PL - Netherlands
- TA - Schizophr Res
- JT - Schizophrenia research
- JID - 8804207
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - *Antipsychotic Agents/therapeutic use
- MH - Humans
- MH - *Psychotic Disorders/drug therapy
- OTO - NOTNLM
- OT - Discontinuation
- OT - Long-term outcome
- OT - Maintenance treatment
- OT - Psychosis
- OT - Remission
- OT - Schizophrenia
- COIS- Declaration of competing interest E.Y.H.C. reports having received speaker
- honoraria from Otsuka and DSK BioPharma; received research funding from Otsuka;
- participated in paid advisory boards for Jansen and DSK BioPharma; received
- funding to attend conferences from Otsuka and DSK BioPharma. The remaining
- authors declare no competing interests.
- EDAT- 2020/03/03 06:00
- MHDA- 2021/06/22 06:00
- CRDT- 2020/03/03 06:00
- PHST- 2020/01/03 00:00 [received]
- PHST- 2020/02/13 00:00 [revised]
- PHST- 2020/02/15 00:00 [accepted]
- PHST- 2020/03/03 06:00 [pubmed]
- PHST- 2021/06/22 06:00 [medline]
- PHST- 2020/03/03 06:00 [entrez]
- AID - S0920-9964(20)30083-9 [pii]
- AID - 10.1016/j.schres.2020.02.007 [doi]
- PST - ppublish
- SO - Schizophr Res. 2020 Nov;225:82-89. doi: 10.1016/j.schres.2020.02.007. Epub 2020
- Feb 27.
- PMID- 35261544
- OWN - NLM
- STAT- PubMed-not-MEDLINE
- LR - 20220310
- IS - 1176-6328 (Print)
- IS - 1178-2021 (Electronic)
- IS - 1176-6328 (Linking)
- VI - 18
- DP - 2022
- TI - Discontinuing Antipsychotic Medication After Remission from First-Episode
- Psychosis: A Survey of Psychiatrists' Attitudes in Taiwan.
- PG - 465-475
- LID - 10.2147/NDT.S339866 [doi]
- AB - BACKGROUND: Patients in remission after first-episode psychosis are inclined to
- discontinue antipsychotic treatment, which may lead to higher risk of relapse and
- unfavorable outcomes. Paradoxically, also there are evidences suggesting that
- certain patients may stay well in drug-free condition. Psychiatrists' views
- towards this dilemma might affect their approaches to these patients, and
- discrepant attitudes are noted between Western and Asian clinicians. This study
- aimed to examine psychiatrists' attitudes about discontinuing antipsychotic
- medications after remission from first-episode psychosis. METHODS: Psychiatrists
- were recruited for this study using convenience sampling. A cross-sectional
- survey was conducted using a set of questionnaires comprising nine items for
- attitudes toward medication discontinuation, six vignettes for probing
- psychiatrists' practice in designated clinical scenarios, and a list of criteria
- that may affect their responses. RESULTS: Responses were provided by 118
- psychiatrists, two-thirds men, mean age 39.8 ± 10.1 years and mean experience
- 12.7 ± 9.7 years. Half of the participants endorsed that fewer than 20% of the
- remitted patients should stop medication completely; the majority advised that an
- observation period of 1 year or longer is necessary while discontinuing
- medication. The majority would not initiate discussion with patients about
- discontinuing medication. Responding to two case vignettes, those who endorsed
- that more patients could stop antipsychotics were also more inclined to discuss
- it with patients, but not consistently in response to the other four case
- vignettes. Taiwan psychiatrists expressed a wide range of decision-making
- considerations for discontinuing antipsychotics. CONCLUSION: The majority of
- Taiwan psychiatrists thought it was not feasible to stop medications completely
- but were willing to consider this option. Once being presented with actual
- clinical scenarios, many participants hesitated to discontinue antipsychotic
- medications for various reasons. The proactive attitude of psychiatrists towards
- conducting clinical trials to test the feasibility of medication discontinuation
- may help to provide better reference for this clinical dilemma.
- CI - © 2022 Yen et al.
- FAU - Yen, Ko
- AU - Yen K
- AUID- ORCID: 0000-0003-3527-5189
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- FAU - Liu, Chen-Chung
- AU - Liu CC
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- AD - Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch,
- Hsin-Chu, Taiwan.
- FAU - Lin, Yi-Ting
- AU - Lin YT
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Chien, Yi-Ling
- AU - Chien YL
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Hsieh, Ming H
- AU - Hsieh MH
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Liu, Chih-Min
- AU - Liu CM
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Hwang, Tzung-Jeng
- AU - Hwang TJ
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Liao, Wei-Hsiang
- AU - Liao WH
- AUID- ORCID: 0000-0003-0132-6435
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- FAU - Hwu, Hai-Gwo
- AU - Hwu HG
- AUID- ORCID: 0000-0002-2582-2807
- AD - Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- AD - Department of Psychiatry, College of Medicine, National Taiwan University,
- Taipei, Taiwan.
- LA - eng
- PT - Journal Article
- DEP - 20220301
- PL - New Zealand
- TA - Neuropsychiatr Dis Treat
- JT - Neuropsychiatric disease and treatment
- JID - 101240304
- PMC - PMC8898187
- OTO - NOTNLM
- OT - antipsychotics
- OT - attitude
- OT - discontinuation
- OT - first-episode psychosis
- OT - questionnaire
- OT - remission
- COIS- All authors declare no conflicts of interest.
- EDAT- 2022/03/10 06:00
- MHDA- 2022/03/10 06:01
- CRDT- 2022/03/09 08:43
- PHST- 2021/09/28 00:00 [received]
- PHST- 2021/12/26 00:00 [accepted]
- PHST- 2022/03/09 08:43 [entrez]
- PHST- 2022/03/10 06:00 [pubmed]
- PHST- 2022/03/10 06:01 [medline]
- AID - 339866 [pii]
- AID - 10.2147/NDT.S339866 [doi]
- PST - epublish
- SO - Neuropsychiatr Dis Treat. 2022 Mar 1;18:465-475. doi: 10.2147/NDT.S339866.
- eCollection 2022.
- PMID- 29706449
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20190520
- LR - 20190520
- IS - 1573-2509 (Electronic)
- IS - 0920-9964 (Linking)
- VI - 201
- DP - 2018 Nov
- TI - Predictors of 'all-cause discontinuation' of initial oral antipsychotic
- medication in first episode psychosis.
- PG - 287-293
- LID - S0920-9964(18)30240-8 [pii]
- LID - 10.1016/j.schres.2018.04.027 [doi]
- AB - INTRODUCTION: Discontinuation of the initial oral antipsychotic prescribed for a
- first episode of psychosis (FEP) can derail outcome. Our objective was to examine
- the rate of and time to all-cause discontinuation of the first antipsychotic
- prescribed and the factors influencing such discontinuation. METHODS: In a sample
- of 390 FEP patients, we estimated the rate of and time to discontinuation of the
- initial antipsychotic over a one-year period. The effects of a number of putative
- predictors of discontinuation were estimated using regression analyses. RESULTS:
- Rate of discontinuation of the first antipsychotic was 72%, with no difference
- between the 3 investigated antipsychotics (olanzapine (73%), risperidone (68%)
- and aripiprazole (75%)), (χ(2) (2) = 1.89, p = 0.388). Mean time to
- discontinuation was 7.2 (4.6) months and was not different among the three
- antipsychotics (Log-rank χ(2) (2) = 0.257, p = 0.879). Binary logistic regression
- showed that higher positive and negative symptoms remission and baseline
- functioning were associated with lower rates of discontinuation (Nagelkerke
- R(2) = 0.36, χ(2) (10) = 66.9, p < 0.001). Multiple linear regression showed the
- same predictors, in addition to male gender and less weight gain per month of
- exposure to the initial antipsychotic, to be associated with longer time to
- discontinuation (adjusted R(2) = 0.336, F (9, 219) = 13.8, p < 0.001).
- CONCLUSION: Discontinuation of the initial antipsychotic is a major concern in
- the course of treating FEP. Symptom relief, better functioning and lower side
- effects appear to be the major factors associated with continuing an
- antipsychotic medication.
- CI - Copyright © 2018 Elsevier B.V. All rights reserved.
- FAU - Mustafa, Sally
- AU - Mustafa S
- AD - Douglas Mental Health University Institute, Montreal, QC, Canada.
- FAU - Joober, Ridha
- AU - Joober R
- AD - Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental
- Health University Institute, Montreal, QC, Canada.
- FAU - Lepage, Martin
- AU - Lepage M
- AD - Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental
- Health University Institute, Montreal, QC, Canada.
- FAU - Iyer, Srividya
- AU - Iyer S
- AD - Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental
- Health University Institute, Montreal, QC, Canada.
- FAU - Shah, Jai
- AU - Shah J
- AD - Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental
- Health University Institute, Montreal, QC, Canada.
- FAU - Malla, Ashok
- AU - Malla A
- AD - Department of Psychiatry, McGill University, Montréal, QC, Canada; Douglas Mental
- Health University Institute, Montreal, QC, Canada. Electronic address:
- ashok.malla@mcgill.ca.
- LA - eng
- PT - Journal Article
- PT - Research Support, N.I.H., Extramural
- PT - Research Support, Non-U.S. Gov't
- DEP - 20180426
- PL - Netherlands
- TA - Schizophr Res
- JT - Schizophrenia research
- JID - 8804207
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - Administration, Oral
- MH - Antipsychotic Agents/*administration & dosage/adverse effects
- MH - Female
- MH - Follow-Up Studies
- MH - Humans
- MH - Male
- MH - Patient Acceptance of Health Care/psychology
- MH - Prognosis
- MH - Prospective Studies
- MH - Psychotic Disorders/diagnosis/*drug therapy/psychology
- MH - Remission Induction
- MH - Weight Gain/drug effects
- MH - Young Adult
- OTO - NOTNLM
- OT - Baseline functioning
- OT - Discontinuation
- OT - Initial antipsychotic
- OT - Remission
- OT - Weight gain
- EDAT- 2018/05/01 06:00
- MHDA- 2019/05/21 06:00
- CRDT- 2018/05/01 06:00
- PHST- 2017/08/22 00:00 [received]
- PHST- 2018/01/08 00:00 [revised]
- PHST- 2018/04/14 00:00 [accepted]
- PHST- 2018/05/01 06:00 [pubmed]
- PHST- 2019/05/21 06:00 [medline]
- PHST- 2018/05/01 06:00 [entrez]
- AID - S0920-9964(18)30240-8 [pii]
- AID - 10.1016/j.schres.2018.04.027 [doi]
- PST - ppublish
- SO - Schizophr Res. 2018 Nov;201:287-293. doi: 10.1016/j.schres.2018.04.027. Epub 2018
- Apr 26.
- PMID- 32033579
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20201123
- LR - 20220412
- IS - 1745-6215 (Electronic)
- IS - 1745-6215 (Linking)
- VI - 21
- IP - 1
- DP - 2020 Feb 7
- TI - To continue or not to continue? Antipsychotic medication maintenance versus
- dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic
- multicenter single-blind randomized controlled trial.
- PG - 147
- LID - 10.1186/s13063-019-3822-5 [doi]
- LID - 147
- AB - BACKGROUND: Antipsychotic medication is effective for symptomatic treatment in
- schizophrenia-spectrum disorders. After symptom remission, continuation of
- antipsychotic treatment is associated with lower relapse rates and lower symptom
- severity compared to dose reduction/discontinuation. Therefore, most guidelines
- recommend continuation of treatment with antipsychotic medication for at least 1
- year. Recently, however, these guidelines have been questioned as one study has
- shown that more patients achieved long-term functional remission in an early
- discontinuation condition-a finding that was not replicated in another recently
- published long-term study. METHODS/DESIGN: The HAMLETT (Handling Antipsychotic
- Medication Long-term Evaluation of Targeted Treatment) study is a multicenter
- pragmatic single-blind randomized controlled trial in two parallel conditions
- (1:1) investigating the effects of continuation versus
- dose-reduction/discontinuation of antipsychotic medication after remission of a
- first episode of psychosis (FEP) on personal and social functioning, psychotic
- symptom severity, and health-related quality of life. In total 512 participants
- will be included, aged between 16 and 60 years, in symptomatic remission from a
- FEP for 3-6 months, and for whom psychosis was not associated with severe or
- life-threatening self-harm or violence. Recruitment will take place at 24 Dutch
- sites. Patients are randomized (1:1) to: continuation of antipsychotic medication
- until at least 1 year after remission (original dose allowing a maximum reduction
- of 25%, or another antipsychotic drug in similar dose range); or gradual dose
- reduction till eventual discontinuation of antipsychotics according to a tapering
- schedule. If signs of relapse occur in this arm, medication dose can be increased
- again. Measurements are conducted at baseline, at 3, and 6 months post-baseline,
- and yearly during a follow-up period of 4 years. DISCUSSION: The HAMLETT study
- will offer evidence to guide patients and clinicians regarding questions
- concerning optimal treatment duration and when to taper off medication after
- remission of a FEP. Moreover, it may provide patient characteristics associated
- with safe dose reduction with a minimal risk of relapse. TRIAL STATUS: Protocol
- version 1.3, October 2018. The study is active and currently recruiting patients
- (since September 2017), with the first 200 participants by the end of 2019. We
- anticipate completing recruitment in 2022 and final assessments (including
- follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION: European
- Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.
- FAU - Begemann, Marieke J H
- AU - Begemann MJH
- AUID- ORCID: 0000-0001-6448-2799
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands. m.j.h.begemann@umcg.nl.
- FAU - Thompson, Ilse A
- AU - Thompson IA
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- FAU - Veling, Wim
- AU - Veling W
- AD - Department of Psychiatry, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- FAU - Gangadin, Shiral S
- AU - Gangadin SS
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- AD - Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center
- Utrecht, Utrecht, The Netherlands.
- FAU - Geraets, Chris N W
- AU - Geraets CNW
- AD - Department of Psychiatry, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- FAU - van 't Hag, Erna
- AU - van 't Hag E
- AD - Department of Psychiatry, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- FAU - Müller-Kuperus, Sanne J
- AU - Müller-Kuperus SJ
- AD - Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center
- Utrecht, Utrecht, The Netherlands.
- FAU - Oomen, Priscilla P
- AU - Oomen PP
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- FAU - Voppel, Alban E
- AU - Voppel AE
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- FAU - van der Gaag, Mark
- AU - van der Gaag M
- AD - Parnassia Psychiatric Institute, The Hague, The Netherlands.
- AD - Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
- FAU - Kikkert, Martijn J
- AU - Kikkert MJ
- AD - Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
- FAU - Van Os, Jim
- AU - Van Os J
- AD - Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center
- Utrecht, Utrecht, The Netherlands.
- AD - Department of Psychiatry and Neuropsychology, School for Mental Health and
- Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The
- Netherlands.
- AD - Department of Psychosis Studies, Institute of Psychiatry, Psychology &
- Neuroscience, King's College London, London, UK.
- FAU - Smit, H Filip E
- AU - Smit HFE
- AD - Department of Epidemiology and Biostatistics, Amsterdam Public Health Research
- Institute, VU University Medical Center, Amsterdam, The Netherlands.
- AD - Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public
- Health Research Institute, VU University Medical Center, Amsterdam, The
- Netherlands.
- AD - Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental
- Health), Utrecht, The Netherlands.
- FAU - Knegtering, Rikus H
- AU - Knegtering RH
- AD - Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands.
- AD - Rob Giel Research Center, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- FAU - Wiersma, Sybren
- AU - Wiersma S
- AD - Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care,
- Hoofddorp, The Netherlands.
- FAU - Stouten, Luyken H
- AU - Stouten LH
- AD - Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The
- Netherlands.
- FAU - Gijsman, Harm J
- AU - Gijsman HJ
- AD - Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health,
- Wolfheze, The Netherlands.
- FAU - Wunderink, Lex
- AU - Wunderink L
- AD - Department of Psychiatry, University of Groningen, University Medical Center
- Groningen, Groningen, The Netherlands.
- AD - Department of Education and Research, Friesland Mental Health Care Services,
- Leeuwarden, The Netherlands.
- FAU - Staring, Anton B P
- AU - Staring ABP
- AD - Department ABC, Altrecht Psychiatric Institute, Utrecht, The Netherlands.
- FAU - Veerman, Selene R T
- AU - Veerman SRT
- AD - Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The
- Netherlands.
- FAU - Mahabir, Amrita G S
- AU - Mahabir AGS
- AD - Early Psychosis Team, GGNet, Apeldoorn, The Netherlands.
- FAU - Kurkamp, Jörg
- AU - Kurkamp J
- AD - Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands.
- FAU - Pijnenborg, Gerdina H M
- AU - Pijnenborg GHM
- AD - Department of Psychotic Disorders, GGZ-Drenthe, Assen, The Netherlands.
- FAU - Veen, Natalie D
- AU - Veen ND
- AD - GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands.
- FAU - Marcelis, Machteld
- AU - Marcelis M
- AD - Department of Psychiatry and Neuropsychology, School for Mental Health and
- Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The
- Netherlands.
- AD - Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands.
- FAU - Grootens, Koen P
- AU - Grootens KP
- AD - Reinier van Arkel Institute for Mental Health Care, 's Hertogenbosch, The
- Netherlands.
- AD - Radboud University Medical Centre, Nijmegen, The Netherlands.
- FAU - Faber, Gunnar
- AU - Faber G
- AD - Yulius, Mental Health Institute, Dordrecht, The Netherlands.
- FAU - van Beveren, Nico J
- AU - van Beveren NJ
- AD - Antes Center for Mental Health Care, Rotterdam, The Netherlands.
- AD - Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands.
- AD - Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.
- FAU - Been, Agaath
- AU - Been A
- AD - Center for Developmental Disorders, Dimence Institute for Mental Health,
- Deventer, The Netherlands.
- FAU - van den Brink, Truus
- AU - van den Brink T
- AD - Early Intervention Team, GGZ Centraal, Amersfoort, The Netherlands.
- FAU - Bak, Maarten
- AU - Bak M
- AD - Department of Psychiatry and Neuropsychology, School for Mental Health and
- Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The
- Netherlands.
- AD - Mondriaan Mental Health Care, Heerlen, The Netherlands.
- FAU - van Amelsvoort, Therese A M J
- AU - van Amelsvoort TAMJ
- AD - Department of Psychiatry and Neuropsychology, School for Mental Health and
- Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The
- Netherlands.
- AD - Mondriaan Mental Health Care, Heerlen, The Netherlands.
- FAU - Ruissen, Andrea
- AU - Ruissen A
- AD - Emergis, Kenniscentrum, Goes, The Netherlands.
- FAU - Blanke, Christine
- AU - Blanke C
- AD - Anoiksis, University Medical Center Utrecht, Utrecht, The Netherlands.
- FAU - Groen, Karin
- AU - Groen K
- AD - MIND Ypsilon, Organization of Relatives and Carers of People with a Vulnerability
- to Psychosis, The Hague, The Netherlands.
- FAU - de Haan, Lieuwe
- AU - de Haan L
- AD - Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam,
- The Netherlands.
- FAU - Sommer, Iris E C
- AU - Sommer IEC
- AD - Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences,
- University of Groningen, University Medical Center Groningen (UMCG), Groningen,
- The Netherlands.
- LA - eng
- GR - 80-84800-98-41015/ZonMw/
- PT - Clinical Trial Protocol
- PT - Journal Article
- DEP - 20200207
- PL - England
- TA - Trials
- JT - Trials
- JID - 101263253
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - Adolescent
- MH - Adult
- MH - Antipsychotic Agents/*administration & dosage/standards
- MH - Dose-Response Relationship, Drug
- MH - Drug Administration Schedule
- MH - Female
- MH - Follow-Up Studies
- MH - Humans
- MH - Male
- MH - Middle Aged
- MH - Multicenter Studies as Topic
- MH - Practice Guidelines as Topic
- MH - Pragmatic Clinical Trials as Topic
- MH - Psychotic Disorders/diagnosis/*drug therapy
- MH - Quality of Life
- MH - Remission Induction/methods
- MH - Severity of Illness Index
- MH - Single-Blind Method
- MH - Treatment Outcome
- MH - Young Adult
- PMC - PMC7006112
- OTO - NOTNLM
- OT - Antipsychotic medication, first episode psychosis
- OT - Discontinuation
- OT - Maintenance
- OT - Randomized controlled trial
- OT - Tapering, global functioning
- OT - Treatment
- COIS- The authors declare that they have no competing interests.
- EDAT- 2020/02/09 06:00
- MHDA- 2020/11/24 06:00
- CRDT- 2020/02/09 06:00
- PHST- 2019/04/04 00:00 [received]
- PHST- 2019/10/22 00:00 [accepted]
- PHST- 2020/02/09 06:00 [entrez]
- PHST- 2020/02/09 06:00 [pubmed]
- PHST- 2020/11/24 06:00 [medline]
- AID - 10.1186/s13063-019-3822-5 [pii]
- AID - 3822 [pii]
- AID - 10.1186/s13063-019-3822-5 [doi]
- PST - epublish
- SO - Trials. 2020 Feb 7;21(1):147. doi: 10.1186/s13063-019-3822-5.
- PMID- 18832960
- OWN - NLM
- STAT- MEDLINE
- DCOM- 20090317
- LR - 20220310
- IS - 1538-1145 (Electronic)
- IS - 1527-4160 (Linking)
- VI - 14
- IP - 5
- DP - 2008 Sep
- TI - A review of second-generation antipsychotic discontinuation in first-episode
- psychosis.
- PG - 289-300
- LID - 10.1097/01.pra.0000336756.65308.83 [doi]
- AB - "All-causes discontinuation" refers to discontinuation of treatment for any
- reason, and adherence to medication is an important component of this measure.
- Two recent landmark studies suggest that adherence is a major issue in patients
- with first-episode psychosis (FEP) right from the onset of treatment. In this
- review, the incidence, reasons for, and clinical outcomes of medication
- discontinuation in FEP are considered. More than 40% of patients with FEP
- discontinue medication during the first 9 months of treatment, at which point the
- chances of relapse increase dramatically. Findings concerning predictors of
- medication discontinuation in this patient population that have been replicated
- in more than one study include severity of psychopathology, lack of insight into
- illness, negative attitudes towards medications, comorbid substance use, and
- medication side effects. Interventions that have the potential to decrease
- discontinuation rates in patients with psychotic disorders include orally
- disintegrating tablets, long-acting injectable drugs, cognitive-behavioral
- therapy, compliance therapy, family support/intervention, and peer support,
- although these strategies have largely been unexplored in FEP. In addition to the
- question of medication discontinuation in the acute treatment of FEP, another
- important issue is how long patients with FEP should be treated with
- antipsychotics once they have achieved remission; unfortunately, little evidence
- is available to guide the decision as to whether medication should be
- discontinued or maintenance treatment provided in this situation. Studies are
- therefore needed to identify predictors of patients with remitted FEP who are
- less likely to relapse when medication is discontinued. Taken together, the
- findings presented in this article underscore the importance of addressing issues
- related to medication discontinuation as a means of preventing long-term
- morbidity and enhancing remission and functional recovery in FEP.
- FAU - Miller, Brian J
- AU - Miller BJ
- AD - Department of Psychiatry and Health Behavior, Medical College of Georgia,
- Augusta, GA 30912, USA. brmiller@mcg.edu
- LA - eng
- PT - Journal Article
- PT - Review
- PL - United States
- TA - J Psychiatr Pract
- JT - Journal of psychiatric practice
- JID - 100901141
- RN - 0 (Antipsychotic Agents)
- SB - IM
- MH - Antipsychotic Agents/*therapeutic use
- MH - Cognitive Behavioral Therapy
- MH - Family Therapy
- MH - Humans
- MH - Incidence
- MH - *Psychotic Disorders/epidemiology/psychology/therapy
- MH - Remission Induction
- MH - Severity of Illness Index
- MH - Social Support
- MH - Withholding Treatment/*statistics & numerical data
- RF - 77
- EDAT- 2008/10/04 09:00
- MHDA- 2009/03/18 09:00
- CRDT- 2008/10/04 09:00
- PHST- 2008/10/04 09:00 [pubmed]
- PHST- 2009/03/18 09:00 [medline]
- PHST- 2008/10/04 09:00 [entrez]
- AID - 00131746-200809000-00005 [pii]
- AID - 10.1097/01.pra.0000336756.65308.83 [doi]
- PST - ppublish
- SO - J Psychiatr Pract. 2008 Sep;14(5):289-300. doi:
- 10.1097/01.pra.0000336756.65308.83.
- PMID- 35935409
- OWN - NLM
- STAT- PubMed-not-MEDLINE
- LR - 20220809
- IS - 1664-0640 (Print)
- IS - 1664-0640 (Electronic)
- IS - 1664-0640 (Linking)
- VI - 13
- DP - 2022
- TI - Tapered discontinuation vs. maintenance therapy of antipsychotic medication in
- patients with first-episode schizophrenia: Obstacles, findings, and lessons
- learned in the terminated randomized clinical trial TAILOR.
- PG - 910703
- LID - 10.3389/fpsyt.2022.910703 [doi]
- LID - 910703
- AB - AIM: Evidence is insufficient regarding the consequences of discontinuing vs.
- maintaining antipsychotic medication in patients with first-episode
- schizophrenia. Our aim was to examine tapered discontinuation vs. maintenance
- treatment regarding remission of psychotic symptoms and impact on other areas.
- METHODS: Patients included had a diagnosis of schizophrenia, were treated with
- antipsychotic medication, and were in remission of psychotic symptoms.
- Participants were randomized to tapered discontinuation or maintenance treatment
- with antipsychotic medication. Assessments were undertaken at baseline and after
- 1-year. The primary outcome was remission of psychotic symptoms without
- antipsychotic medication. RESULTS: The trial was terminated due to insufficient
- recruitment. In total, 29 participants were included: 14 in the
- tapering/discontinuation group and 15 in the maintenance group. Adherence to
- maintenance treatment was poor. At 1-year follow-up, remission of psychotic
- symptoms without antipsychotic medication for 3 months was observed in five
- participants in the tapering/discontinuation group and two in the maintenance
- group. CONCLUSION: Due to insufficient recruitment this study does not provide a
- conclusion on whether unfavorable outcomes or advantages follow tapering of
- antipsychotic medication. Recruitment and adherence to maintenance treatment
- encountered obstacles. Based on experiences from this trial, we discussed
- alternative study designs as consistent evidence is still needed on whether to
- continue or discontinue antipsychotic medication in remitted patients with
- first-episode schizophrenia. CLINICAL TRIAL REGISTRATION:
- https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-000565-23/DK, EU
- Clinical Trials Register-EudraCT no. 2016-000565-23.
- CI - Copyright © 2022 Stürup, Hjorthøj, Albert, Dolmer, Birk, Ebdrup, Eplov, Jensen,
- Vernal, Speyer, Mors and Nordentoft.
- FAU - Stürup, Anne Emilie
- AU - Stürup AE
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- FAU - Hjorthøj, Carsten
- AU - Hjorthøj C
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- AD - Section of Epidemiology, Department of Public Health, University of Copenhagen,
- Copenhagen, Denmark.
- FAU - Albert, Nikolai
- AU - Albert N
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- AD - Psychiatry Øst, Region Sjælland, Roskilde, Denmark.
- FAU - Dolmer, Signe
- AU - Dolmer S
- AD - Psychosis Research Unit, Department of Clinical Medicine, Aarhus University
- Hospital, Aarhus, Denmark.
- FAU - Birk, Merete
- AU - Birk M
- AD - Psychosis Research Unit, Department of Clinical Medicine, Aarhus University
- Hospital, Aarhus, Denmark.
- FAU - Ebdrup, Bjørn H
- AU - Ebdrup BH
- AD - Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre
- Glostrup, University of Copenhagen, Glostrup, Denmark.
- AD - Department of Clinical Medicine, Faculty of Health and Medical Sciences,
- University of Copenhagen, Copenhagen, Denmark.
- FAU - Eplov, Lene Falgaard
- AU - Eplov LF
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- FAU - Jensen, Heidi
- AU - Jensen H
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- FAU - Vernal, Ditte Lammers
- AU - Vernal DL
- AD - Unit for Psychiatric Research, Psychiatry, Department of Clinical Medicine,
- Aalborg University Hospital, Aalborg University, Aalborg, Denmark.
- FAU - Speyer, Helene
- AU - Speyer H
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- FAU - Mors, Ole
- AU - Mors O
- AD - Psychosis Research Unit, Department of Clinical Medicine, Aarhus University
- Hospital, Aarhus, Denmark.
- FAU - Nordentoft, Merete
- AU - Nordentoft M
- AD - Copenhagen Research Center for Mental Health (CORE), Mental Health Center
- Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- LA - eng
- PT - Journal Article
- DEP - 20220722
- PL - Switzerland
- TA - Front Psychiatry
- JT - Frontiers in psychiatry
- JID - 101545006
- PMC - PMC9355082
- OTO - NOTNLM
- OT - antipsychotics
- OT - design
- OT - discontinuation
- OT - first-episode schizophrenia
- OT - maintenance
- OT - relapse
- OT - remission
- OT - tapering
- COIS- BE is part of the Advisory Board of Eli Lilly Denmark A/S, Janssen-Cilag,
- Lundbeck Pharma A/S, and Takeda Pharmaceutical Company Ltd; and has received
- lecture fees from Bristol-Myers Squibb, Otsuka Pharma Scandinavia AB, Eli Lilly
- Company, Boehringer Ingelheim Denmark A/S, and Lundbeck Pharma A/S. DV has
- received speaking fees from Lundbeck. The remaining authors declare that the
- research was conducted in the absence of any commercial or financial
- relationships that could be construed as a potential conflict of interest.
- EDAT- 2022/08/09 06:00
- MHDA- 2022/08/09 06:01
- CRDT- 2022/08/08 03:31
- PHST- 2022/04/01 00:00 [received]
- PHST- 2022/06/30 00:00 [accepted]
- PHST- 2022/08/08 03:31 [entrez]
- PHST- 2022/08/09 06:00 [pubmed]
- PHST- 2022/08/09 06:01 [medline]
- AID - 10.3389/fpsyt.2022.910703 [doi]
- PST - epublish
- SO - Front Psychiatry. 2022 Jul 22;13:910703. doi: 10.3389/fpsyt.2022.910703.
- eCollection 2022.
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