Journal
SCHIZOPHRENIA RESEARCH
Volume 152, Issue 2-3, Pages 408-414Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.schres.2013.08.001
Keywords
First episode psychosis; Schizophrenia; Relapse; Recurrence; Antipsychotic; Withdrawal; Discontinuation
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Funding
- Roche
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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. (C) 2013 Elsevier B.V. All rights reserved.
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