Continuing, reducing, switching, or stopping antipsychotics in individuals with schizophrenia-spectrum disorders who are clinically stable: a systematic review and network meta-analysis

Letter Psychiatry

Limitations in Research on Maintenance Treatment for Individuals With Schizophrenia

Mikkel Hojlund et al.

JAMA PSYCHIATRY (2022)

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Article Medicine, General & Internal

Preventing relapse in schizophrenia needs better evidence

Giovanni Ostuzzi et al.

LANCET (2022)

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News Item Medicine, General & Internal

Antipsychotics and schizophrenia, tolerance first

[Anonymous]

EXERCER-LA REVUE FRANCOPHONE DE MEDECINE GENERALE (2022)

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Article Psychiatry

Oral and long-acting antipsychotics for relapse prevention in schizophrenia-spectrum disorders: a network meta-analysis of 92 randomized trials including 22,645 participants

Giovanni Ostuzzi et al.

Summary: According to current evidence and guidelines, long-term antipsychotic treatment is essential for preventing relapse in patients with schizophrenia-spectrum disorders. While oral antipsychotics are commonly prescribed, long-acting injectable antipsychotics are valuable for addressing adherence issues.

WORLD PSYCHIATRY (2022)

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Review Psychiatry

Systematic literature review of schizophrenia clinical practice guidelines on acute and maintenance management with antipsychotics

Christoph U. Correll et al.

Summary: Clinical practice guidelines translate evidence into recommendations for improving patient care and outcomes. This review summarizes the recommendations for acute and maintenance management of schizophrenia with antipsychotics based on a systematic literature review of English-language guidelines. The guidelines recommend antipsychotic monotherapy for first-episode schizophrenia, but no consensus on the preferred antipsychotic. There is also variation in recommendations for the maximum duration of maintenance therapy and the use of long-acting injectable antipsychotics. Clozapine is recommended for treatment-resistant schizophrenia.

SCHIZOPHRENIA (2022)

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Article Psychiatry

Maintenance Treatment With Long-Acting Injectable Antipsychotics for People With Nonaffective Psychoses: A Network Meta-Analysis

Giovanni Ostuzzi et al.

Summary: This study compared the efficacy and acceptability of long-acting injectable antipsychotics in adults with nonaffective psychoses, finding that paliperidone (3-month formulation), aripiprazole, olanzapine, and paliperidone (1-month formulation) showed the highest effect sizes and certainty of evidence for relapse prevention and acceptability.

AMERICAN JOURNAL OF PSYCHIATRY (2021)

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Review Psychiatry

Does Switching Antipsychotics Ameliorate Weight Gain in Patients With Severe Mental Illness? A Systematic Review and Meta-analysis

Dan Siskind et al.

Summary: Switching to antipsychotics with lower weight gain potential, such as aripiprazole and ziprasidone, can improve weight profile and other cardiometabolic outcomes in patients with severe mental illness. It is important to consider the weight gain potential of both the pre- and post-switch antipsychotic agents when making medication changes to ensure the patient's psychiatric stability and reduce the risk of cardiometabolic diseases.

SCHIZOPHRENIA BULLETIN (2021)

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Article Medicine, General & Internal

Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals' perspectives

Annabel Nash et al.

Summary: This study explores healthcare professionals’ perspectives on switching antipsychotics to support physical health in individuals with severe mental illness. Differences in awareness and knowledge of antipsychotic side effects and risk profiles were observed between primary and secondary care clinicians. Collaboration between primary and secondary care may support switching antipsychotics to address physical health inequalities in individuals with severe mental illness.

BMJ OPEN (2021)

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Article Psychiatry

A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse

Mark Abie Horowitz et al.

Summary: The process of stopping antipsychotics may lead to relapse, related to neuroadaptations that persist after cessation. It is suggested to taper medications gradually over months or years and in a hyperbolic manner to reduce the risk of relapse. This approach should be tested in randomized controlled trials to evaluate its effectiveness.

SCHIZOPHRENIA BULLETIN (2021)

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Review Psychiatry

Pharmacological Interventions to Treat Antipsychotic-Induced Dyslipidemia in Schizophrenia Patients: A Systematic Review and Meta Analysis

Pruntha Kanagasundaram et al.

Summary: Pharmacological interventions are effective in reducing LDL cholesterol, triglycerides, and total cholesterol levels while increasing HDL cholesterol levels in patients with schizophrenia. Certain interventions such as antipsychotic switching, antipsychotic add-ons, and off label lipid-lowering agents may be more effective in improving specific lipid parameters. Future studies should explore novel interventions for managing antipsychotic-induced dyslipidemia.

FRONTIERS IN PSYCHIATRY (2021)

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Article Psychiatry

Examination of Dosing of Antipsychotic Drugs for Relapse Prevention in Patients With Stable Schizophrenia A Meta-analysis

Stefan Leucht et al.

Summary: This meta-analysis examined dose-response findings in randomized clinical trials for antipsychotic drugs in preventing relapse in stable schizophrenia patients. The results indicated that doses higher than 5mg/d risperidone equivalent may not provide significant additional benefit for relapse prevention but may lead to more adverse events. On the other hand, patients in remission may require lower doses as low as 2.5mg/d risperidone equivalent. Individual factors such as metabolism, age, illness stage, and comorbidities may also influence the optimal dosage needed for each patient.

JAMA PSYCHIATRY (2021)

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Review Endocrinology & Metabolism

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

Helene Speyer et al.

Summary: The study found that reducing dosage, discontinuing medication, or switching to a partial agonist can lead to a small but significant weight loss of around 1.5 kg. The overall weight change from pre to post intervention was a reduction of 1.13 kg.

FRONTIERS IN ENDOCRINOLOGY (2021)

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Review Neurosciences