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Cited by 567Schizophrenia research and treatmentBipolar Disorder and TreatmentPsychiatric care and mental health services

Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-term Follow-up of a 2-Year Randomized Clinical Trial

Wunderink, Lex, Nieboer, Roeline M., Wiersma, Durk, Sytema, Sjoerd, Nienhuis, Fokko J.·2013·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.19
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Abstract

IMPORTANCE: Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before. OBJECTIVE: To compare rates of recovery in patients with remitted FEP after 7 years of follow-up of a dose reduction/discontinuation (DR) vs maintenance treatment (MT) trial. DESIGN: Seven-year follow-up of a 2-year open randomized clinical trial comparing MT and DR. SETTING: One hundred twenty-eight patients participating in the original trial were recruited from 257 patients with FEP referred from October 2001 to December 2002 to 7 mental health care services in a 3.2 million-population catchment area. Of these, 111 patients refused to participate and 18 patients did not experience remission. PARTICIPANTS After 7 years, 103 patients (80.5%) of 128 patients who were included in the original trial were located and consented to follow-up assessment. INTERVENTION: After 6 months of remission, patients were randomly assigned to DR strategy or MT for 18 months. After the trial, treatment was at the discretion of the clinician. MAIN OUTCOMES AND MEASURES: Primary outcome was rate of recovery, defined as meeting the criteria of symptomatic and functional remission. Determinants of recovery were examined using logistic regression analysis; the treatment strategy (MT or DR) was controlled for baseline parameters. RESULTS: The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%). Logistic regression showed an odds ratio of 3.49 (P = .01). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates. CONCLUSIONS AND RELEVANCE: Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates compared with the rates achieved with MT. To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN16228411.

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  • Relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.

    “That is, relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [57]

  • Relapse rates are raised in the discontinuation group for 1-3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.

    “It appears that relapse rates are raised in the discontinuation group for 1–3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.3,56–59”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [57]

  • In one study with more than 2 years follow-up after treatment discontinuation, 43% of the original cohort relapsed in the first year, 21.5% in the second year, and 3.7% a year in each of the 5 years following.

    “one found 43% of the original cohort of patients relapsed in the first year, 21.5% in the second year, and just 3.7% a year in each of the 5 years following57,61”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [57]

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Authors
Wunderink, L., Nieboer, R. M., Wiersma, D., Sytema, S., & Nienhuis, F. J.
Affiliations
University Medical Center Groningen (NL)
Corresponding author
Wunderink, Lex
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2013-09-01
Volume
70
Issue
9
Pages
913
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.19
OpenAlex
W2125616168
Cited by
567
References
24
Citations by year
2026: 17 · 2025: 27 · 2024: 31 · 2023: 39 · 2022: 37 · 2021: 47 · 2020: 42 · 2019: 71 · 2018: 59 · 2017: 43 · 2016: 65 · 2015: 42 · 2014: 36 · 2013: 8
FWCI
35.58
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
first-episode psychosis, remission, antipsychotic dose reduction, antipsychotic discontinuation, long-term antipsychotic treatment, long-term recovery, functional remission, symptom remission, relapse
MeSH terms
Adult, Female, Follow-Up Studies, Humans, Long-Term Care, Male, Psychotic Disorders, Recurrence, Remission Induction, Antipsychotic Agents, Treatment Outcome, Age of Onset, Young Adult, Maintenance Chemotherapy

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