CoChat
Sign Up
Cited by 19Schizophrenia research and treatmentMental Health and PsychiatryTreatment of Major Depression

Achieving the lowest effective antipsychotic dose for patients with remitted psychosis: a proposed guided dose-reduction algorithm

Liu, Chen-Chung, Takeuchi, Hiroyoshi·2020·CNS Drugs
DOI 10.1007/s40263-019-00682-8
Open this paper in CoChat — free account

Abstract

Continuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well along this path. We anticipate that this approach can help optimize the risk-benefit ratio and instill a hope in patients with schizophrenia that they can maintain in stable remission under a lower antipsychotic dose without an increased risk of relapse.

Integrity signals

Registry

Crossref · 10.1007/s40263-019-00682-8

Cites

95 of 95 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • One study found that reducing antipsychotics in patients with remitted psychosis by 25% of the most recent dose every 6 months (a logarithmic pattern approximating hyperbolic dose reductions) allowed three quarters of patients to achieve between 25% and 71.4% dose reduction without relapse in the first year.

    “One study has investigated reducing antipsychotics in patients with remitted psychosis by 25% of the most recent dose every 6 months (a logarithmic pattern that closely approximates hyperbolic dose reductions), with 3 quarters of patients able to achieve between 25% and 71.4% dose reduction without relapse in the first year of the study.100”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [100]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Liu, C.-C., & Takeuchi, H.
Affiliations
  • National Taiwan University (TW)
  • Centre for Addiction and Mental Health (CA)
Corresponding author
Liu, Chen-Chung
ORCID
Venue
CNS Drugs
Publisher
Springer Science and Business Media LLC
Published
2019-11-18
Volume
34
Issue
2
Pages
117-126
ISSN
  • 1172-7047 (ISSN-L)
  • 1179-1934
DOI
10.1007/s40263-019-00682-8
OpenAlex
W2986981536
Cited by
19
References
95
Citations by year
2026: 1 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 5
FWCI
1.19
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • CNS Drugs (publishedVersion)
  • PubMed (publishedVersion)
Funders
Ministry of Science and Technology, Taiwan (MOST 106-2314-B-002-106, MOST 107-2314-B-002-222-MY3)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
antipsychotic dose reduction, schizophrenia, drug discontinuation, relapse prevention, intermittent dosing, patient empowerment, benefits and risks, pharmacodynamics
MeSH terms
Algorithms, Humans, Psychotic Disorders, Recurrence, Schizophrenia, Antipsychotic Agents

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review