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Cited by 62Schizophrenia research and treatmentBipolar Disorder and TreatmentMental Health and Psychiatry

Clinical and demographic predictors of continuing remission or relapse following discontinuation of antipsychotic medication after a first episode of psychosis. a systematic review

Bowtell, Meghan, Ratheesh, Aswin, McGorry, Patrick, Killackey, Eoin, O'Donoghue, Brian·2018·Schizophrenia Research
DOI 10.1016/j.schres.2017.11.010
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Abstract

Background Clinical guidelines recommend maintenance treatment with antipsychotic medication for one to two years following remission of symptoms after a first episode of psychosis. However, recent research has suggested that this may not be indicated. Consistent predictors of outcome would be beneficial to guide clinicians as to which individuals are likely to have a successful discontinuation.Objectives This study reviews the literature with the aim of identifying demographic and clinical predictors of either relapse or continued remission in those with a first episode of psychosis following discontinuation of antipsychotic medication.Methodology Data Sources: A systematic search of PubMed, CINAHL, and PsychInfo databases was performed. Eligibility Criteria: Cohort, case-control and clinical trials that were published in English, included participants with a first episode of psychosis, and examined clinical and demographic predictors of relapse or continued remission after antipsychotic discontinuation.Results Eleven studies fulfilled inclusion criteria. No positive findings were replicated across cohorts. Predictors of relapse: male sex, unemployment, prior psychiatric admission, premorbid adjustment, childhood isolation, premorbid functioning, schizoid-schizotypal traits, schizophrenia diagnosis, concomitant medication, and more severe negative symptoms. Some positive findings must be interpreted in the context of conflicting and replicated negative findings: sex, employment status, level of education, premorbid functioning, symptom severity, and schizophrenia diagnosis. Other replicated non-predictive findings: age, ethnicity, marital status, family history, disorganized thoughts, affective symptoms, cannabis abuse, clinical global impression, social integration, duration and dose of antipsychotic treatment, and compliance.Conclusion No positive findings have been replicated across study cohorts. Non-predictive findings have been replicated.

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  • The discontinuation group showed more relapses than the maintenance group in all but 3 studies examined.

    “The discontinuation group showed more relapses than the maintenance group83,84 in all but 3 studies examined.57,74,85”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [84]

  • It is likely that discontinuation studies employing linear dose reductions will be more likely to induce withdrawal reactions (including, potentially, withdrawal psychosis) because reductions in D2 antagonism become increasingly large, causing greater likelihood of dopaminergic rebound.

    “It is, therefore, likely that discontinuation studies employing linear dose reductions,74,83,84,86,87 as recommended in some older guidelines,94 will be more likely to induce withdrawal reactions (including, potentially, withdrawal psychosis) because reductions in D2 antagonism become increasingly large, causing greater likelihood of dopaminergic rebound.”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [84]

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Authors
Bowtell, M., Ratheesh, A., McGorry, P., Killackey, E., & O'Donoghue, B.
Affiliations
The University of Melbourne (AU)
Corresponding author
O'Donoghue, Brian
ORCID
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2018-07
Volume
197
Pages
9-18
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/j.schres.2017.11.010
OpenAlex
W2769633033
Cited by
62
References
43
Citations by year
2026: 1 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 10 · 2021: 13 · 2020: 7 · 2019: 12 · 2018: 5 · 2017: 1
FWCI
1.04
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Schizophrenia Research (publishedVersion)
  • PubMed (publishedVersion)
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 › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
first-episode psychosis, antipsychotic discontinuation
MeSH terms
Humans, Psychotic Disorders, Remission Induction, Antipsychotic Agents, Disease Progression

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