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Cited by 33Schizophrenia research and treatmentBipolar Disorder and TreatmentMental Health and Psychiatry

Risk factors for psychotic relapse after dose reduction or discontinuation of antipsychotics in patients with chronic schizophrenia: a systematic review and meta-analysis

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Bogers, Jan P A M, Hambarian, George, Michiels, Maykel, Vermeulen, Jentien, de Haan, Lieuwe·2020·Schizophrenia Bulletin Open
DOI 10.1093/schizbullopen/sgaa002PMC PMC13701044
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Abstract

Abstract High doses of antipsychotics in patients with chronic schizophrenia might lead to more severe side effects and possibly hamper recovery, but dose reduction carries the risk of psychotic relapse. It would be helpful to establish risk factors for relapse during dose reduction. We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through June 2019 and reviewed studies that reported on relapse rates (event rates [ERs]) after dose reduction or discontinuation of antipsychotics in cohorts of patients with chronic schizophrenia. We calculated ERs (with 95% CIs) per person-year and sought to identify potential risk factors, such as patient characteristics, dose reduction/discontinuation characteristics, and study characteristics. Of 165 publications, 40 describing dose reduction or discontinuation in 46 cohorts (1677 patients) were included. The pooled ER for psychotic relapse was 0.55 (95% CI 0.46–0.65) per person-year. The ER was significantly higher in inpatients, patients with a shorter duration of illness, patients in whom antipsychotics were discontinued or in whom the dose was reduced to less than 5 mg haloperidol equivalent, studies with a short follow-up or published before 1990, and studies in which relapse was based on clinical judgment (ie, rating scales were not used). Clinicians should consider several robust risk factors for psychotic relapse in case of dose reduction in chronic schizophrenia.

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Crossref · 10.1093/schizbullopen/sgaa002

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  • Abruptly stopping antipsychotic medication is the method most likely to induce relapse and withdrawal symptoms.

    “Abruptly stopping antipsychotic medication is the method most likely to induce relapse and withdrawal symptoms.3,4”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [4]

  • A more recent meta-analysis finds an inverse dose response between the duration of discontinuation and the rate of relapse over the next year: abrupt stopping led to relapse in 77% of patients; stopping over 1-2 weeks to relapse in 57%; 3-10 weeks to 47%; and stopping over longer than 10 weeks led to a relapse rate of 31%.

    “However, 4 weeks is a brief period and a more recent meta-analysis finds an inverse dose response between the duration of discontinuation and the rate of relapse over the next year: abrupt stopping led to relapse in 77% of patients; stopping over 1–2 weeks to relapse in 57%; 3–10 weeks to 47%; and stopping over longer than 10 weeks led to a relapse rate of 31%.4”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [4]

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Authors
Bogers, J. P. A. M., Hambarian, G., Michiels, M., Vermeulen, J., & de Haan, L.
Affiliations
  • GGZ Rivierduinen (NL)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
Corresponding author
Bogers, Jan P A M
ORCID
Venue
Schizophrenia Bulletin Open
Publisher
Oxford University Press (OUP)
Published
2020-01-01
Volume
1
Issue
1
Pages
sgaa002-sgaa002
ISSN
2632-7899 (ISSN-L)
DOI
10.1093/schizbullopen/sgaa002
PMC
PMC13701044
OpenAlex
W3009122577
Cited by
33
References
79
Citations by year
2026: 2 · 2025: 6 · 2024: 3 · 2023: 4 · 2022: 9 · 2021: 8 · 2020: 1
FWCI
0.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Schizophrenia Bulletin Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
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
psychotic relapse, chronic schizophrenia, antipsychotic dose reduction, antipsychotic discontinuation, risk factors, relapse rate, disease duration, hospitalized patients, antipsychotic adverse effects

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