Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients: results from an aborted randomised trial
Abstract
OBJECTIVE: To assess the effect of withdrawal of antipsychotic treatment on relapse risk in remitted first-episode schizophrenia patients. METHODS: First-episode 1-year stable and remitted outpatients with a schizophrenic disorder were randomly allocated to continuation of their antipsychotic regimen for at least 6 months (N = 9), or gradual withdrawal (N = 11). Primary outcome was the difference in cumulative relapse-free survival at 9 months. RESULTS: Recruitment was terminated prematurely on 26 October 2005. The cumulative relapse-free survival was 88% (SE = 0.12) in the continuation and 18% (SE = 0.12) in the discontinuation group (P = 0.001) at 9 months follow-up. CONCLUSIONS: Discontinuation of antipsychotic medication markedly increases the risk of relapse in stable remitted first-episode schizophrenia patients. In future studies the topics of safety monitoring and sampling of patients should receive extra attention.
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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 [86]
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A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse
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- Authors
- Boonstra, G., Burger, H., Grobbee, D. E., & Kahn, R. S.
- Affiliations
- University Medical Center Utrecht (NL)
- University Medical Center Groningen (NL)
- Utrecht University (NL)
- Corresponding author
- Boonstra, Geartsje
- Venue
- International Journal of Psychiatry in Clinical Practice
- Publisher
- Informa UK Limited
- Published
- 2010-11-30
- Volume
- 15
- Issue
- 2
- Pages
- 128-134
- ISSN
- 1365-1501 (ISSN-L)
- 1471-1788
- OpenAlex
- W2096205994
- Cited by
- 38
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 2 · 2016: 1 · 2015: 4 · 2014: 3 · 2013: 3 · 2012: 3
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Psychiatry in Clinical Practice (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)
- Funders
- Eli Lilly and Company
- 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
- antipsychotic prophylaxis, antipsychotic withdrawal, first-episode schizophrenia, remission, relapse risk, relapse-free survival, drug discontinuation
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Schizophrenia, Antipsychotic Agents, Disease-Free Survival, Secondary Prevention
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