Discontinuation vs. continuation treatment with neuroleptics for a better long-term outcome
| Autor: | Fokko Nienhuis, Durk Wiersma, Lex Wunderink, Sjoerd Sytema, Roeline Nieboer |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Psychosis medicine.medical_treatment Odds ratio Functional recovery Logistic regression medicine.disease 030227 psychiatry Discontinuation 03 medical and health sciences Psychiatry and Mental health 0302 clinical medicine Internal medicine medicine Haloperidol CONTINUATION TREATMENT Psychiatry Antipsychotic Psychology medicine.drug |
| Zdroj: | European Psychiatry. 33:S50-S50 |
| ISSN: | 1778-3585 0924-9338 |
| DOI: | 10.1016/j.eurpsy.2016.01.918 |
| Popis: | BackgroundLong-term functional outcome of dose-reduction/discontinuation strategies in first-episode psychosis (FEP) has not been studied before. The present study compared 7-year outcome of an early antipsychotic dose-reduction/discontinuation (DR) strategy with maintenance treatment (MT). Primary outcome was (symptomatic and functional) recovery; relapse rates, functional and symptomatic remission were secondary outcomes.MethodsFEP patients (n = 128) symptomatically remitted for 6 m during their first treatment year who completed an 18 months trial comparing MT and DR were followed-up at 7 years. Symptomatic remission criteria were adopted from Andreasen et al., functional remission criteria were based on a functioning scale. Recovery was defined as meeting both criteria sets. MT or DR strategy, and baseline parameters were entered in a logistic regression analysis with symptom and functional remission and recovery at 7-years follow-up as dependent variables.ResultsOne hundred and three patients consented to participate. DR-patients showed twice the recovery-rate of MT-patients (40% against 18%), odds ratio 3.5 (P = .014). Symptomatic remission-rates were equal (69% and 67%). Better DR recovery-rates were attributable to higher functional remission-rates (46% vs. 20%) in DR. Predictors of recovery were DR, baseline living together and less severe negative symptoms. During the last 2 years of follow-up the mean daily dose in haloperidol equivalents was 2.20 mg in DR vs. 3.60 mg in MT (P = .031).Relapse rates were initially higher in DR but leveled at 3 years; 61.5% relapsed in DR and 68.6% in MT in 7 years.ConclusionDR of antipsychotics during early stages of remitted FEP significantly improved 7-years outcome in terms of recovery and functional remission compared to maintenance treatment. Though initially relapse rates in GD were higher, these equalled those in MT from 3 years to the end of the study. While the necessity of immediate antipsychotic treatment in FEP and positive symptoms relapse is robustly demonstrated in a great number of studies, this study suggests that we are faced with a dilemma concerning the drawbacks of long-term maintenance antipsychotic treatment on functional capacity. Though antipsychotic discontinuation appears only feasible without relapse in a substantial minority of patients, guided dose-reduction as far as positive symptoms remain subsided and allow it, appears a feasible strategy in view of functional recovery, doing justice to both sides of the dilemma.Disclosure of interestThe authors have not supplied their declaration of competing interest. |
| Databáze: | OpenAIRE |
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