Antipsychotic treatment in the maintenance phase of schizophrenia: An updated systematic review of the guidelines and algorithms
| Autor: | Hiroyoshi Takeuchi, Takefumi Suzuki, Masaru Mimura, Yuhei Kikuchi, Hiroyuki Uchida, Yutaro Shimomura |
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| Rok vydání: | 2020 |
| Předmět: |
Schizophrenia (object-oriented programming)
medicine.medical_treatment MEDLINE Antipsychotic treatment 03 medical and health sciences 0302 clinical medicine Secondary Prevention Humans Medicine Maintenance phase Agree ii Antipsychotic Biological Psychiatry business.industry 3. Good health 030227 psychiatry Discontinuation Psychiatry and Mental health Practice Guidelines as Topic Schizophrenia Dose reduction business Algorithm Algorithms 030217 neurology & neurosurgery Antipsychotic Agents |
| Zdroj: | Schizophrenia Research. 215:8-16 |
| ISSN: | 0920-9964 |
| Popis: | Background We updated our previous systematic review regarding clinical guidelines and algorithms on antipsychotic treatment in the maintenance phase of schizophrenia (doi: 10.1016/j.schres.2011.11.021) to incorporate and synthesize more recent findings to guide clinical practice. Methods We conducted a systematic literature search to identify clinical guidelines and algorithms describing antipsychotic treatment in the maintenance phase of schizophrenia using MEDLINE and Embase. We assessed overall quality of the guidelines/algorithms according to the AGREE II instrument and extracted information on treatment recommendations. Results We identified 20 guidelines/algorithms from various regions, including 11 updated or newly launched ones after the previous systematic review in 2012. All of the guidelines/algorithms satisfied a certain level of quality. Where mentioned, endorsements were sorted into “recommended”, “partially recommended”, or “not recommended”. As for antipsychotic discontinuation strategy, a majority of guidelines/algorithms that mentioned this strategy did not recommend it for multiple-episode schizophrenia (N = 5/6). On the other hand, the guidelines/algorithms tended to shift from “not recommended” to “partially recommended” both for schizophrenia in general (N = 7/13, N = 7/8 for those published after 2013) and first-episode schizophrenia (N = 10/11, N = 7/7 for those published after 2013) regarding this strategy. All guidelines/algorithms (N = 9/9) converged to discourage antipsychotic intermittent/targeted strategy. Similar to antipsychotic discontinuation strategy, all of the updated or new guidelines/algorithms (N = 6/6) endorsed antipsychotic dose reduction/lower dose strategy. Conclusion Recent clinical guidelines and algorithms on antipsychotic maintenance treatment in schizophrenia shifted more toward a possibility of antipsychotic discontinuation and dose reduction/lower dose strategies. Nonetheless, clinicians need to contemplate on the risk-benefit balance of these strategies for individual patients. |
| Databáze: | OpenAIRE |
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