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Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis: systematic review
- Source :
- BJPsych Open, Thompson, A, Winsper, C, Marwaha, S, Haynes, J, Alvarez-Jimenez, M, Hetrick, S, Realpe, A, Vail, L, Dawson, S & Sullivan, S 2018, ' Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis : a systematic review ', BJPsych Open, vol. 4, no. 4, pp. 215-225 . https://doi.org/10.1192/bjo.2018.17
- Publication Year :
- 2017
-
Abstract
- BackgroundUnderstanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice.MethodA systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP.ResultsSeven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis.ConclusionsThere is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies.Declaration of interestA.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Review
Relapse prevention
Placebo
law.invention
maintenance
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
first episode psychosis
Medicine
Antipsychotic
relapse
business.industry
Absolute risk reduction
030227 psychiatry
Discontinuation
antipsychotic
Psychiatry and Mental health
Relative risk
business
Psychosocial
030217 neurology & neurosurgery
discontinuation
Subjects
Details
- ISSN :
- 20564724
- Volume :
- 4
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- BJPsych open
- Accession number :
- edsair.doi.dedup.....fa7157c9b2cfe29de94f3dd4e3c4d669