首次发作精神分裂症患者出院服药情况1年调查

目的 了解首次发作(以下简称首发)精神分裂症患者出院服用抗精神病药的特点.方法 对137例首发精神分裂症患者出院后的服药情况进行问卷式跟踪随访调查1年,并比较服用第1代抗精神病药患者(64例)和第2代抗精神病药患者(73例)的差异.结果 首发精神分裂症患者服药依从性随时间推延逐渐降低,与所服药物类型无关.第1代抗精神病药组出院后第1、3、6、12个月的停药率分别为0%、7%、18%、50%,第2代抗精神病药组的停药率依次为3%、11%、21%、55%,2组各时点的差别无统计学意义.第1代抗精神病药锥体外系不良反应明显多于第2代抗精神病药,随访第12个月时分别为30%、7%, χ2=12.310,P<0.01.而后者在随访第12个月时出现内分泌系统不良反应比例(40%)高于第1代抗精神病药(5%)(χ2=13.433,P<0.05).结论 如何提高首发精神分裂症长期维持治疗的依从性是精神卫生服务的重要内容.     

5种新一代抗精神病药治疗首发精神分裂症的对照研究

目的比较利培酮、喹硫平、奥氮平、阿立哌唑和齐拉西酮治疗首发精神分裂症的疗效、可接受性及安全性。方法将200例首发精神分裂症患者随机给予上述5种之一的新一代抗精神病药治疗;采用《简明精神病量表》评定临床疗效,同时比较5种抗精神病药物的可接受性(合并用药率、换药率及维持原药率)和不良反应。结果 1临床疗效:阿立哌唑、利培酮、喹硫平、奥氮平、齐拉西酮治疗首发精神分裂症患者后BPRS评分较治疗前差异均有统计学意义(P0.01);经方差分析和LSD检验提示,利培酮组BPRS减分率显著高于阿立哌唑组(P0.01)和奥氮平组(P0.05)。2可接受性比较:经χ2检验提示(χ~2=15.55,P=0.049);经过分割χ2检验,奥氮平较阿立哌唑、齐拉西酮差异均有统计学意义(P0.05);同时喹硫平较齐拉西酮差异也有统计学意义(P0.05)。3不良反应比较:在锥体外系反应、ECG改变、肝功能异常、便秘、白细胞减少5个方面差异均无统计学意义(均P0.05)。结论 5种新一代抗精神病药治疗精神分裂症首次发病患者疗效均较好,奥氮平、喹硫平可接受性较好;5种药物之间不良反应类似。     

奥氮平与氯氮平维持治疗精神分裂症的比较分析

目的比较奥氮平与氯氮平维持治疗精神分裂症患者1年的有效性和不良反应。方法对符合CC-MD-3精神分裂症诊断标准的患者,分别使用奥氮平和氯氮平治疗,病程≤5年稳定期的138例精神分裂症患者给予1年的维持治疗,以治疗中断率、中断前治疗时间并结合临床疗效评价抗精神病药的总体有效性,采用不良事件和实验室检查评价安全性,并评估患者出现的不良反应。结果随访1年,138例患者中有60例（43.5%）中断治疗。两药组间治疗中断率及中断前治疗时间的差异均无统计学意义（P〉0.05）;56例（40.6%）完成1年随访并达到临床痊愈标准,临床痊愈率在两组间的差异无统计学意义（P〉0.05）。两药总的不良反应发生率的差异无统计学意义（P〉0.05）,但镇静作用、锥体外系不良反应、月经紊乱及体质量增加等不良反应在不同药物间的差异有统计学意义（P〈0.01和0.05）。结论两药治疗精神分裂症患者1年的临床疗效相当,但药物的不良反应各异。     

258例儿童青少年精神分裂症住院患者药物治疗现状

目的了解儿童青少年精神分裂症患者药物治疗现状。方法调查2010年1月~2015年12月在我院住院的258例儿童青少年精神分裂症患者的药物治疗情况。结果单用非典型抗精神病药物186例(72.1%),两种抗精神病药物联用72例(27.9%)。单用利培酮66例(25.6%),奥氮平56例(21.7%),阿立哌唑35例(13.6%)。男性使用利培酮多于女性、使用阿立哌唑少于女性,差异有统计学意义(χ~2=9.905,8.380,均P0.01)。合用抗抑郁剂48例(18.6%),合用情绪稳定剂16例(6.2%),合用苯二氮卓类药物(BZD)32例(12.4%),不同性别、年龄比较差异无统计学意义(χ~2=0.016~1.482,均P0.05)。结论儿童青少年精神分裂症患者药物治疗以单用非典型抗精神病药物为主。使用利培酮和阿立哌唑存在性别差异,少部分患者联合两种抗精神病药物,部分患者合用抗抑郁剂、情绪稳定剂和BZD。     

阿立哌唑治疗精神分裂症疗效与安全性的meta分析

目的系统评价阿立哌唑治疗精神分裂症的疗效与安全性。方法检索2005～2006年中国期刊全文数据库阿立哌唑治疗精神分裂症的随机对照研究,对14个研究共1206例精神分裂症患者的研究来源、样本量、研究持续时间、疗效与安全性等进行meta分析。结果临床痊愈率及有效率阿立哌唑与其它抗精神病药差异无统计学意义(P>0.05);6周末阿立哌唑组阳性与阴性症状量表(PANSS)阴性症状分低于其它抗精神病药组(P<0.05);阿立哌唑锥体外系不良反应、静坐不能、震颤、肌强直及体重增加不良反应发生率显著低于其它抗精神病药(P<0.01)。结论阿立哌唑治疗精神分裂症的总疗效与其它药物相当,在改善阴性症状方面有一定优势,锥体外系及体重增加不良反应较小。     

CBT联合小剂量利培酮治疗精神分裂症患者幻听的临床效果及安全性研究

目的探讨认知行为治疗(CBT)联合小剂量利培酮在治疗精神分裂症幻听中的临床效果和安全性。方法采用随机数字表法将80例符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)精神分裂症诊断标准的伴有幻听的患者分为CBT干预组(研究组)与药物治疗组(对照组)各40例,均采用非典型抗精神病药利培酮片治疗,CBT组药物剂量约为对照组的1/3,同时予以CBT干预。分别于入组时、3个月、6个月及随访6个月采用阳性和阴性症状量表(PANSS)、幻听量表(AHRS)、副反应量表(TESS)评定患者的临床疗效及副反应情况。结果治疗3个月、6个月及随访6个月两组的PNASS评分、AHRS评分均较治疗前降低,差异有统计学意义(P0.05或0.01);随访6个月时,两组间比较差异有统计学意义(P0.05)。对照组不良反应发生率高于研究组,差异有统计学意义(χ2=5.7826,P0.05)。结论 CBT联合小剂量抗精神病药物及足量抗精神病药物治疗精神分裂症幻听均有临床效果,前者疗效的持续性及不良反应发生率可能优于后者,但需要进一步研究。     

住院精神分裂症患者抗精神病药物联合治疗的处方调查

目的了解住院精神分裂症患者抗精神病药物联合治疗(APP)的情况,为精神分裂症的临床用药提供参考。方法连续入组2014年1月1日-12月31日在广州医科大学附属脑科医院住院的精神分裂症患者,收集患者的社会人口学资料,使用临床总体印象量表-病情严重程度量表(CGI-SI)评估患者疾病严重程度,在患者出院日记录抗精神病药物的使用情况,比较接受单一抗精神病药物治疗患者(单药组)与接受APP患者(APP组)的临床特点,描述APP中具体抗精神病药物的使用情况。结果共入组801例住院精神分裂症患者,其中364例(45.4%)使用APP。与单药组相比,APP组发病年龄更小、本次住院时间和总病程更长、住院次数更多,差异均有统计学意义(P均0.05)。APP组中78.0%的患者为同时使用两种第二代抗精神病药物(SGA),常见的联用方式为利培酮(47.3%)、氯氮平(44.5%)和奥氮平(40.1%)联合另一种抗精神病药物。结论住院精神分裂症患者中,接受APP方案的患者发病较早且病程迁延;两种SGA联用是APP中最常见的疗法,APP方案中使用频率最高的药物依次为利培酮、氯氮平和奥氮平。     

抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者一年结局的影响

目的 比较抗精神病药单用与结合心理社会干预对非慢性精神分裂症患者1年结局的影响.方法 多中心随机对照研究,将1239例病程≤5年、稳定期的精神分裂症患者随机分为单纯药物治疗组(以下简称药物组,635例)和药物结合心理社会干预组(以下简称干预组,604例)治疗随访1年.心理社会干预包括健康教育、家庭干预、技能训练及认知行为治疗.主要结局指标为各种原因造成的治疗中断率、疾病复发率和再入院率;次要结局指标为自知力与治疗态度问卷(ITAQ)、健康状况问卷(SF-36)、大体评定量表(GAS)和社会功能缺陷筛选量表(SDSS)评分的变化.结果 (1)干预组和药物组总的治疗中断率分别为32.8%和46.8%[相对危险度(RR)=1.61],复发率分别为13.8%和21.3%(RR=1.76),再入院率分别为6.5%和11.2%(RR=1.99),差异均有统计学意义(P均<0.01～0.05).(2)干预组ITAQ总分变化值[(4.7±0.1)分]、6项SF-36因子分改善值、GAS总分变化值[(6.9±0.2)分]、SDSS总分变化值[(1.5±0.1)分]均明显高于药物组[分别为(1.5±0.1)分、(3.7±0.2)分、(1.0±0.1)分;P均<0.01～0.05].结论 抗精神病药结合心理社会干预治疗非慢性精神分裂症患者,中断率、复发率和再入院率均低于单用抗精神病药患者,自知力、治疗依从性、生活质量、社会功能的改善优于单用抗精神病药患者.     

1986年至2006年间4个年份唐山市精神分裂症住院患者抗精神病药物使用变化趋势

目的 分析近20年精神分裂症住院患者抗精神病药物治疗种类和剂量变化趋势.方法 调查1986年、1996年、2001年和2006年4个年份在唐山市6所精神病院出院的2 718例精神分裂症患者的3 195份住院病历,用专门设计的调查表记录患者的社会人口学资料、疾病特征以及患者出院时药物治疗信息.结果 ①治疗药物的变化:1986年、1996年、2001年和2006年最常使用的抗精神病药物分别是第一代抗精神病药物、氯氮平、氯氮平、除氯氮平外的第二代抗精神病药物,使用率分别为93.8%(396/422)、45%(285/634)、59.9%(557/930)、51.6%(623/1206).2006年氯氮平使用率达35.7%(431/1206).4个年份间患者出院时合并使用2种以上抗精神病药物治疗的比例旱升高趋势(趋势X~2=99.10,P＜0.001),从1986年的10.43%(44/422)渐升至2006年的26.29%(317/1209).②药物剂量变化:4个年份出院时患者服用抗精神病药物的氯丙嗪等效日剂量组间比较差异有统计学意义(Kruskal-Wallis X~2=43.32,P＜0.001),4个年份的出院患者日服药剂量随年份增长而呈下降趋势(Spearman R=-0.13,P＜0.001);抗精神病药的单一治疗日剂量低于合并治疗,差异有统计学意义(Kruskal-Wallis X~2=14.23,P＜0.001).③多元回归分析表明,患者出院时服用抗精神病药物的氯丙嗪等效剂量与抗精神病药物联合治疗(b=163.86,P＜0.001)、住院大数(b:25.76,P＜0.001)呈正相关;与使用第二代抗精神病药物(b=-114.92,P＜0.001)、发病年龄(b=-3.87,P＜0.001)呈负相关.结论 近20年第二代抗精神病药物已逐渐成为抗精神病治疗的主要用药,抗精神病药合并治疗的比例增加.临床实践中应考虑到氯氮平一直保持较高使用率的利弊和合并用药可能带来的药物不良反应.     

2006年我国十省市抗精神病药处方方式的现况调查

目的 调查2006年我国10省市抗精神病药处方方式;分析4年间我国抗精神病药处方方式的变化趋势.方法 按照作者2002年的调查方法,选择10省市41所精神疾病专科医院或综合医院精神科的5898例精神分裂症门诊和住院患者,于2006年5月22-28日使用自制修订的调查问卷进行精神分裂症处方方式的现况调查.结果 (1)5898例患者中,门诊患者为2716例(46.0%);住院患者为3182例(54.0%);男3041例(51.6%),女2803例(47.5%),缺失54例数据.(2)99.1%的患者接受了抗精神病药治疗,使用频率在前7位的药物依次为:氯氮平(31.7%),利培酮(30.5%),舒必利(14.5%),氯丙嗪(10.8%),奋乃静(9.2%)、喹硫平(7.2%),氟哌啶醇(5.8%).换算为氯丙嗪等效剂量后,住院患者平均药物剂量显著高于门诊患者.(3)72.7%的患者使用第2代抗精神病药治疗;第1代抗精神病药的使用频率为38.3%;6.19%的患者接受了长效药物治疗.(4)75.6%的患者接受了单一非长效抗精神病药治疗;24.4%的患者联合使用2种或2种以上抗精神病药.(5)54.1%的患者联合了抗胆碱能药、苯二氮革类、β-受体阻断剂、抗抑郁药和心境稳定剂,主要用于控制不良反应或增效治疗.结论 第2代抗精神病药已经成为我国治疗精神分裂症的主流药物,反映出精神分裂症治疗理念和治疗技术的进展.     

Time-to-therapy discontinuation in patients newly diagnosed with schizophrenia initiated on long-acting injectable versus oral dopamine receptor blocking agents

Aim

The purpose of this project is to assess the time-to-therapy discontinuation and hospital readmission rate among patients newly diagnosed with schizophrenia who are prescribed long-acting injectable versus oral dopamine receptor blocking agents.

Methods

A retrospective review of medical records was performed for adult patients admitted to an 80-bed inpatient behavioural health facility with a new diagnosis of schizophrenia. The primary outcome studied was time to therapy discontinuation within 1 year of discharge, while secondary outcomes assessed were time-to-therapy discontinuation within 90 days and readmission rate at 30-days, 6 months, and 1 year. Multivariate Cox proportional hazard and linear regression modelling were used for statistical analysis.

Results

A total of 425 patients were included in the analysis, with 66.4% (n = 282) discharged on oral and 33.6% (n = 143) on long-acting injectable dopamine receptor blocking agents. At 1 year post-discharge, the rates of discontinuation were 49.7% for those prescribed long-acting injectable and 55.7% for those prescribed oral formulations (adjusted hazard ratio = 0.54, p = .012). There was no statistically significant difference in readmission rate between the patients prescribed long-acting injectable and oral dopamine receptor blocking agents at any timepoint tested.

Conclusions

The use of long-acting injectable dopamine receptor blocking agents was associated with longer time-to-discontinuation compared to oral agents when prescribed to patients newly diagnosed with schizophrenia in the inpatient setting. However, this was not associated with significant reductions in rehospitalization, calling into question the clinical impact. Future studies will seek to confirm these findings using a prospective study design.     

Antipsychotic treatment discontinuation in previously untreated patients with schizophrenia: 36-month results from the SOHO study

Data from the 3-year, prospective, observational SOHO study were used to compare the effectiveness (in terms of treatment discontinuation) and the tolerability of olanzapine, risperidone, other atypicals and typical antipsychotics in 1009 previously untreated outpatients with schizophrenia who started monotherapy at baseline. Kaplan-Meier survival analysis estimated the time to treatment discontinuation by the treatment group, Cox proportional hazards regression models identified the variables associated with treatment discontinuation (adjusted for baseline differences between treatment groups), and logistic regression models compared the tolerability profiles of the different treatment groups. Of the 931 patients analyzed, 31.9% discontinued the medication initiated at baseline during the 3-year follow-up. Olanzapine had the lowest rate of discontinuation (28.9%), followed by other atypical (34.0%), risperidone (36.2%) and typical antipsychotics (44.5%). Compared to olanzapine, risk of treatment discontinuation was higher with typical antipsychotics (hazard ratio [HR] 1.75; 95% confidence interval [CI] 1.11, 2.78) or risperidone (HR 1.36; 95% CI 1.02, 1.82). A higher baseline Clinical Global Impression (CGI) positive score was associated with a higher risk of treatment discontinuation (HR 1.18; 95% CI 1.06, 1.30). Olanzapine was associated with a lower frequency of extrapyramidal symptoms than other antipsychotics, fewer prolactin-related adverse events than risperidone and other atypical antipsychotics, but greater weight gain than typicals and risperidone. For all analyses, comparison with the other atypical group is limited due to its small sample size (n = 50). In conclusion, treatment effectiveness and tolerability varied among antipsychotic medications in previously untreated patients with schizophrenia. The results should be interpreted conservatively given the observational study design.     

Self-reported reasons for discontinuation or continuation of antipsychotic medication in individuals with first-episode schizophrenia

Aim

Many individuals with schizophrenia discontinue initially prescribed antipsychotics. Knowledge on reasons for discontinuation among individuals with first-episode schizophrenia is sparse. We aimed to describe reasons for discontinuation and continuation, differences between individuals discontinuing and continuing, and factors predicting reasons for discontinuation or continuation.

Methods

This was a prospective cohort study with a post hoc design. Individuals with first-episode schizophrenia were included from early intervention teams in Denmark from 2009–2012. Sociodemographic and clinical variables were collected at baseline and reasons for discontinuation and continuation of antipsychotics were assessed at 3.5-year follow-up.

Results

Among 215 patients, 76 reported reasons for discontinuation and 139 for continuation. The most frequent reasons for discontinuation were “side effects” and “patient believed he/she no longer needed the medication because he/she was now better”. The most frequent reasons for continuation were “benefits for positive symptoms” and “another person told them to”. Individuals who discontinued antipsychotics were at baseline younger, had longer DUP, less negative symptoms, better social function, lower compliance, higher self-belief of coping, and fewer used antipsychotics compared to those continuing antipsychotics.

Conclusions

The effect of antipsychotics is the main reason to continue, whereas side effects were the main reason to discontinue. Knowledge of reasons to discontinue or continue is helpful in shared decision-making, identifying individuals with high odds of discontinuation, improving adherence, and helping with safe discontinuation.     

维思通维持性治疗首发精神分裂症的剂量选择及其随访结果

目的；为探讨采用维思通维持特性治疗首发精神分裂症的最佳剂量。方法：将1998年3月－1998年12月从我院出院服用维思通治疗的首发精神分裂症患者23例，随机分成治疗量维持组和治疗量的半量维持组，并采用简明精神量评定量表（BPRS）、大体评定量表（GAS）和副反应评定量表（TESS）对患者进行了2年的调查研究。结果：两组患者复发率、缓解率和副反应出现频率均无显著差异。结论：采用维思通治疗量的半量可能是维持性治疗首发精神分裂症的最佳治疗剂量。     

The effectiveness of antipsychotic medications in patients who use or avoid illicit substances: results from the CATIE study

OBJECTIVE: This double-blind study compared a second generation (atypical) antipsychotic drugs compared to a representative older agent for patients with schizophrenia who use or avoid illicit substances. METHODS: Schizophrenic subjects were recruited at 57 U.S. sites and randomly assigned to olanzapine, perphenazine, quetiapine, risperidone or ziprasidone for up to 18 months. The primary aim of this analysis was to delineate differences between the overall effectiveness of these five treatments among patients who used or did not use illicit substances. RESULTS: There were no significant differences between treatment groups in time to all-cause treatment discontinuation among patients who use illicit drugs (median 3.3 to 6.8 months). Among non-users time to treatment discontinuation was significantly longer for patients treated with olanzapine (median 13.0 months) than perphenazine ( 5.9 months), risperidone (5.6 months), or quetiapine (5.0 months); time to discontinuation for ziprasidone (4.3 months) was even shorter, although the latter difference was not significant. The difference between risperidone and quetiapine, although small, was significant. All remaining differences were non-significant. Similar results were found for discontinuation due to inefficacy. There were no differences between illicit users and non-users in symptom reduction and global improvement, after adjustment for differential duration of treatment. Differences in discontinuation results were attenuated by non-compliance, but the trends persisted after controlling for treatment compliance. CONCLUSIONS: Among patients with chronic schizophrenia who avoid use of illicit drugs, olanzapine was more effective than other antipsychotics as reflected by longer time to all-cause discontinuation, but illicit substance abuse attenuated this advantage, reinforcing the need for concurrent substance abuse treatment.     

Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy

PURPOSE: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. METHODS: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for >or=1 year during the follow-up period. RESULTS: Sixty-six (75%) patients achieved complete seizure freedom for >or=1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n=60), and in seven (12%) patients after discontinuation of AEDs (n=38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free >or=1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. CONCLUSIONS: Our results suggest that seizure freedom without aura at >or=1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.     

Effectiveness of olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia after discontinuing perphenazine: a CATIE study

OBJECTIVE: The relative effectiveness of newly started antipsychotic drugs for individuals with schizophrenia may depend on multiple factors, including each patient's previous treatment response and the reason for a new medication trial. This randomized, double-blind study compared olanzapine, quetiapine, and risperidone in patients who had just discontinued the older antipsychotic perphenazine. METHOD: Subjects with schizophrenia (N=114) who had been randomly assigned to and then discontinued perphenazine in phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study were reassigned randomly to double-blinded treatment with olanzapine, 7.5-30.0 mg/day (N=38); quetiapine, 200-800 mg/day (N=38); or risperidone, 1.5-6.0 mg/day (N=38). The primary aim was to determine whether there were differences among these three treatments in effectiveness, as measured by time to treatment discontinuation for any reason. Secondary outcomes included reasons for treatment discontinuation and measures of drug tolerability. RESULTS: The time to treatment discontinuation was longer for patients treated with quetiapine (median, 9.9 months) and olanzapine (7.1 months) than with risperidone (3.6 months). There were no significant differences between treatments on discontinuation due to inefficacy, intolerability, or patient decision. CONCLUSIONS: Among this group of patients with chronic schizophrenia who had just discontinued the older antipsychotic perphenazine, quetiapine and olanzapine were more effective than risperidone, as reflected by longer time to discontinuation for any reason. In the context of other results from the CATIE study, the effectiveness and acceptability of antipsychotic drugs appears to vary considerably according to clinical circumstances.     

Does short-term antipsychotic discontinuation of up to 3 weeks worsen symptoms in acute schizophrenia? A pooled analysis of placebo washout data

Aim

This study aimed to examine symptom changes during short-term discontinuation of antipsychotics up to 3 weeks including the placebo washout phase in acute schizophrenia.

Methods

The data from three double-blind, randomized, controlled trials comparing lurasidone versus placebo in patients with acute exacerbation of schizophrenia were analyzed. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS) total and the Clinical Global Impression–Severity scale (CGI-S) scores. The scores before and after the antipsychotic discontinuation phase were compared, and factors associated with score changes were explored.

Results

Among 2154 patients participating in the trials, 600 who received antipsychotic monotherapy and completed the antipsychotic discontinuation phase were included in the analysis. No patients received clozapine. The mean duration of the discontinuation phase was 5.9 ± 2.5 days. The PANSS total and CGI-S scores significantly changed from 94.0 ± 9.5 to 95.4 ± 10.5 (P < 0.001) and from 4.9 ± 0.6 to 4.9 ± 0.7 (P = 0.041), respectively, during this phase; however, the absolute difference was minimal. The score changes were not associated with the type or dose of prior antipsychotics, or the duration or strategy (abrupt vs gradual) of antipsychotic discontinuation.

Conclusions

Symptoms may not worsen to a clinically meaningful degree after short-term discontinuation of non-clozapine antipsychotics up to 3 weeks in patients with acute exacerbation of schizophrenia, suggesting that antipsychotic efficacy persists at least several days after discontinuation. This finding supports once-daily dosing regimen of antipsychotics and abrupt antipsychotic discontinuation when switching to another antipsychotic.     

Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia.

OBJECTIVE: The goal of this report was to examine the clinical course following neuroleptic discontinuation of patients with recent-onset schizophrenia who had been receiving maintenance antipsychotic treatment for at least 1 year. METHOD: Fifty-three volunteer patients with recent-onset schizophrenia who had been clinically stabilized on a maintenance regimen of fluphenazine decanoate for a mean of 16.7 months had their antipsychotic medications withdrawn under clinical supervision. Participants initially entered a 24-week, double-blind crossover trial in which fluphenazine and placebo were administered for 12 weeks each. For those who did not experience symptom exacerbation or relapse during this period, fluphenazine was openly withdrawn; participants were then followed for up to 18 additional months. RESULTS: When a low threshold for defining symptom reemergence was used, 78% (N=39 of 50) of the patients experienced an exacerbation or relapse within 1 year; 96% (N=48 of 50) did so within 2 years. Mean time to exacerbation or relapse was 235 days. When hospitalization was used as a relapse criterion, only six of 45 of individuals (13%) experiencing an exacerbation or relapse who continued in treatment in the clinic were hospitalized, demonstrating the sensitivity of the psychotic exacerbation criterion. CONCLUSIONS: The vast majority of clinically stable individuals with recent-onset schizophrenia will experience an exacerbation or relapse after antipsychotic discontinuation, even after more than a year of maintenance medication. However, clinical monitoring and a low threshold for reinstating medications can prevent hospitalization for the majority of these patients.