Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients: Results from an aborted randomised trial

Boonstra, Geartsje; Burger, Huibert; Grobbee, Diederick E.; Kahn, R.

doi:10.3109/13651501.2010.534801

Cited by 35 publications

(38 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In all of the studies, the relapse rate was higher for those withdrawn from the medication. 65,66,67,68,69 This was consistent with Leucht's meta-analysis of this literature (reviewed earlier in this paper. )…”

Section: ) Drug-withdrawal Studiessupporting

confidence: 90%

Reservasjonsrett i psykiatrien nå!

Nesset¹,

Teien²

2017

Tidsskriftet

View full text Add to dashboard Cite

Section: ) Drug-withdrawal Studiessupporting

confidence: 90%

Reservasjonsrett i psykiatrien nå!

Nesset¹,

Teien²

2017

Tidsskriftet

View full text Add to dashboard Cite

“…All other study characteristics Fig. 9 Relapse rates in firstepisode psychotic patients after randomization to intermittent or continuous treatment strategies [29,31,35,116,117] Fig. 10 Relapse rates at 2 years in multi-episode psychotic patients after randomization to intermittent or continuous treatment strategies [18,26,27,31] ( , availability of psychological treatment, tapering, funding by a pharmaceutical company, and whether subjects were on LAAP before randomization) were found to be non-significant.…”

Section: Meta-analyticmentioning

confidence: 94%

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

et al. 2015

View full text Add to dashboard Cite

With continuous treatment, patients have a lower risk of relapse and remain relapse free for a longer period of time compared with placebo and intermittent treatment strategies. Moreover, 'success rates' in the intermittent treatment conditions are expected to be an overestimate of actual outcome rates. Therefore, continuous treatment remains the 'gold standard' for good clinical practice, particularly as, until now, only a few and rather general valid predictors for relapse in schizophrenia are known and subsequent relapses may contribute to functional deterioration as well as treatment resistance in patients with schizophrenia.

show abstract

“…We identified eight studies, details of which are summarised in Table 1. As with the multi-episode samples, these studies report varying rates of relapse, with four reporting symptom recurrence rates of close to 80% at 12 months after discontinuation [10,21-23] and two reporting rates of about 95% at 24 months [10,21]. Reasons for the lower reported recurrence rates in the other studies are not entirely apparent, although the Kane et al study [24] had a high dropout rate (40%) and these patients were considered not to have relapsed; and in the Wunderink et al study [25], of 65 patients randomized to the discontinuation arm 14 (21.5%) did not have symptom recurrence.…”

Section: Reviewmentioning

confidence: 99%

The nature of relapse in schizophrenia

et al. 2013

View full text Add to dashboard Cite

BackgroundMultiple relapses characterise the course of illness in most patients with schizophrenia, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications.MethodsWe critically review selected literature regarding the nature and underlying neurobiology of relapse.ResultsRelapse rates are very high when treatment is discontinued, even after a single psychotic episode; a longer treatment period prior to discontinuation does not reduce the risk of relapse; many patients relapse soon after treatment reduction and discontinuation; transition from remission to relapse may be abrupt and with few or no early warning signs; once illness recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode; while most patients respond promptly to re-introduction of antipsychotic treatment after relapse, the response time is variable and notably, treatment failure appears to emerge in about 1 in 6 patients. These observations are consistent with contemporary thinking on the dopamine hypothesis, including the aberrant salience hypothesis.ConclusionsGiven the difficulties in identifying those at risk of relapse, the ineffectiveness of rescue medications in preventing full-blown psychotic recurrence and the potentially serious consequences, adherence and other factors predisposing to relapse should be a major focus of attention in managing schizophrenia. The place of antipsychotic treatment discontinuation in clinical practice and in placebo-controlled clinical trials needs to be carefully reconsidered.

show abstract

Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients: Results from an aborted randomised trial

Abstract: 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.

Cited by 35 publications

References 21 publications

Reservasjonsrett i psykiatrien nå!

Reservasjonsrett i psykiatrien nå!

The Use of Continuous Treatment Versus Placebo or Intermittent Treatment Strategies in Stabilized Patients with Schizophrenia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with First- and Second-Generation Antipsychotics

The nature of relapse in schizophrenia

Contact Info

Product

Resources

About