Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals

Son, Jacqueline Mayoral‐van; Foz, Víctor Ortiz‐García de la; Martínez-Garcia, Obdulia; Moreno, T.; Parrilla-Escobar, Maria A.; Valdizán, Elsa M.; Crespo‐Facorro, Benedicto

doi:10.4088/jcp.14m09540

Cited by 55 publications

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“…The optimal duration of treatment following a first episode of schizophrenia is therefore an important health question. In one recent study, the relapse rate for those who discontinued medication following 18 months of treatment (and were in clinical remission for more than 12 months with 6 months or more of functional recovery) was twice that of those who continued maintenance antipsychotic medication over the 3-year study period 51. There is evidence of benefit for service users who remain in contact with an early intervention service for up to 5 years compared to those who do not 42.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode

Keating¹,

McWilliams²,

Schneider

et al. 2017

BMJ Open

113

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ObjectivesClinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia.MethodsA multidisciplinary group identified key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia. The MEDLINE and EMBASE databases, websites of professional organisations and international guideline repositories, were searched for CPGs that met the inclusion criteria. The AGREE II instrument was applied by three raters and data were extracted from the guidelines in relation to the key health questions.ResultsIn total, 3299 records were screened. 10 guidelines met the inclusion criteria. 3 guidelines scored well across all domains. Recommendations varied in specificity. Side effect concerns, rather than comparative efficacy benefits, were a key consideration in antipsychotic choice. Antipsychotic medication is recommended for maintenance of remission following a first episode of schizophrenia but there is a paucity of evidence to guide duration of treatment. Clozapine is universally regarded as the medication of choice for treatment resistance. There is less evidence to guide care for those who do not respond to clozapine.ConclusionsAn individual's experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.

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Section: Discussionmentioning

confidence: 99%

Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode

Keating¹,

McWilliams²,

Schneider

et al. 2017

BMJ Open

113

View full text Add to dashboard Cite

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“…In clinical practice, due to the lack of insight into the prophylactic effects of drugs, emergence of disturbing side effects, and concerns over the long-term harm associated with antipsychotics, it is unlikely that patients will accept an indefinite treatment after a single episode of psychosis [20]. However, stopping antipsychotic medication has been repeatedly demonstrated as the biggest predictor of relapse after a first episode [153–155].…”

Section: Other Keystone Aspects In the Treatment Of First-episode Indmentioning

confidence: 99%

“…Strikingly, those patients with an earlier reduction or discontinuation treatment strategy appear to have long-term functional gains compared with individuals who maintained treatment [157, 158]. In a recent investigation, Mayoral-van Son et al [20] described a high risk of symptom recurrence after antipsychotic treatment discontinuation in individuals who had accomplished a functional recovery after a single psychotic episode. Moreover, those relapsed individuals had a greater severity of symptoms and lower functional status after 3 years.…”

Section: Other Keystone Aspects In the Treatment Of First-episode Indmentioning

confidence: 99%

“…The profile of individuals who would benefit from treatment discontinuation, and the optimal duration of prophylactic antipsychotic medication remain unclear. The lowest effective-dose regimen is highly recommended [20, 154] and a trial off antipsychotic medication is not to be recommended [159]. Clinicians should provide accurate information to people with a FEP (and relatives) about the fact that even if they have been symptom free and functionally recovered on antipsychotic treatment, the risk of relapse is still likely to be high if antipsychotics are discontinued [160].…”

Section: Other Keystone Aspects In the Treatment Of First-episode Indmentioning

confidence: 99%

“…Non-adherence to antipsychotic treatment and lack of insight into the illness are very frequent in people with a FEP [18]. Poor adherence to treatment is associated with an increased rate of relapse [19, 20]. Lack of insight promotes non-adherence to medication and leads to a poorer course of illness and functioning [21–23].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Crespo‐Facorro

Pelayo-Terán²,

Son³

2016

Neurol Ther

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Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.

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Improving outcomes of first‐episode psychosis: an overview

2017

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Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.

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Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals

Abstract: ClinicalTrials.gov identifier: NCT02220504.

Cited by 55 publications

References 0 publications

Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode

Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Improving outcomes of first‐episode psychosis: an overview

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