Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal‐related relapse

Moncrieff, J.

doi:10.1111/j.1600-0447.2006.00787.x

Cited by 207 publications

(160 citation statements)

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“…Eine Dosisminderung kann vermutlich manche unerwünschten Effekte der Antipsychotika auf das Hirnvolumen abschwächen. Ein plötzliches Absetzen von Antipsychotika ist jedoch kontraindiziert, auch aufgrund des erhöh-ten Rückfallrisikos [117,118,119,120]. In einer Übersichtsarbeit [121] war dies allerdings nicht nachweisbar, wobei die durchschnittliche Dauer des Ausschleichens in den ausgewerteten Studien nur etwa 4 Wochen betrug.…”

Section: Therapeutische Schlussfolgerungenunclassified

Frontale Hirnvolumenminderung durch Antipsychotika?

et al. 2014

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Zusammenfassung In dieser Übersicht werden die Ergebnisse longitudinaler Studien zur frontalen Hirnvolumenminderung bei Menschen mit einer Erkrankung aus dem Spektrum schizophrener Psychosen dargestellt und zur Behandlung mit Antipsychotika in Beziehung gesetzt. Nach einer systematischen Literaturrecherche wurden alle Studien ausgewertet, in denen an einer größeren Population Ergebnisse bildgebender Diagnostik zur Veränderung der Hirnstruktur im Langzeitverlauf mit Daten zur antipsychotischen Behandlung und zur Schwere der Erkrankung korreliert wurden. Die Ergebnisse zeigen, dass es eine Evidenz für eine Volumenminderung grauer und weißer Substanz des Frontalhirns gibt, die sich nicht alleine durch die Erkrankung selbst und ihre Krankheitsschwere erklären lässt, sondern mit hoher Wahrscheinlichkeit auch Ausdruck einer langfristigen Antipsychotikawirkung auf das Gehirn ist. Ob sog. „Second-generation“-Antipsychotika hier einen mittel- bis längerfristigen Vorteil gegenüber „First-generation“-Antipsychotika besitzen, ist derzeit unklar. Angesichts des Beitrags von Antipsychotika zu den hirnstrukturellen Veränderungen, die offenbar kumulativ dosisabhängig sind und negative Auswirkungen für die Neurokognition, die Positiv- und Negativsymptomatik und das soziale Anpassungsniveau mit sich bringen können, sollten die Empfehlungen zur antipsychotischen Langzeitbehandlung neu überdacht werden. Vor dem Hintergrund der neurobiologischen Befunde empfehlen wir und andere, möglichst niedrige antipsychotische Dosierungen zur Symptomkontrolle einzusetzen. Bei psychiatrischen Störungen außerhalb des Schizophreniespektrums sollten Antipsychotika ebenfalls nur mit Vorsicht und nach sorgfältiger Abwägung von Risiken und Nutzen angewandt werden. In diesem Kontext werden zunehmend auch Behandlungsansätze relevant, welche die antipsychotische Medikation minimieren oder sogar einen nur selektiven Einsatz erlauben.

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Section: Therapeutische Schlussfolgerungenunclassified

Frontale Hirnvolumenminderung durch Antipsychotika?

et al. 2014

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“…Another possibility to consider is an antipsychotic withdrawal syndrome. 5 In our case, olanzpine was tapered over 21 days, allowing for a gradual reduction of olanzapine-induced D 2 blockade. In addition, the described activation episode occurred 16 days after olanzapine treatment was completely discontinued, reducing the likelihood of an antipsychotic withdrawal reaction as a possible mechanism.…”

Section: Activation Induced By High-dose Ziprasidone: a Case Reportmentioning

confidence: 99%

“…There have been a few reports of activation at US Food and Drug Administration-approved dosages. [1][2][3][4][5][6] Ziprasidone has been used in dosages well above 160 mg/d by clinicians and has been shown to be effective and well tolerated in patients with schizophrenia. 7 Here we report a case of psychomotor activation in a patient who was treated with higher than 160 mg/d of ziprasidone owing to lack of response to lower doses of prior antipsychotics.…”

Section: Activation Induced By High-dose Ziprasidone: a Case Reportmentioning

confidence: 99%

Activation Induced by High-Dose Ziprasidone

Kaushik¹,

Maccabee²,

Kaushik³

et al. 2009

J. Clin. Psychiatry

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“…Remarkably, similar considerations apply to the whole evidence base on LAIs. There are interesting pharmacokinetic features of LAIs that may suggest potential advantages over oral antipsychotics (Ereshefsky & Mascarenas, 2003;Moncrieff, 2006), however systematic reviews of clinical trial data, including a recent meta-analysis of randomised trials comparing oral v. LAIs of the same antipsychotic drug, failed to find any differences in terms of efficacy or tolerability (Leucht et al 2011;Kishimoto et al 2014;Misawa et al 2016). Another expected advantage of LAIs would be better treatment adherence.…”

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confidence: 99%

New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base

Ostuzzi

Papola

Gastaldon

et al. 2016

Epidemiol Psychiatr Sci

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This Section of Epidemiology and Psychiatric Sciences appears in each issue of the Journal to stress the role of the epidemiological approach to promote advances in the field of clinical psychopharmacology, with a particular attention to controversial findings. The ultimate aims are to help develop a more critical attitude towards the results of research studies published in the international literature, to promote original research projects with higher methodological standards, and to implement the most relevant results of research in every-day clinical practice. These contributions are written in house by the journal's editorial team or commissioned by the Section Editor (no more than 1000 words, short unstructured abstract, 4 key-words, one Table or Three-month long-acting paliperidone is a new, recently marketed, formulation of paliperidone, characterised by the longest available dosing interval among long-acting antipsychotics. The clinical profile of 3-month long-acting paliperidone was recently summarised by the European Medicines Agency (EMA) in a public assessment report, released in April 2016. In this commentary, the main strengths and limitations of the EMA assessment report were appraised and discussed, in order to highlight possible implications for clinical practice, future research and regulatory practices for drug approval. In April 2016, the European Medicines Agency (EMA) released a public assessment report on paliperidone palmitate 3-month injections (PP3M), a new longacting injectable (LAI) formulation of paliperidone that requires an injection once every third month. This new formulation adds to other two already in use formulations: an oral prolonged-release tablet formulation, and a 1-month long-acting formulation (PP1M). The EMA document reported a positive opinion for granting a marketing authorisation for four new strengths of PP3M, with an indication for the maintenance treatment of schizophrenia in adult patients who have been adequately treated with PP1M (European Medicines Agency, Committee for Medicinal Products for Human Use, 2016). The main innovation of PP3M relies in a much slower release in the bloodstream as compared with PP1M. This Commentary critically appraises the clinical data reported in the EMA document, and attempts to identify some of the challenging issues related to the use of PP3M in everyday practice.The EMA report covers two randomised studies: one phase-3, randomised, double-blind, placebocontrolled trial comparing PP3M v. placebo (Berwaerts et al. 2015), and one phase-3, randomised, double-blind, head-to-head, non-inferiority trial, comparing PP3M v. PP1M (Savitz et al. 2016).The placebo-controlled trial included 305 randomised subjects in the double-blind phase and showed the superiority of PP3M over placebo in terms of relapse prevention (hazard ratio (HR) 3.45; 95% * Address for correspondence: Dr G. Ostuzzi, Section of Psychiatry, University of Verona, Ospedale Policlinico GB Rossi, Piazzale L.A. Scuro, 10 -37134 Verona, Italy.(Email: giovanni.ostuzzi@gm...

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Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal‐related relapse

Abstract: These effects require further urgent research. Interventions to reduce morbidity after drug withdrawal need to be developed.

Cited by 207 publications

References 50 publications

Frontale Hirnvolumenminderung durch Antipsychotika?

Frontale Hirnvolumenminderung durch Antipsychotika?

Activation Induced by High-Dose Ziprasidone

New EMA report on paliperidone 3-month injections: taking clinical and policy decisions without an adequate evidence base

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