Predictors for Antipsychotic Dosage Change in the First Year of Treatment in Schizophrenia Spectrum and Bipolar Disorders

Abstract

Background: Use of antipsychotic medication is central in the treatment of psychotic disorders. However, there is limited knowledge about prescription practice of antipsychotics in the critical early phase of these disorders. Clinical guidelines recommend low dosages, but no discontinuation of antipsychotic medication during the first year of treatment in first episode patients. The main aim of this study was to identify clinical predictors for dosage change or discontinuation of antipsychotics during this period. Methods: A total of 426 antipsychotic-using patients with schizophrenia spectrum or bipolar disorder, including both a first treatment sample and a sample of patients with previous treated episodes (“multi-episode” sample) from the same diagnostic groups, underwent thorough clinical and sociodemographic assessment at study baseline and after 1 year. Prescribed dosage levels at baseline and follow-up and change in dosage or discontinuation of antipsychotics from baseline to follow-up were compared between groups, controlling for possible confounders. Results: We found reduced dosages over the first year in both first treatment groups across diagnoses, but not in multi-episode groups. Weight increase predicted dosage reduction in the schizophrenia group, while the level of psychotic symptoms at baseline predicted dosage reduction in the bipolar group. We found higher baseline levels of antipsychotic use in the schizophrenia group than in the bipolar group. Conclusion: We found indications of a trans-diagnostic reduction of prescribed dosages of antipsychotics over the first year in treatment, but with different predictors for this reduction in the two diagnostic groups. The findings increase the understanding of drivers of early medication change in psychotic disorder.

Stable patients with schizophrenia switched to paliperidone palmitate 3-monthly formulation in a naturalistic setting: impact of patient age and disease duration on outcomes

“…Of note, in this analysis a slightly higher proportion of younger than older patients experienced weight increase (10.7% and 7.2%) while in the current study the difference was limited (6.6% versus 7.2%). 48 PP3M generally exhibited a favourable safety profile and was well tolerated in both age and duration groups. The proportion of patients with possible/probable or very likely drug-related TEAEs was slightly higher in the younger versus the older group and was also higher in the shorter versus longer duration group.…”

“…Of note, in this analysis a slightly higher proportion of younger than older patients experienced weight increase (10.7% and 7.2%) while in the current study the difference was limited (6.6% versus 7.2%). 48 …”

Cariprazine in Three Special Different Areas: A Real-World Experience

“…Currently, SGAs are considered the mainstay of treatment for both acute episodes’ management and relapse prevention of schizophrenia. 4 Moreover, they are increasingly used in different phases of BD. 5 Clinical evidence has shown that cariprazine could be especially favorable for patients with predominant negative symptoms with an excellent tolerability profile.…”

High Rate of Discontinuation during Long-Acting Injectable Antipsychotic Treatment in Patients with Psychotic Disorders

“…Although the predictors of antipsychotic LAI discontinuation were not studied extensively, different factors including the number of hospitalizations before treatment, the setting where the treatment was started, dose of LAI antipsychotic, history of combined antipsychotic treatment, substance abuse and duration of illness were found to be related to treatment discontinuation [37,52] Similarly, we showed that the type of prescribed antipsychotic LAI at baseline together with a history of multiple substance use disorders may favor treatment discontinuation during the 12-month follow-up period. In this regard, some authors reported that early non-response to an antipsychotic is associated with long-term discontinuation of this antipsychotic [53]. For instance, a RCT study found that early response to olanzapine LAI predicts long-term clinical stabilization, similarly to what happens with oral antipsychotics [54].…”