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

Abstract

AimMany 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.MethodsThis 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.ResultsAmong 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.ConclusionsThe 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.

Brexpiprazole in patients with schizophrenia with or without substance use disorder: an observational study

“…When choosing a prescription, clinicians should balance efficacy with safety and adverse events. The latter may impair the patient's quality of life (QoL) and lead to treatment discontinuation ( 31 , 32 ). This, in turn, may be followed by symptom exacerbation, which is the main reason for subsequent hospitalization ( 33 ).…”

Response to: “Consistent terminology for medication-related problems in pharmacogenomic cases”

“… 3 When treatments fail to improve the outcomes, this is mostly because patients are not able to continue with the treatment owing to adverse effects. 4 As such, the ultimate treatment choice is made on the basis of tolerance rather than efficacy. In a similar vein, for a clinician treating first-episode psychosis, the need for pharmacogenomic testing is likely to arise mostly on the basis of adverse effects rather than poor efficacy at high doses, providing the rationale for the context in our hypothetical case report.…”

“…We take this opportunity to highlight that these 2 phenomena are not mutually exclusive, at least in the first episode clinical setting, where patients cite both as prominent reasons for their decisions to discontinue treatment. 4 , 5 …”