PoplarV1, Main, Exploration, bibRecord, 001993

Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era.

Identifieur interne : 001993 ( Main/Exploration ); précédent : 001992; suivant : 001994

Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era.

Auteurs : M. Alvarez-Jimenez [Australie] ; B. O'Donoghue [Australie] ; A. Thompson [Royaume-Uni] ; J F Gleeson [Australie] ; S. Bendall [Australie] ; C. Gonzalez-Blanch [Espagne] ; E. Killackey [Australie] ; L. Wunderink [Pays-Bas] ; P D Mcgorry [Australie]

Source :

CNS drugs [ 1179-1934 ] ; 2016.

RBID : pubmed:27106296

Descripteurs français

KwdFr :
- Guides de bonnes pratiques cliniques comme sujet (MeSH), Humains (MeSH), Induction de rémission (MeSH), Neuroleptiques (administration et posologie), Neuroleptiques (usage thérapeutique), Résultat thérapeutique (MeSH), Schizophrénie (traitement médicamenteux), Troubles psychotiques (traitement médicamenteux).
MESH :
- administration et posologie : Neuroleptiques.
- traitement médicamenteux : Schizophrénie, Troubles psychotiques.
- usage thérapeutique : Neuroleptiques.
- Guides de bonnes pratiques cliniques comme sujet, Humains, Induction de rémission, Résultat thérapeutique.

English descriptors

KwdEn :
- Antipsychotic Agents (administration & dosage), Antipsychotic Agents (therapeutic use), Humans (MeSH), Practice Guidelines as Topic (MeSH), Psychotic Disorders (drug therapy), Remission Induction (MeSH), Schizophrenia (drug therapy), Treatment Outcome (MeSH).
MESH :
- chemical , administration & dosage : Antipsychotic Agents.
- chemical , therapeutic use : Antipsychotic Agents.
- drug therapy : Psychotic Disorders, Schizophrenia.
- Humans, Practice Guidelines as Topic, Remission Induction, Treatment Outcome.

Abstract

Treatment guidelines for first episode psychosis (FEP) recommend at least 1 year of antipsychotic treatment following remission; however, in light of some recent research and the preference of some individuals to discontinue their medication sooner, this recommendation can be questioned. The aim of this article is to appraise the current discontinuation studies given our views on how this field should progress. We conducted a review of randomized controlled trials investigating dose-reduction/medication discontinuation compared with treatment maintenance in clinically remitted FEP patients. Seven trials were identified, and these reported a higher rate of relapse in the dose reduction or discontinuation groups. Relapse rates were higher when a lower threshold for relapse was utilized. However, only three studies specified that concurrent psychosocial interventions were also provided, despite an evidence base for these interventions in reducing symptom severity and relapse. Length of follow-up may also be important, as the study with the longest follow-up (7 years), albeit with some methodological shortcomings, found greater functional recovery in the dose-reduction group and that relapse rates between the two groups (dose-reduction vs. maintenance) were equal after 3 years. Finally, in addition to discontinuation or dose reduction, a diagnosis of schizophrenia, a longer duration of illness, and poor premorbid functioning were associated with a greater risk of relapse. Further trials are needed in this area to establish the long-term risk-benefit ratio of antipsychotic medication in FEP. Meanwhile, young people with FEP who do not fulfil criteria for a diagnosis of a schizophrenia disorder, achieve clinical remission for at least 3 months, attain early functional recovery, and have good social support may be possible candidates for discontinuation of antipsychotic medication bolstered by effective psychosocial interventions provided in the context of a specialized FEP service.

DOI: 10.1007/s40263-016-0331-x
PubMed: 27106296

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 001825
to stream Main, to step Curation: 001825

Le document en format XML

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<term>Practice Guidelines as Topic (MeSH)</term>
<term>Psychotic Disorders (drug therapy)</term>
<term>Remission Induction (MeSH)</term>
<term>Schizophrenia (drug therapy)</term>
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<term>Neuroleptiques (administration et posologie)</term>
<term>Neuroleptiques (usage thérapeutique)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Schizophrénie (traitement médicamenteux)</term>
<term>Troubles psychotiques (traitement médicamenteux)</term>
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<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antipsychotic Agents</term>
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<front><div type="abstract" xml:lang="en">Treatment guidelines for first episode psychosis (FEP) recommend at least 1 year of antipsychotic treatment following remission; however, in light of some recent research and the preference of some individuals to discontinue their medication sooner, this recommendation can be questioned. The aim of this article is to appraise the current discontinuation studies given our views on how this field should progress. We conducted a review of randomized controlled trials investigating dose-reduction/medication discontinuation compared with treatment maintenance in clinically remitted FEP patients. Seven trials were identified, and these reported a higher rate of relapse in the dose reduction or discontinuation groups. Relapse rates were higher when a lower threshold for relapse was utilized. However, only three studies specified that concurrent psychosocial interventions were also provided, despite an evidence base for these interventions in reducing symptom severity and relapse. Length of follow-up may also be important, as the study with the longest follow-up (7 years), albeit with some methodological shortcomings, found greater functional recovery in the dose-reduction group and that relapse rates between the two groups (dose-reduction vs. maintenance) were equal after 3 years. Finally, in addition to discontinuation or dose reduction, a diagnosis of schizophrenia, a longer duration of illness, and poor premorbid functioning were associated with a greater risk of relapse. Further trials are needed in this area to establish the long-term risk-benefit ratio of antipsychotic medication in FEP. Meanwhile, young people with FEP who do not fulfil criteria for a diagnosis of a schizophrenia disorder, achieve clinical remission for at least 3 months, attain early functional recovery, and have good social support may be possible candidates for discontinuation of antipsychotic medication bolstered by effective psychosocial interventions provided in the context of a specialized FEP service.</div>
</front>
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<Abstract><AbstractText>Treatment guidelines for first episode psychosis (FEP) recommend at least 1 year of antipsychotic treatment following remission; however, in light of some recent research and the preference of some individuals to discontinue their medication sooner, this recommendation can be questioned. The aim of this article is to appraise the current discontinuation studies given our views on how this field should progress. We conducted a review of randomized controlled trials investigating dose-reduction/medication discontinuation compared with treatment maintenance in clinically remitted FEP patients. Seven trials were identified, and these reported a higher rate of relapse in the dose reduction or discontinuation groups. Relapse rates were higher when a lower threshold for relapse was utilized. However, only three studies specified that concurrent psychosocial interventions were also provided, despite an evidence base for these interventions in reducing symptom severity and relapse. Length of follow-up may also be important, as the study with the longest follow-up (7 years), albeit with some methodological shortcomings, found greater functional recovery in the dose-reduction group and that relapse rates between the two groups (dose-reduction vs. maintenance) were equal after 3 years. Finally, in addition to discontinuation or dose reduction, a diagnosis of schizophrenia, a longer duration of illness, and poor premorbid functioning were associated with a greater risk of relapse. Further trials are needed in this area to establish the long-term risk-benefit ratio of antipsychotic medication in FEP. Meanwhile, young people with FEP who do not fulfil criteria for a diagnosis of a schizophrenia disorder, achieve clinical remission for at least 3 months, attain early functional recovery, and have good social support may be possible candidates for discontinuation of antipsychotic medication bolstered by effective psychosocial interventions provided in the context of a specialized FEP service.</AbstractText>
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<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Alvarez-Jimenez</LastName>
<ForeName>M</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia. mario.alvarez@orygen.org.au.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia. mario.alvarez@orygen.org.au.</Affiliation>
</AffiliationInfo>
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</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia. brian.odonoghue@orygen.org.au.</Affiliation>
</AffiliationInfo>
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</AffiliationInfo>
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<Initials>S</Initials>
<AffiliationInfo><Affiliation>Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.</Affiliation>
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<ForeName>C</ForeName>
<Initials>C</Initials>
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</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Killackey</LastName>
<ForeName>E</ForeName>
<Initials>E</Initials>
<AffiliationInfo><Affiliation>Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia.</Affiliation>
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<AffiliationInfo><Affiliation>Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.</Affiliation>
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<Initials>L</Initials>
<AffiliationInfo><Affiliation>Education and Research, Friesland Mental Health Services, Leeuwarden and University Medical Center Groningen, Sixmastraat 2, 8932 PA, Leeuwarden, The Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>McGorry</LastName>
<ForeName>P D</ForeName>
<Initials>PD</Initials>
<AffiliationInfo><Affiliation>Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.</Affiliation>
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   |texte=   Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era.
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Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era.

Beyond Clinical Remission in First Episode Psychosis: Thoughts on Antipsychotic Maintenance vs. Guided Discontinuation in the Functional Recovery Era.

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