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Antipsychotic Withdrawal Symptoms: A Systematic Review and Meta-Analysis.

作者信息

Brandt Lasse, Bschor Tom, Henssler Jonathan, Müller Martin, Hasan Alkomiet, Heinz Andreas, Gutwinski Stefan

机构信息

Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany.

出版信息

Front Psychiatry. 2020 Sep 29;11:569912. doi: 10.3389/fpsyt.2020.569912. eCollection 2020.


DOI:10.3389/fpsyt.2020.569912
PMID:33132934
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7552943/
Abstract

OBJECTIVE: Avoiding withdrawal symptoms following antipsychotic discontinuation is an important factor when planning a safe therapy. We performed a systematic review and meta-analysis concerning occurrence of withdrawal symptoms after discontinuation of antipsychotics. DATA SOURCES: We searched the databases CENTRAL, Pubmed, and EMBASE with no restriction to the beginning of the searched time period and until October 1, 2019 (PROSPERO registration no. CRD42019119148). STUDY SELECTION: Of the 18,043 screened studies, controlled and cohort trials that assessed withdrawal symptoms after discontinuation of oral antipsychotics were included in the random-effects model. Studies that did not implement placebo substitution were excluded from analyses. The primary outcome was the proportion of individuals with withdrawal symptoms after antipsychotic discontinuation. We compared a control group with continued antipsychotic treatment in the assessment of odds ratio and number needed to harm (NNH). DATA EXTRACTION: We followed guidelines by the Cochrane Collaboration, PRISMA, and MOOSE. RESULTS: Five studies with a total of 261 individuals were included. The primary outcome, proportion of individuals with withdrawal symptoms after antipsychotic discontinuation, was 0.53 (95% CI, 0.37-0.70; = 82.98%, < 0.01). An odds ratio of 7.97 (95% CI, 2.39-26.58; = 82.7%, = 0.003) and NNH of 3 was calculated for the occurrence of withdrawal symptoms after antipsychotic discontinuation. CONCLUSION: Withdrawal symptoms appear to occur frequently after abrupt discontinuation of an oral antipsychotic. The lack of randomized controlled trials with low risk of bias on antipsychotic withdrawal symptoms highlights the need for further research.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/c9f1d514b1ff/fpsyt-11-569912-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/253854b38943/fpsyt-11-569912-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/0e1a1c540cc8/fpsyt-11-569912-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/c9f1d514b1ff/fpsyt-11-569912-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/253854b38943/fpsyt-11-569912-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/0e1a1c540cc8/fpsyt-11-569912-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b752/7552943/c9f1d514b1ff/fpsyt-11-569912-g003.jpg

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本文引用的文献

[1]
Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis.

Lancet. 2019-7-11

[2]
Antidepressant Withdrawal and Rebound Phenomena.

Dtsch Arztebl Int. 2019-5-17

[3]
Addiction theory matters-Why there is no dependence on caffeine or antidepressant medication.

Addict Biol. 2020-3

[4]
Tapering of SSRI treatment to mitigate withdrawal symptoms.

Lancet Psychiatry. 2019-6

[5]
Relapse After Antipsychotic Discontinuation in Schizophrenia as a Withdrawal Phenomenon vs Illness Recurrence: A Post Hoc Analysis of a Randomized Placebo-Controlled Study.

J Clin Psychiatry. 2018-6-19

[6]
Do antipsychotic drugs lose their efficacy for relapse prevention over time?

Br J Psychiatry. 2017-9

[7]
Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy.

Psychother Psychosom. 2017-6-24

[8]
Antipsychotic-induced sensitization and tolerance: Behavioral characteristics, developmental impacts, and neurobiological mechanisms.

J Psychopharmacol. 2016-8

[9]
Clozapine withdrawal emergent dystonia, oculogyric crisis and rebound psychosis in a single patient.

Ther Adv Psychopharmacol. 2016-4

[10]
Withdrawal symptoms and rebound syndromes associated with switching and discontinuing atypical antipsychotics: theoretical background and practical recommendations.

CNS Drugs. 2013-7

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