Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Early Interv Psychiatry. 2022 Feb;16(2):139-146. doi: 10.1111/eip.13138. Epub 2021 Mar 22.
There is an ongoing debate regarding the optimal timing of discontinuation of antipsychotic drugs for patients with first episode psychosis. Although most guidelines recommend maintenance therapy for at least 1 or 2 years after reaching remission, study results indicate that early discontinuation may be beneficial for at least a subsample of patients. To date, little is known about which medication strategies are applied in patients recovering from a first psychotic episode. In this study, we examined the beliefs and practices of clinicians on medication discontinuation.
We performed a survey among 50 experienced Dutch psychiatrists to assess how often specific treatment strategies have been applied in the past 12 months, as well as their knowledge and expectations with respect to medication discontinuation.
Psychiatrists estimated that, after remission, they continued medication at the same dose for at least 12 months in 51.2% of cases, continued in a reduced dose in 33.8% of cases and discontinued medication in 9.1% of cases after 4.4 months of remission on average. Although the medication is discontinued in only a relatively small proportion of patients, almost half of all clinicians (45.9%) used this strategy at least once in the past 12 months.
There is substantial practice variation in antipsychotic medication strategies after remission from a first psychotic episode. Future research on long-term effects of early medication discontinuation can guide clinicians in making evidence-based decisions when treating first-episode patients.
对于首发精神病患者，抗精神病药物停药的最佳时机仍存在争议。尽管大多数指南建议在缓解后至少维持治疗 1 或 2 年，但研究结果表明，早期停药可能对至少一部分患者有益。迄今为止，对于从首发精神病发作中康复的患者，我们对应用何种药物治疗策略知之甚少。在这项研究中，我们考察了临床医生对停药的信念和做法。
我们对 50 名经验丰富的荷兰精神科医生进行了一项调查，以评估在过去 12 个月中特定治疗策略的应用频率，以及他们对停药的知识和期望。
精神科医生估计，在缓解后，他们以相同剂量继续用药至少 12 个月的情况占 51.2%，以较低剂量继续用药的情况占 33.8%，平均缓解后 4.4 个月停药的情况占 9.1%。尽管只有相对较小比例的患者停药，但近一半的临床医生（45.9%）在过去 12 个月中至少使用过一次这种策略。
首发精神病缓解后，抗精神病药物治疗策略存在很大的实践差异。关于早期停药的长期效果的未来研究可以为治疗首发患者时临床医生做出基于证据的决策提供指导。
