首发精神分裂症谱系障碍患者抗精神病药停药指南：基于亚洲早期精神病专家网络的综合意见和文献回顾。
Guidelines for Discontinuation of Antipsychotics in Patients Who Recover From First-Episode Schizophrenia Spectrum Disorders: Derived From the Aggregated Opinions of Asian Network of Early Psychosis Experts and Literature Review.
出版信息
Int J Neuropsychopharmacol. 2022 Sep 28;25(9):737-758. doi: 10.1093/ijnp/pyac002.
OBJECTIVE
Antipsychotic discontinuation has been a long-standing clinical and medicolegal issue. The Asian Network of Early Psychosis developed guidelines for antipsychotic discontinuation in patients who recover from first-episode non-affective psychosis. We reviewed the existing studies and guidelines on antipsychotic discontinuation to develop guidelines for antipsychotic discontinuation in such patients.
METHODS
We reviewed the relevant studies, reviews, guidelines, and ongoing trials related to antipsychotic discontinuation in patients with first-episode psychosis or schizophrenia. The quality of randomized controlled trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS
Most studies had low to very low quality, and 2 had moderate quality. All studies, except 1, advised against antipsychotic discontinuation because of higher relapse rates in the antipsychotic discontinuation group (19%-82% at 1-year follow-up) than the treatment maintenance group compared with the maintenance group. Based on expert opinion and Grading of Recommendations Assessment, Development, and Evaluation evidence of trials, guidelines have been recommended for future discontinuation studies on patients with first-episode schizophrenia spectrum disorders.
CONCLUSIONS
Currently, there are no recommendations for antipsychotic discontinuation in patients with first-episode schizophrenia spectrum disorders. However, there is a pressing need to conduct more rigorous research in remitted patients using more stringent criteria of full recovery, which can form the basis of guidelines on when and how antipsychotics should be tapered and discontinued. Studies that evaluate the patient characteristics and biomarkers that predict successful antipsychotic discontinuation are also needed.
目的
抗精神病药停药一直是一个长期存在的临床和法医学问题。亚洲首发非情感性精神病网络制定了首发非情感性精神病患者抗精神病药停药指南。我们回顾了现有的抗精神病药停药研究和指南，以制定此类患者抗精神病药停药指南。
方法
我们回顾了与首发精神病或精神分裂症患者抗精神病药停药相关的研究、综述、指南和正在进行的试验。使用推荐评估、制定与评估分级方法评估随机对照试验的质量。
结果
大多数研究质量为低到极低，2 项研究为中质量。除 1 项研究外，所有研究均不建议抗精神病药停药，因为停药组（1 年随访时为 19%~82%）的复发率高于治疗维持组（与维持组相比）。基于专家意见和推荐评估、制定与评估分级方法的试验证据，建议对首发精神分裂症谱系障碍患者进行未来停药研究。
结论
目前，对于首发精神分裂症谱系障碍患者，尚无抗精神病药停药建议。但是，迫切需要在缓解患者中开展更严格的研究，使用更严格的完全康复标准，这可以为何时以及如何逐渐减少和停止使用抗精神病药提供指南基础。还需要评估可以预测成功抗精神病药停药的患者特征和生物标志物的研究。
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