Potla Shanthi, Al Qabandi Yousif, Nandula Savitri Aninditha, Boddepalli Chinmayi Sree, Gutlapalli Sai Dheeraj, Lavu Vamsi Krishna, Abdelwahab Mohamed Abdelwahab Rana, Huang Ruimin, Hamid Pousette
Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2023 Feb 7;15(2):e34746. doi: 10.7759/cureus.34746. eCollection 2023 Feb.
The act of discontinuing the antipsychotic medication may be directly associated with relapse. This relationship might be due to adaptations that continue to exist after treatment is stopped, such as dopaminergic hypersensitivity. Therefore, more progressive weaning off antipsychotic medication may help reduce the likelihood of relapse when the medication is stopped. As there is a need to gradually reduce or stop using antipsychotic medication, our team tried to conduct a more in-depth search to give further answers to the suggested recommendations. Around 192 articles were gathered for our research, but we could only narrow our search to 36, which were further filtered, and eight were used. We went through all of the pertinent information available until May 2022 and reviewed it to determine the risks associated with prolonged antipsychotic usage and abrupt cessation in the psychotic spectrum of diseases. PubMed, Google Scholar, and Psychiatry Online were the databases used, and the keywords that were looked for and utilized were antipsychotics, tapering, relapse, maintenance dosage, schizophrenia, and psychosis. The recurrence incidence was high in patients in whom antipsychotics were stopped and in whom the dosage was quickly lowered. Patients who were gradually weaned off their antipsychotic medication and kept on the lowest effective dose had a much lower risk of experiencing a relapse. We suggest more studies, including randomized clinical trials and monitoring, considering the enhancement of guidelines for the total cessation of antipsychotic medication use.
停用抗精神病药物的行为可能与复发直接相关。这种关系可能是由于停药后仍持续存在的适应性变化，如多巴胺能超敏反应。因此，更渐进地停用抗精神病药物可能有助于降低停药时复发的可能性。由于需要逐渐减少或停用抗精神病药物，我们的团队试图进行更深入的搜索，以进一步回答所提出的建议。我们的研究收集了约192篇文章，但只能将搜索范围缩小到36篇，对其进一步筛选后，最终使用了8篇。我们查阅了截至2022年5月所有可用的相关信息，并对其进行审查，以确定在精神病性疾病谱中与长期使用抗精神病药物及突然停药相关的风险。使用的数据库有PubMed、谷歌学术和《精神病学在线》，搜索和使用的关键词是抗精神病药物、逐渐减量、复发、维持剂量、精神分裂症和精神病。在停用抗精神病药物且剂量迅速降低的患者中，复发率很高。逐渐停用抗精神病药物并维持在最低有效剂量的患者复发风险要低得多。考虑到要加强关于完全停用抗精神病药物使用的指南，我们建议开展更多研究，包括随机临床试验和监测。
