Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.
Eur Psychiatry. 2023 Aug 14;66(1):e66. doi: 10.1192/j.eurpsy.2023.2440.
Patients with remitted psychosis wish to reduce antipsychotic doses yet facing increased risks of relapse. Examining dose-tapering processes may provide insights to re-evaluate the risk-to-benefit balance. We aimed to depict and subgroup tapering trajectories, and explore factors associated with different dose-reduction patterns.
A 2-year open-label randomized prospective comparative trial from August 2017 to September 2022 in Taiwan. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomizing a proportion to conduct guided dose reduction. We depicted the trajectories of individual patients and named subgroups based on dose-tapering patterns. Predictors of baseline characteristics for designated subgroups were examined by logistic regression analysis; changes in outcomes were compared by paired t-test.
Fifty-one patients undergoing guided dose reduction, 18 (35.3%) reduced 4 steps consecutively (sequential reducers, SR), 14 (27.5%) reduced 1 to 3 steps (modest reducers, MR), 3 (5.9%) re-escalated to previous level (alert reducers, AR), 7 (13.7%) returned to baseline level (baseline returners, BR), 6 (11.7%) relapsed (failed reducers, FR) and 3 (5.9%) withdrew without relapse (early exits, EE). Patients with a history of relapse assumed a conservative dose-tapering pace; only the SR subgroup exhibited significant improvements in functioning and quality of life while failing to identify variables for predicting who would become SR or FR.
Guided dose reduction comprises dynamic processes with differences between individual trajectories. The proposed naming of dose-tapering patterns/subgroups provides a framework depicting patients undergoing dose-tapering. Longer-term observation and more flexible tapering approaches are anticipated to reveal favorable outcomes.
缓解期精神病患者希望减少抗精神病药物剂量，但面临复发风险增加的问题。研究剂量逐渐减少的过程可能有助于重新评估风险-效益平衡。我们旨在描绘和亚组逐渐减少的轨迹，并探讨与不同剂量减少模式相关的因素。
这是一项 2017 年 8 月至 2022 年 9 月在台湾进行的为期 2 年的开放性、随机、前瞻性对照试验。符合条件的患者为患有与精神分裂症相关的精神障碍，症状稳定，正在服用药物，随机分为两组，一组进行指导剂量减少。我们描绘了个体患者的轨迹，并根据剂量减少模式命名了亚组。使用逻辑回归分析检查指定亚组基线特征的预测因素；通过配对 t 检验比较结果的变化。
51 名接受指导剂量减少的患者中，18 名（35.3%）连续减少 4 个剂量（连续减少者，SR），14 名（27.5%）减少 1 至 3 个剂量（适度减少者，MR），3 名（5.9%）重新增加到以前的水平（警惕减少者，AR），7 名（13.7%）恢复到基线水平（基线恢复者，BR），6 名（11.7%）复发（失败减少者，FR），3 名（5.9%）未复发但退出（早期退出者，EE）。有复发史的患者采取保守的剂量减少速度；只有 SR 亚组在功能和生活质量方面表现出显著改善，但未能确定谁会成为 SR 或 FR 的预测变量。
指导剂量减少包括个体轨迹之间存在差异的动态过程。提出的剂量减少模式/亚组命名提供了一个描绘正在进行剂量减少的患者的框架。预期进行更长期的观察和更灵活的逐渐减少方法将揭示有利的结果。
