Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
Psychiatry Res. 2022 Nov;317:114928. doi: 10.1016/j.psychres.2022.114928. Epub 2022 Oct 24.
The issue of antipsychotic (dis)continuation has been a long-standing clinical dilemma. While the routine usage of antipsychotic is associated with side effects and stigma, short-term evidence suggest that the risk of relapse is heightened following antipsychotics withdrawal. Clinical guidelines therefore propose a one to two years duration of maintenance treatment upon remission in first episode psychosis (FEP), but guidance beyond which remains unclear. Only two controlled studies have addressed the long-term consequences of antipsychotic discontinuation. While Wunderink et al. concluded that dose reduction is associated with a higher rate of recovery, Hui et al. found discontinuation to be associated with better clinical outcomes. Data from Hui et al.'s study further suggests that treatment should be maintained for at least the first three years upon remission in FEP in order reduce the risk of relapse, as well as subsequent poor long-term outcome. It is noted that the two studies not only differ in outcome measures, but also in their strategies of "antipsychotic discontinuation". Considering that discontinuation is a more compelling option to most patients, it may therefore be more clinically relevant. More long-term follow-up discontinuation studies are needed to provide further evidence in the development of treatment guidelines for FEP.
抗精神病药（停）用问题一直是一个长期存在的临床难题。虽然常规使用抗精神病药会带来副作用和耻辱感，但短期证据表明，抗精神病药停药后复发的风险会增加。因此，临床指南建议在首发精神病（FEP）缓解后进行一到两年的维持治疗，但之后的指导仍不清楚。只有两项对照研究探讨了抗精神病药停药的长期后果。Wunderink 等人的结论是，减少剂量与更高的康复率相关，而 Hui 等人则发现停药与更好的临床结果相关。Hui 等人的研究数据进一步表明，为了降低复发风险以及随后较差的长期结果，FEP 缓解后至少应维持治疗三年。值得注意的是，这两项研究不仅在结果衡量标准上存在差异，而且在“抗精神病药停药”策略上也存在差异。考虑到停药对大多数患者来说是更具吸引力的选择，因此它可能更具有临床相关性。需要更多的长期随访停药研究为 FEP 的治疗指南制定提供进一步的证据。
