Nøstdal Alexander, Hilker Rikke, Halgren Christina, Speyer Helene, Nielsen Mette Ødegaard, Nielsen Jimmi
Unit for Complicated Schizophrenia, Mental Health Centre Glostrup, Copenhagen University Hospital - Rigshospitalet, Nordstjernevej, 2600 Glostrup, Denmark.
Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark.
Psychol Med. 2024 Oct 15;54(13):1-10. doi: 10.1017/S0033291724001910.
While antipsychotic medication reduces the risk of relapse for patients with schizophrenia, high prevalence of adverse effects results in low adherence. Lower doses of antipsychotics have been associated with increased level of function but also with increased risk of relapse. This study presents findings from a specialized deprescribing clinic. In addition, we aim to identify clinical predictors for relapse.
Patients diagnosed with schizophrenia were referred to the clinic, which offers a six-month guided tapering program. Antipsychotic dose was reduced by 10% every four weeks. Patients were monitored closely for symptom progression or decrease in level of function, with defined cut-offs prompting a pause in or cessation of dose reduction.
After 12 months, the antipsychotic dose was reduced from 404 (±320 mg) to 255 (±236 mg) chlorpromazine equivalent. Of the 88 patients included, 22 (27%) experienced relapse during the six-month tapering period, while 29 (37%) experienced relapse at the 12-month follow-up visit and nine patients were antipsychotic free. Patients who remained stable experienced a slightly increased level of functioning and markedly fewer side effects ( < 0.001). Following relapse, patients were clinically stabilized and showed an improved attitude toward antipsychotic medication. The predictive models were weak.
We show that most patients undergoing guided antipsychotic tapering remained stable after one year and improved in level of function, while most patients who relapsed were quickly stabilized. Our inability to create strong predictive models could be due to limitations in the study design, warranting future studies exploring tapering of antipsychotics in patients with schizophrenia.
虽然抗精神病药物可降低精神分裂症患者的复发风险，但不良反应的高发生率导致依从性较低。较低剂量的抗精神病药物与功能水平提高相关，但也与复发风险增加有关。本研究展示了来自一家专门的减药诊所的研究结果。此外，我们旨在确定复发的临床预测因素。
被诊断为精神分裂症的患者被转诊至该诊所，该诊所提供为期六个月的指导减药计划。每四周将抗精神病药物剂量降低10%。密切监测患者的症状进展或功能水平下降情况，设定明确的临界值以促使暂停或停止减药。
12个月后，抗精神病药物剂量从404（±320毫克）氯丙嗪等效剂量降至255（±236毫克）氯丙嗪等效剂量。在纳入的88名患者中，22名（27%）在六个月的减药期内复发，29名（37%）在12个月的随访时复发，9名患者停用了抗精神病药物。保持稳定的患者功能水平略有提高，副作用明显减少（<0.001）。复发后，患者在临床上得到稳定，对抗精神病药物的态度有所改善。预测模型的效果较弱。
我们发现，大多数接受指导下抗精神病药物减药治疗的患者在一年后保持稳定，功能水平有所改善，而大多数复发患者很快得到稳定。我们无法建立强大预测模型可能是由于研究设计的局限性，这需要未来开展研究探索精神分裂症患者抗精神病药物的减药问题。
