How long to wait before reducing antipsychotic dosage in stabilized patients with schizophrenia? A retrospective chart review

Hiroyoshi Takeuchi, Takefumi Suzuki, Hiroyuki Uchida, Toshiaki Kikuchi, Shinichiro Nakajima, Hiroshi Manki, Koichiro Watanabe, Haruo Kashima

Research output: Contribution to journalArticle

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Abstract

Objective: Antipsychotic dose reduction is generally recommended to occur after six months of clinical stabilization despite inadequate evidence. This timing issue was addressed in this study. Methods: This is an observational, retrospective and medical chart-based study. Inclusion criteria were (1) diagnosis of schizophrenia (DSM-IV), (2) being acutely psychotic at their first outpatient visit from May, 2002 to April, 2003, (3) having responded to antipsychotics and achieved clinical stabilization of acute symptoms, indexed as a fixation of regimen for four or more weeks, and (4) having one or more years of follow-up. Patients who had their antipsychotic doses reduced were then identified, and they were divided into two groups based on the waiting period before dose reduction: <24 weeks (Early Group) and ≥24 weeks (Standard Group). The rate of dose escalation for ≥20% during follow-up period was investigated as a proxy of clinical worsening. Results: After excluding stable patients at baseline, 211 patients met inclusion criteria. The mean ± SD waiting period before reducing antipsychotics was 122 ± 102 days. The rates of patients needing dose escalation were not significantly different between patients whose dose was reduced (N = 83) and those who was not (N = 128) (57.8% vs. 59.4%), and between Early Group (N = 59) and Standard Group (N = 24) (61.0% vs. 50.0%) although the reduction rate in antipsychotic dosage was significantly greater in Early Group (58.7% vs. 43.3%, p < 0.05). Conclusion: These findings may indicate that timeline until antipsychotic reduction in stable patients with schizophrenia could be earlier than recommended, although caution is needed in interpreting our retrospective results.

Original languageEnglish
Pages (from-to)1083-1088
Number of pages6
JournalJournal of Psychiatric Research
Volume45
Issue number8
DOIs
Publication statusPublished - 2011 Aug

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Antipsychotic Agents
Schizophrenia
Proxy
Diagnostic and Statistical Manual of Mental Disorders
Outpatients

Keywords

  • Antipsychotics
  • Dose reduction
  • Schizophrenia
  • Timing
  • Waiting period

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

How long to wait before reducing antipsychotic dosage in stabilized patients with schizophrenia? A retrospective chart review. / Takeuchi, Hiroyoshi; Suzuki, Takefumi; Uchida, Hiroyuki; Kikuchi, Toshiaki; Nakajima, Shinichiro; Manki, Hiroshi; Watanabe, Koichiro; Kashima, Haruo.

In: Journal of Psychiatric Research, Vol. 45, No. 8, 08.2011, p. 1083-1088.

Research output: Contribution to journalArticle

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abstract = "Objective: Antipsychotic dose reduction is generally recommended to occur after six months of clinical stabilization despite inadequate evidence. This timing issue was addressed in this study. Methods: This is an observational, retrospective and medical chart-based study. Inclusion criteria were (1) diagnosis of schizophrenia (DSM-IV), (2) being acutely psychotic at their first outpatient visit from May, 2002 to April, 2003, (3) having responded to antipsychotics and achieved clinical stabilization of acute symptoms, indexed as a fixation of regimen for four or more weeks, and (4) having one or more years of follow-up. Patients who had their antipsychotic doses reduced were then identified, and they were divided into two groups based on the waiting period before dose reduction: <24 weeks (Early Group) and ≥24 weeks (Standard Group). The rate of dose escalation for ≥20{\%} during follow-up period was investigated as a proxy of clinical worsening. Results: After excluding stable patients at baseline, 211 patients met inclusion criteria. The mean ± SD waiting period before reducing antipsychotics was 122 ± 102 days. The rates of patients needing dose escalation were not significantly different between patients whose dose was reduced (N = 83) and those who was not (N = 128) (57.8{\%} vs. 59.4{\%}), and between Early Group (N = 59) and Standard Group (N = 24) (61.0{\%} vs. 50.0{\%}) although the reduction rate in antipsychotic dosage was significantly greater in Early Group (58.7{\%} vs. 43.3{\%}, p < 0.05). Conclusion: These findings may indicate that timeline until antipsychotic reduction in stable patients with schizophrenia could be earlier than recommended, although caution is needed in interpreting our retrospective results.",
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AB - Objective: Antipsychotic dose reduction is generally recommended to occur after six months of clinical stabilization despite inadequate evidence. This timing issue was addressed in this study. Methods: This is an observational, retrospective and medical chart-based study. Inclusion criteria were (1) diagnosis of schizophrenia (DSM-IV), (2) being acutely psychotic at their first outpatient visit from May, 2002 to April, 2003, (3) having responded to antipsychotics and achieved clinical stabilization of acute symptoms, indexed as a fixation of regimen for four or more weeks, and (4) having one or more years of follow-up. Patients who had their antipsychotic doses reduced were then identified, and they were divided into two groups based on the waiting period before dose reduction: <24 weeks (Early Group) and ≥24 weeks (Standard Group). The rate of dose escalation for ≥20% during follow-up period was investigated as a proxy of clinical worsening. Results: After excluding stable patients at baseline, 211 patients met inclusion criteria. The mean ± SD waiting period before reducing antipsychotics was 122 ± 102 days. The rates of patients needing dose escalation were not significantly different between patients whose dose was reduced (N = 83) and those who was not (N = 128) (57.8% vs. 59.4%), and between Early Group (N = 59) and Standard Group (N = 24) (61.0% vs. 50.0%) although the reduction rate in antipsychotic dosage was significantly greater in Early Group (58.7% vs. 43.3%, p < 0.05). Conclusion: These findings may indicate that timeline until antipsychotic reduction in stable patients with schizophrenia could be earlier than recommended, although caution is needed in interpreting our retrospective results.

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