A review of second-generation antipsychotic discontinuation in first-episode psychosis

Research output: Contribution to journalReview article

34 Citations (Scopus)

Abstract

"All-causes discontinuation" refers to discontinuation of treatment for any reason, and adherence to medication is an important component of this measure. Two recent landmark studies suggest that adherence is a major issue in patients with first-episode psychosis (FEP) right from the onset of treatment. In this review, the incidence, reasons for, and clinical outcomes of medication discontinuation in FEP are considered. More than 40% of patients with FEP discontinue medication during the first 9 months of treatment, at which point the chances of relapse increase dramatically. Findings concerning predictors of medication discontinuation in this patient population that have been replicated in more than one study include severity of psychopathology, lack of insight into illness, negative attitudes towards medications, comorbid substance use, and medication side effects. Interventions that have the potential to decrease discontinuation rates in patients with psychotic disorders include orally disintegrating tablets, long-acting injectable drugs, cognitive-behavioral therapy, compliance therapy, family support/intervention, and peer support, although these strategies have largely been unexplored in FEP. In addition to the question of medication discontinuation in the acute treatment of FEP, another important issue is how long patients with FEP should be treated with antipsychotics once they have achieved remission; unfortunately, little evidence is available to guide the decision as to whether medication should be discontinued or maintenance treatment provided in this situation. Studies are therefore needed to identify predictors of patients with remitted FEP who are less likely to relapse when medication is discontinued. Taken together, the findings presented in this article underscore the importance of addressing issues related to medication discontinuation as a means of preventing long-term morbidity and enhancing remission and functional recovery in FEP.

Original languageEnglish (US)
Pages (from-to)289-300
Number of pages12
JournalJournal of Psychiatric Practice
Volume14
Issue number5
DOIs
StatePublished - Sep 1 2008

Fingerprint

Psychotic Disorders
Antipsychotic Agents
Therapeutics
Recurrence
Family Therapy
Medication Adherence
Cognitive Therapy
Psychopathology
Tablets
Compliance
Morbidity
Injections
Incidence
Pharmaceutical Preparations
Population

Keywords

  • Epidemiology
  • First-episode psychosis
  • Medication discontinuation
  • Schizophrenia
  • Second-generation antipsychotics

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A review of second-generation antipsychotic discontinuation in first-episode psychosis. / Miller, Brian J.

In: Journal of Psychiatric Practice, Vol. 14, No. 5, 01.09.2008, p. 289-300.

Research output: Contribution to journalReview article

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