Medication strategies in first episode psychosis patients: A survey among psychiatrists

Aim There is an ongoing debate regarding the optimal timing of discontinuation of antipsychotic drugs for patients with first episode psychosis. Although most guidelines recommend maintenance therapy for at least 1 or 2 years after reaching remission, study results indicate that early discontinuatio...

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Published in:	Early intervention in psychiatry Vol. 16; no. 2; pp. 139 - 146
Main Authors:	Kikkert, Martijn J., Veling, Wim, Haan, Lieuwe, Begemann, Marieke J. H., Koning, Mariken, Sommer, Iris, Os, Jim, Smit, Filip, Begemann, Marieke, Schuite‐Koops, Sanne, Marcelis, Machteld, Kikkert, Martijn, Beveren, Nico, Boonstra, Nynke, Rosema, Bram‐Sieben, Bakker, P. Roberto, Gülöksüz, Sinan, Lokkerbol, Joran, Brand, Bodyl, Gangadin, Shiral, Geraets, Chris, van't Hag, Erna, Oomen, Priscilla, Voppel, Alban, Amelsvoort, Therese, Bak, Maarten, Been, Agaath, Bosch, Marinte, Brink, Truus, Faber, Gunnar, Grootens, Koen, Jonge, Martin, Knegtering, Henderikus, Kurkamp, Jörg, Mahabir, Amrita, Pijnenborg, Gerdina Hendrika Maria, Staring, Tonnie, Vaes, Wiek, Veen, Natalie, Veerman, Selene, Wiersma, Sybren, Sommer, Iris E.
Format:	Journal Article
Language:	English
Published:	Melbourne Wiley Publishing Asia Pty Ltd 01-02-2022 Wiley Subscription Services, Inc
Subjects:	Antipsychotic Agents - therapeutic use antipsychotic medication Antipsychotics discontinuation Humans maintenance treatment Original Psychiatrists Psychiatry Psychosis Psychotic Disorders - drug therapy Psychotropic drugs Remission Induction schizophrenia Surveys and Questionnaires schizophrenia discontinuation antipsychotic medication maintenance treatment
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Summary:	Aim There is an ongoing debate regarding the optimal timing of discontinuation of antipsychotic drugs for patients with first episode psychosis. Although most guidelines recommend maintenance therapy for at least 1 or 2 years after reaching remission, study results indicate that early discontinuation may be beneficial for at least a subsample of patients. To date, little is known about which medication strategies are applied in patients recovering from a first psychotic episode. In this study, we examined the beliefs and practices of clinicians on medication discontinuation. Methods We performed a survey among 50 experienced Dutch psychiatrists to assess how often specific treatment strategies have been applied in the past 12 months, as well as their knowledge and expectations with respect to medication discontinuation. Results Psychiatrists estimated that, after remission, they continued medication at the same dose for at least 12 months in 51.2% of cases, continued in a reduced dose in 33.8% of cases and discontinued medication in 9.1% of cases after 4.4 months of remission on average. Although the medication is discontinued in only a relatively small proportion of patients, almost half of all clinicians (45.9%) used this strategy at least once in the past 12 months. Conclusions There is substantial practice variation in antipsychotic medication strategies after remission from a first psychotic episode. Future research on long‐term effects of early medication discontinuation can guide clinicians in making evidence‐based decisions when treating first‐episode patients.
Bibliography:	Funding information Members of the HAMLETT and OPHELIA Consortium are provided in Appendix. ZonMw, Grant/Award Numbers: #348041003, #636340001 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Funding information ZonMw, Grant/Award Numbers: #348041003, #636340001
ISSN:	1751-7885 1751-7893
DOI:	10.1111/eip.13138