Psychiatrists' opinion towards medication discontinuation in remitted first‐episode psychosis: A multi‐site study of the Asian Network for Early Psychosis

• Published in: Early intervention in psychiatry Vol. 13; no. 6; pp. 1329 - 1337
• Main Authors: Hui, Christy L.‐M., Wong, Andreas K.‐H., Leung, Whitty W.‐T., Lee, Edwin H.‐M., Chan, Sherry K.‐W., Chang, Wing‐Chung, Chen, Eric Y.‐H., Chan, Tommy C.‐T., Swapna, Verma, Tagata, Hiromi, Tsujino, Naohisa, Nemoto, Takahiro, Mizuno, Masafumi, Kang, Nam‐In, Kim, Sung‐Wan, Chung, Young‐Chul
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01-12-2019; Wiley Subscription Services, Inc
• Subjects: Adult; Antipsychotic Agents - therapeutic use; Asia; Asian Network for Early Psychosis; Attitude of Health Personnel; Clinical practice guidelines; Female; first‐episode psychosis; Humans; Maintenance; Male; medication discontinuation; Middle Aged; Norms; Psychiatrists; Psychiatry; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - drug therapy; Questionnaires; relapse; remission; Remission (Medicine); Remission Induction; Surveys and Questionnaires; Withholding Treatment - standards; Asia; Hong Kong China; Japan; Singapore; relapse; Asian Network for Early Psychosis; first-episode psychosis; remission; medication discontinuation
• ISSN: 1751-7885; 1751-7893
• DOI: 10.1111/eip.12765

Aim
The study investigated psychiatrists' views towards the issue of medication discontinuation for patients in remission from first‐episode psychosis in four countries (Hong Kong, Korea, Singapore and Japan) that are part of the Asian Network for Early Psychosis, focusing on whether the views of these countries differ with one another.
Methods
A questionnaire was distributed to psychiatrists for completion. The questionnaire contained three sections: direct questions probing at views on medication discontinuation, case vignettes to assess applied decision‐making and a checklist of criteria psychiatrists may view as necessary for the patient to satisfy before discontinuation. Total of 484 psychiatrists (97 from Hong Kong, 88 from Korea, 64 from Singapore and 233 from Japan) completed the questionnaire.
Results
We found that (a) Asian psychiatrists believed that 1% to 19% of remitted patients can discontinue medication, an estimation that was lower than Western psychiatrists; (b) in agreement with clinical guidelines, Asian psychiatrists believed that patients should remain on medication for at least 1 to 2 years following the absence of psychotic symptoms; (c) “Absence of any relapsing episode following first episode” was considered the most important criterion when making a decision; and (d) there were significant differences in clinicians' perceptions across the four countries: for instance, Korean psychiatrists were more conservative with the duration of antipsychotics maintenance, while Singaporean psychiatrists were more open‐minded towards clinical trials.
Conclusions
Culture and social norms appear to determine the relative importance of factors that psychiatrists might consider during the decision‐making process, thereby producing variations in the views held in different countries.