Addressing mental health in the Black community is one thing, but following through with seeking treatment and continuing on with it until the end is an entirely different hurdle. This is important because medications are prescribed during some treatments and must be monitored for effectiveness and in some cases adverse side effects. Furthermore, a follow-up study suggests, discontinuing antipsychotic medication in some patients with first-episode psychosis may be harmful and have an even worse outcome than not taking the medication at all.
“In patients with first-episode psychosis with a full initial response to treatment, medication continuation for at least the first 3 years after starting treatment decreases the risk of relapse and poor long-term clinical outcome,” Dr. Christy L. M. Hui of the University of Hong Kong and colleagues write in The Lancet Psychiatry.
Dr. Hui and her colleagues conducted a ten-year follow-up study of a randomized double-blind clinical trial conducted at seven treatment centers. In the trial, 89 patients with first-episode psychosis with full positive symptom resolution after one year or more of antipsychotic treatment were given 12 months of maintenance treatment (oral quetiapine 400 mg daily) and 89 others were given a placebo.
The researchers defined poor outcome as persistent psychotic symptoms, the need for
clozapine treatment, or death by suicide.
Overall, 35 (39%) patients in the placebo group and 19 (21%) patients in the maintenance treatment group had poor ten-year clinical outcomes (risk ratio, 1.84; P=0.012). Two patients in the maintenance group and four in the placebo group committed suicide.
Dr. Venkata B. Kolli, a psychiatrist at Creighton University in Omaha, Nebraska, told Reuters Health by email, “It is crucial to promote the resolution of psychotic symptoms; and at the same time, it is important to improve functional outcomes. Previous studies have shown that early reduction of antipsychotics improves functional outcomes in patients with schizophrenia. This study cautions against early antipsychotic discontinuation.”
“As the risk of relapse is high following discontinuation of antipsychotics, considerable caution should be exercised during reduction of antipsychotics in first-episode psychosis. One needs to have an enhanced safety net when antipsychotics are reduced or discontinued,” added Dr. Kolli, who was not involved in the study.
“This study attests to the role of medications,” Dr. Kolli said. “However, one should note that most patients in the ten-year follow-up received only outpatient treatments services. They do not seem to
have received psychosocial rehabilitative services. Future studies are required that appraise the use of adjunctive psychosocial interventions in conjunction with pharmacological options.”
Dr. Hossam Guirgis, a psychiatrist at The Ohio State University Wexner Medical Center in Columbus who was not involved in the study, told Reuters Health by phone, “This study is important because it answers a question that many of us clinicians have had. When we treat patients with first-episode psychosis, we don’t think it’s a good idea to take them off their medicine, but we’ve never seen a long-term study that looks at patient outcomes after ten years.”
“My advice to clinicians who treat patients with first-episode psychosis,” added Dr. Guirgis, “is to be very thoughtful and cautious about taking patients off their medicine.”
Both Dr. Guirgis and Dr. Kolli recommended further study, and Dr. Guirgis said he would like to see this study replicated in a Western society.
Find out more about antipsychotic medication and their effects on BlackDoctor.org.
SOURCE: Long-Term Effects of Discontinuation From Antipsychotic Maintenance Following First-Episode Schizophrenia And Related Disorders: A 10 Year Follow-Up Of A Randomized, Double-Blind Trial, Lancet Psychiatry 2018, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30090-7/fulltext
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