Guided antipsychotic reduction to reach minimum effective dose (GARMED) in patients with remitted psychosis: a 2-year randomized controlled trial with a naturalistic cohort.
In: Psychological Medicine, Jg. 53 (2023-11-01), Heft 15, S. 7078-7086
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Zugriff:
Background: Patients with remitted psychosis face a dilemma between the wish to discontinue antipsychotics and the risk of relapse. We test if an operationalized guided-dose-reduction algorithm can help reach a lower effective dose without increased risks of relapse. Methods: A 2-year open-label randomized prospective comparative cohort trial from Aug 2017 to Sep 2022. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomized 2:1 into guided dose reduction group (GDR) v. maintenance treatment group (MT1), together with a group of naturalistic maintenance controls (MT2). We observed if the relapse rates would be different between 3 groups, to what extent the dose could be reduced, and if GDR patients could have improved functioning and quality of life. Results: A total of 96 patients, comprised 51, 24, and 21 patients in GDR, MT1, and MT2 groups, respectively. During follow-up, 14 patients (14.6%) relapsed, including 6, 4, and 4 from GDR, MT1, and MT2, statistically no difference between groups. In total, 74.5% of GDR patients could stay well under a lower dose, including 18 patients (35.3%) conducting 4 consecutive dose-tapering and staying well after reducing 58.5% of their baseline dose. The GDR group exhibited improved clinical outcomes and endorsed better quality of life. Conclusions: GDR is a feasible approach as the majority of patients had a chance to taper antipsychotics to certain extents. Still, 25.5% of GDR patients could not successfully decrease any dose, including 11.8% experienced relapse, a risk comparable to their maintenance counterparts. [ABSTRACT FROM AUTHOR]
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Titel: |
Guided antipsychotic reduction to reach minimum effective dose (GARMED) in patients with remitted psychosis: a 2-year randomized controlled trial with a naturalistic cohort.
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Autor/in / Beteiligte Person: | Liu, Chen-Chung ; Hsieh, Ming H. ; Chien, Yi-Ling ; Liu, Chih-Min ; Lin, Yi-Ting ; Hwang, Tzung-Jeng ; Hwu, Hai-Gwo |
Zeitschrift: | Psychological Medicine, Jg. 53 (2023-11-01), Heft 15, S. 7078-7086 |
Veröffentlichung: | 2023 |
Medientyp: | academicJournal |
ISSN: | 0033-2917 (print) |
DOI: | 10.1017/S0033291723000429 |
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