Frontiers in Psychiatry (Sep 2021)

Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

  • Chen-Chung Liu,
  • Chen-Chung Liu,
  • Chen-Chung Liu,
  • Chih-Min Liu,
  • Chih-Min Liu,
  • Yi-Ling Chien,
  • Yi-Ling Chien,
  • Yi-Ting Lin,
  • Yi-Ting Lin,
  • Ming H. Hsieh,
  • Ming H. Hsieh,
  • Tzung-Jeng Hwang,
  • Tzung-Jeng Hwang,
  • Hai-Gwo Hwu,
  • Hai-Gwo Hwu

DOI
https://doi.org/10.3389/fpsyt.2021.714878
Journal volume & issue
Vol. 12

Abstract

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Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications.Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose.Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients.Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

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