Andrew Thompson1,2, Swaran Singh1,3, Max Birchwood1. 1. Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK. 2. Coventry and Warwickshire NHS Partnership Trust, Coventry, UK. 3. Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.
Abstract
AIMS: Discontinuation of antipsychotics following remission in first episode psychosis (FEP) is a contentious area of practice. We aimed to investigate the views of early psychosis clinicians on this important clinical question. METHODS: We designed an 11 question online survey on medication discontinuation following remission of symptoms in FEP. The questionnaire was distributed to early intervention team workers in England and Wales via members of the National Early Psychosis Network who were requested to distribute it to their teams. RESULTS: We received 172 questionnaire responses; 37% were nurses, 33% doctors, 11% psychologists and 19% were other allied health professionals. The average years of experience in psychiatry was 16.9. 75.4% of respondents thought that greater than 60% of patients would like to be considered for guided medication reduction/discontinuation. Only 31.4% of respondents said that medication should be continued for over a year following remission. 61.4% of respondents felt that the quality of life of individuals was better in those who stop medication following remission. There was a significant difference in the response of professional groups to this question. 82.6% of respondents said they would be happy to support their patients in participating in a randomized trial of graded antipsychotic reduction/discontinuation versus maintenance medication. CONCLUSIONS: The views of clinicians regarding prophylactic antipsychotic medication following remission in FEP are much less conservative than those in current guidelines; concern was expressed by many about the impact of antipsychotic medication on quality of life. A randomized trial of maintenance antipsychotic medication versus graded reduction/discontinuation is feasible and has considerable clinician support.
RCT Entities:
AIMS: Discontinuation of antipsychotics following remission in first episode psychosis (FEP) is a contentious area of practice. We aimed to investigate the views of early psychosis clinicians on this important clinical question. METHODS: We designed an 11 question online survey on medication discontinuation following remission of symptoms in FEP. The questionnaire was distributed to early intervention team workers in England and Wales via members of the National Early Psychosis Network who were requested to distribute it to their teams. RESULTS: We received 172 questionnaire responses; 37% were nurses, 33% doctors, 11% psychologists and 19% were other allied health professionals. The average years of experience in psychiatry was 16.9. 75.4% of respondents thought that greater than 60% of patients would like to be considered for guided medication reduction/discontinuation. Only 31.4% of respondents said that medication should be continued for over a year following remission. 61.4% of respondents felt that the quality of life of individuals was better in those who stop medication following remission. There was a significant difference in the response of professional groups to this question. 82.6% of respondents said they would be happy to support their patients in participating in a randomized trial of graded antipsychotic reduction/discontinuation versus maintenance medication. CONCLUSIONS: The views of clinicians regarding prophylactic antipsychotic medication following remission in FEP are much less conservative than those in current guidelines; concern was expressed by many about the impact of antipsychotic medication on quality of life. A randomized trial of maintenance antipsychotic medication versus graded reduction/discontinuation is feasible and has considerable clinician support.
Authors: M Alvarez-Jimenez; B O'Donoghue; A Thompson; J F Gleeson; S Bendall; C Gonzalez-Blanch; E Killackey; L Wunderink; P D McGorry Journal: CNS Drugs Date: 2016-05 Impact factor: 5.749
Authors: Andrew Thompson; Catherine Winsper; Steven Marwaha; Jon Haynes; Mario Alvarez-Jimenez; Sarah Hetrick; Alba Realpe; Laura Vail; Sarah Dawson; Sarah A Sullivan Journal: BJPsych Open Date: 2018-06-29
Authors: Martijn J Kikkert; Wim Veling; Lieuwe de Haan; Marieke J H Begemann; Mariken de Koning; Iris E Sommer Journal: Early Interv Psychiatry Date: 2021-03-22 Impact factor: 2.721