Insufficient benefit now the principal reason for discontinuation of antipsychotics in persons with first-episode psychosis

As we conclude a transition from first- to second-generation  (atypical) neuroleptics for psychotic and manic symptoms, the principal reason for self-discontinuation of pharmacotherapeutic treatment has shifted from adverse effects (of the older drugs) to insufficient benefit from the newer, current generation.  A recently reported study by Montreal’s Douglas Mental Health University and Institute and McGill University researchers (S Mustafa and colleagues, Schizophrenia Research, published on the Web, ahead of print, on April 26, 2018, doi: 10.1016/}.schres.2018.04.027) elicited self-reports of 390 persons with first-episode psychoses who had discontinued medications prescribed for what they correctly understood as prophylaxis, and the authors analyzed their reports for rates and times of discontinuation over their first years of treatment.

Seventy-two percent of the patients discontinued the first drugs prescribed for them (olanzapine, risperidone or aripiprazole), and did so after a mean duration of 7.2 months (which did not differ for the drugs prescribed). Associated with lower rates of discontinuation were high rates of remission of both positive and negative symptoms and higher baseline function (whether or not alluding to pretreatment functionality unspecified).Times to discontinuation were longer in patients with less drug-related weight gain per month.

The authors consider the 72-percent rate of first-year medication discontinuation they observed “a major concern” in patients with first-episode psychosis, and consider insufficient symptom relief and “better functioning” important drivers of that concern. The sole adverse effect driving medication discontinuation was weight gain. Medication discontinuation was in no patient prompted by neuroleptic malignant syndrome, acute extrapyramidal effects, or tardive motor syndromes.

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