Rationale of an Observational Clinical Trial Focused on Guided Dose Reduction of Antipsychotic Treatment for Patients with Remitted State of Psychosis

Poster A115, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Chen-Chung Liu1; 1National Taiwan University Hospital

Whether good responders of early psychosis intervention can stop antipsychotic medication warrants careful deliberation. Randomized control trials (RCT) showed increased risks of relapse if discontinuing antipsychotics; neither intermittent treatment nor dose reduction was recommended; whilst some longitudinal observational studies (LOS) suggested medication discontinuation not parallel to poorer functioning. Methodological issues may explain such discrepancies, as these two approaches were conducted differently in many aspects, rendering possible biases toward over-presenting worsening in RCT yet underreporting symptom fluctuations in LOS. A window of opportunity to get better outcomes under lower doses was opened by the finding that lower dopamine occupancy could be enough for stable patients. Also inspired by the metaphor of mathematician Cantor’s Ternary Set, theoretically we can delete a fraction of a line reiteratively to make the sum of the remaining fragments approximate to zero but the number of those fragments being infinite. A hypothetical compromised approach “guided dose reduction, but not aiming at discontinuation” was proposed to initiate an observational clinical trial. For patients with remitted state of psychosis, we provide them with sufficient instructions, precautions, monitoring and education, not just the schedule, but more importantly the rationale, of dose reduction. We believe by inviting patients to take more autonomy in management of their illness and treating the role of antipsychotic as an insulator to elevate thresholds of their psychosis-proneness, patients can be less vulnerable to develop full-blown psychosis while being triggered by potential risk factors. Our goal is to optimize the risk and benefit ratio of antipsychotic treatment.

Topic Area: Psychopharmacology

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