title: How long to wait before reducing antipsychotic dosage in stabilized patients with schizophrenia? A retrospective chart review.
abstract: OBJECTIVE
  Antipsychotic dose reduction is generally recommended to occur after six months of clinical stabilization despite inadequate evidence. This timing issue was addressed in this study.
  
  
  METHODS
  This is an observational, retrospective and medical chart-based study. Inclusion criteria were (1) diagnosis of schizophrenia (DSM-IV), (2) being acutely psychotic at their first outpatient visit from May, 2002 to April, 2003, (3) having responded to antipsychotics and achieved clinical stabilization of acute symptoms, indexed as a fixation of regimen for four or more weeks, and (4) having one or more years of follow-up. Patients who had their antipsychotic doses reduced were then identified, and they were divided into two groups based on the waiting period before dose reduction: <24 weeks (Early Group) and ≥24 weeks (Standard Group). The rate of dose escalation for ≥20% during follow-up period was investigated as a proxy of clinical worsening.
  
  
  RESULTS
  After excluding stable patients at baseline, 211 patients met inclusion criteria. The mean ± SD waiting period before reducing antipsychotics was 122 ± 102 days. The rates of patients needing dose escalation were not significantly different between patients whose dose was reduced (N = 83) and those who was not (N = 128) (57.8% vs. 59.4%), and between Early Group (N = 59) and Standard Group (N = 24) (61.0% vs. 50.0%) although the reduction rate in antipsychotic dosage was significantly greater in Early Group (58.7% vs. 43.3%, p < 0.05).
  
  
  CONCLUSIONS
  These findings may indicate that timeline until antipsychotic reduction in stable patients with schizophrenia could be earlier than recommended, although caution is needed in interpreting our retrospective results.
authors.affiliation: Keio University, School of Medicine, Department of Neuropsychiatry, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. hirotak@dk9.so-net.ne.jp
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Takefumi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uchida
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nakajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Manki
authors.forename: Koichiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Haruo
authors.initials: H
authors.lastname: Kashima
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents