PDF(Pubmed)
Abstract：
BACKGROUND: The optimal duration of antipsychotic treatment following remission of first-episode psychosis (FEP) is uncertain, considering potential adverse effects and individual variability in relapse rates. This study aimed to investigate the effect of antipsychotic discontinuation compared to continuation on recovery in remitted FEP patients.
METHODS: CENTRAL, MEDLINE (Ovid), Embase, and PsycINFO databases were searched on November 2, 2023, with no language restrictions. RCTs evaluating antipsychotic discontinuation in remitted FEP patients were selected. The primary outcome was personal recovery, and secondary outcomes included functional recovery, global functioning, hospital admission, symptom severity, quality of life, side effects, and employment. Risk of bias was assessed using the Cochrane risk-of-bias tool 2, and the certainty of evidence was evaluated with GRADE. Meta-analysis used a random-effect model with an inverse-variance approach.
RESULTS: Among 2185 screened studies, 8 RCTs (560 participants) were included. No RCTs reported personal recovery as an outcome. Two studies measured functional recovery, and discontinuation group patients were more likely to achieve functional recovery (RR 2.19; 95% CIs: 1.13, 4.22; I2 = 0%; n = 128), although evidence certainty was very low. No significant differences were found in hospital admission, symptom severity, quality of life, global functioning, or employment between the discontinuation and continuation groups.
CONCLUSIONS: Personal recovery was not reported in any antipsychotic discontinuation trial in remitted FEP. The observed positive effect of discontinuation on functional recovery came from an early terminated trial and an RCT followed by an uncontrolled period. These findings should be interpreted cautiously due to very low certainty of evidence.
METHODS: CENTRAL, MEDLINE (Ovid), Embase, and PsycINFO databases were searched on November 2, 2023, with no language restrictions. RCTs evaluating antipsychotic discontinuation in remitted FEP patients were selected. The primary outcome was personal recovery, and secondary outcomes included functional recovery, global functioning, hospital admission, symptom severity, quality of life, side effects, and employment. Risk of bias was assessed using the Cochrane risk-of-bias tool 2, and the certainty of evidence was evaluated with GRADE. Meta-analysis used a random-effect model with an inverse-variance approach.
RESULTS: Among 2185 screened studies, 8 RCTs (560 participants) were included. No RCTs reported personal recovery as an outcome. Two studies measured functional recovery, and discontinuation group patients were more likely to achieve functional recovery (RR 2.19; 95% CIs: 1.13, 4.22; I2 = 0%; n = 128), although evidence certainty was very low. No significant differences were found in hospital admission, symptom severity, quality of life, global functioning, or employment between the discontinuation and continuation groups.
CONCLUSIONS: Personal recovery was not reported in any antipsychotic discontinuation trial in remitted FEP. The observed positive effect of discontinuation on functional recovery came from an early terminated trial and an RCT followed by an uncontrolled period. These findings should be interpreted cautiously due to very low certainty of evidence.
摘要：
背景：首发精神病（FEP）缓解后抗精神病药物治疗的最佳持续时间尚不确定，考虑到潜在的不良反应和复发率的个体差异。这项研究旨在研究与继续治疗相比，停用抗精神病药对缓解的FEP患者恢复的影响。
方法：中央，MEDLINE(Ovid),Embase,和PsycINFO数据库于2023年11月2日检索,没有语言限制.选择评估缓解的FEP患者的抗精神病药物停药的RCT。主要结果是个人康复，次要结果包括功能恢复，全球运作，入院,症状严重程度,生活质量,副作用,和就业。使用Cochrane偏倚风险工具2评估偏倚风险，并使用GRADE评估证据的确定性。荟萃分析使用具有逆方差方法的随机效应模型。
结果：在2185项筛选研究中，纳入8项RCT（560名参与者）。没有RCT报告个人康复作为结果。两项研究测量了功能恢复，停药组患者更有可能实现功能恢复(RR2.19;95%CI:1.13,4.22;I2=0%;n=128),尽管证据的确定性很低。入院时没有发现显着差异，症状严重程度,生活质量,全球运作，或中止组和继续组之间的就业。
结论：在缓解FEP的任何抗精神病药物停药试验中均未报告个人康复。观察到的停药对功能恢复的积极影响来自早期终止的试验和RCT，然后是不受控制的时期。由于证据的确定性很低，因此应谨慎解释这些发现。
方法：中央，MEDLINE(Ovid),Embase,和PsycINFO数据库于2023年11月2日检索,没有语言限制.选择评估缓解的FEP患者的抗精神病药物停药的RCT。主要结果是个人康复，次要结果包括功能恢复，全球运作，入院,症状严重程度,生活质量,副作用,和就业。使用Cochrane偏倚风险工具2评估偏倚风险，并使用GRADE评估证据的确定性。荟萃分析使用具有逆方差方法的随机效应模型。
结果：在2185项筛选研究中，纳入8项RCT（560名参与者）。没有RCT报告个人康复作为结果。两项研究测量了功能恢复，停药组患者更有可能实现功能恢复(RR2.19;95%CI:1.13,4.22;I2=0%;n=128),尽管证据的确定性很低。入院时没有发现显着差异，症状严重程度,生活质量,全球运作，或中止组和继续组之间的就业。
结论：在缓解FEP的任何抗精神病药物停药试验中均未报告个人康复。观察到的停药对功能恢复的积极影响来自早期终止的试验和RCT，然后是不受控制的时期。由于证据的确定性很低，因此应谨慎解释这些发现。
