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Abstract：
There has been an increasing focus on deprescribing in psychiatry recently, particularly of antipsychotic medication, with recognition that not all patients with psychotic disorders require lifelong medication. We summarize some empirical and theoretical papers, and examine case studies to provide instruction on this topic.
Recent studies have found that slower tapering (over months or longer) of antipsychotics is associated with a lower relapse rate than quicker tapering (weeks). Case studies presented suggest that the process of reduction is associated with the precipitation or exacerbation of psychotic symptoms and that a slower process of reduction may minimize this effect. This may be because faster reductions cause greater disruption of homeostatic equilibria, provoking psychotic symptoms either as direct withdrawal symptoms or consequences of nonpsychotic withdrawal symptoms (e.g. insomnia) - although not all patients will experience withdrawal symptoms. This suggests that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms.
Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse. Exacerbation of psychotic symptoms on antipsychotic reduction may not represent evidence of the need for a higher dose of antipsychotic on a long-term basis but may indicate the need for more gradual reduction. Gradual reduction of antipsychotics, especially after long-term use in clinical practice is prudent.
Recent studies have found that slower tapering (over months or longer) of antipsychotics is associated with a lower relapse rate than quicker tapering (weeks). Case studies presented suggest that the process of reduction is associated with the precipitation or exacerbation of psychotic symptoms and that a slower process of reduction may minimize this effect. This may be because faster reductions cause greater disruption of homeostatic equilibria, provoking psychotic symptoms either as direct withdrawal symptoms or consequences of nonpsychotic withdrawal symptoms (e.g. insomnia) - although not all patients will experience withdrawal symptoms. This suggests that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms.
Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse. Exacerbation of psychotic symptoms on antipsychotic reduction may not represent evidence of the need for a higher dose of antipsychotic on a long-term basis but may indicate the need for more gradual reduction. Gradual reduction of antipsychotics, especially after long-term use in clinical practice is prudent.
摘要：
目的：最近，精神病学中的去处方越来越受到关注，特别是抗精神病药物，认识到并非所有精神病患者都需要终身服药。我们总结了一些实证和理论论文，并研究案例研究，以提供有关此主题的指导。
结果：最近的研究发现，抗精神病药物的缓慢减量（数月或更长时间）与较快减量（数周）相比，复发率较低。所提供的案例研究表明，减少的过程与精神病症状的沉淀或恶化有关，而较慢的减少过程可能会使这种影响最小化。这可能是因为更快的减少会导致稳态平衡的更大破坏，作为直接戒断症状或非精神病戒断症状（例如失眠）引起精神病性症状-尽管并非所有患者都会出现戒断症状。这表明较小的剂量减少，尤其是在较低的剂量下，逐渐地，可以将精神病症状的风险降至最低。
结论：抗精神病药物的逐渐减少可能为适应药物的存在提供时间来解决，从而减少了由剂量减少引起的对稳态平衡的破坏，有可能降低复发的风险。抗精神病药减少后精神病症状的加重可能并不代表长期需要更高剂量抗精神病药的证据，但可能表明需要逐步减少。抗精神病药物逐渐减少，特别是在临床实践中长期使用后是谨慎的。
结果：最近的研究发现，抗精神病药物的缓慢减量（数月或更长时间）与较快减量（数周）相比，复发率较低。所提供的案例研究表明，减少的过程与精神病症状的沉淀或恶化有关，而较慢的减少过程可能会使这种影响最小化。这可能是因为更快的减少会导致稳态平衡的更大破坏，作为直接戒断症状或非精神病戒断症状（例如失眠）引起精神病性症状-尽管并非所有患者都会出现戒断症状。这表明较小的剂量减少，尤其是在较低的剂量下，逐渐地，可以将精神病症状的风险降至最低。
结论：抗精神病药物的逐渐减少可能为适应药物的存在提供时间来解决，从而减少了由剂量减少引起的对稳态平衡的破坏，有可能降低复发的风险。抗精神病药减少后精神病症状的加重可能并不代表长期需要更高剂量抗精神病药的证据，但可能表明需要逐步减少。抗精神病药物逐渐减少，特别是在临床实践中长期使用后是谨慎的。
