The Effects of Antipsychotic Dose Reduction on Movement Disorders and Cardiometabolic Indices in Patients Remitted from a First Episode of Psychosis.
The Effects of Antipsychotic Dose Reduction on Movement Disorders and Cardiometabolic Indices in Patients Remitted from a First Episode of Psychosis.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Groningen, NL · Author affiliation
Department of Biomedical Sciences, Cognitive Neuroscience Center, University Medical Center Groningen (UMCG), University of Groningen, Groningen 9713 GZ, The Netherlands.Location evidence
Birmingham, GB · Author affiliation
Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, United Kingdom.Location evidence
The Hague, NL · Author affiliation
Parnassia Group for Mental Health Care, The Hague 2552 KS, The Netherlands.Location evidence
Rotterdam, NL · Author affiliation
Department of Neuroscience, Erasmus Medical Centre, Rotterdam 3015 GD, The Netherlands.Location evidence
Amsterdam, NL · Author affiliation
Arkin, Institute for Mental Health, Amsterdam 1033 NN, The Netherlands.Location evidence
Maastricht, NL · Author affiliation
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MheNS), Maastricht University Medical Centre, Maastricht 6229 ER, The Netherlands.Location evidence
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Original abstract
BACKGROUND AND HYPOTHESIS: The extent to which tapering antipsychotic (AP) attenuates AP-related movement disorders and cardiometabolic dysfunction remains unclear. We aim to investigate the long-term effects of AP-dose reduction on these adverse effects in patients remitted from a first episode of psychosis (FEP). STUDY METHODS: We included 293 FEP participants from the HAMLETT trial. Movement disorders were assessed using the St. Hans Rating Scale (SHRS) and Barnes Akathisia Rating Scale. Cardiometabolic indices included body mass index (BMI), waist circumference, blood pressure (BP), glucose, triglycerides, and cholesterol. Linear mixed-effects models assessed longitudinal relationships between AP-dose reduction, movement disorders and cardiometabolic indices. STUDY RESULTS: Over an average 29-month follow-up (SD = 19), a 1 mg olanzapine equivalent dose reduction from baseline was associated with a 0.013-point decrease in Parkinsonism (95% CI, -0.019, -0.006), a potential 0.003-point decrease in tardive dyskinesia (95% CI, -0.006, -0.000) on SHRS (range 0-6), and decreases of 0.037 (0.15%) kg/m2 in BMI (95% CI, -0.059, -0.015), 0.153 (0.17%) cm in waist circumference (95% CI, -0.265, -0.037), 0.023 (0.47%) mmol/L in total cholesterol (95% CI, -0.039, -0.007), 0.018 (0.60%) mmol/L in low-density lipoprotein cholesterol (95% CI, -0.032, -0.003), and 0.021 (0.58%) mmol/L in nonhigh-density lipoprotein cholesterol (95% CI, -0.037, -0.005). We found no evidence for an association with tardive dystonia, akathisia, BP, glucose, or triglycerides. CONCLUSIONS: AP-dose reduction modestly benefits AP-related Parkinsonism, weight gain, cholesterol levels and potentially tardive dyskinesia in patients after FEP over time. These benefits should be carefully weighed against the risks of relapse and suicide.