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Treatments for relapse prevention

What is relapse prevention?

Studies have shown that about 80% of patients relapse to psychosis within 5 years of initial diagnosis. Antipsychotic drugs have played a central role in the treatment of schizophrenia for more than 50 years and antipsychotic use significantly reduces the risk of relapse.

What is the evidence for relapse prevention?

Moderate to high quality evidence suggests a medium-sized effect of reduced risk of relapse in people receiving antipsychotics compared to placebo, although antipsychotics resulted in more weight gain, movement disorders and sedation. There is a medium-sized effect for continuous antipsychotic use being more effective than intermittent antipsychotic use for reducing relapse risk. There is a small effect of second generation antipsychotics being more effective for reducing risk of relapse than first generation antipsychotics. Second generation antipsychotics may also be superior for drug tolerability. There are no consistent differences in relapse rates between long-acting injectable antipsychotics and oral antipsychotics.

Moderate quality evidence suggests a small to medium-sized effect of reduced risk of relapse in people receiving standard dose antipsychotics compared to people receiving very low dose antipsychotics (< 50% of daily defined dose), although standard dose antipsychotics resulted in more people dropping out of trials due to side effects. No differences were reported in relapses or side effects when low dose (50 to < 100% of daily defined dose) was compared to standard dose.

High quality evidence shows a small effect of specialist first-episode psychosis programs compared to treatment as usual for reducing the risk of relapse. These programs may also reduce the length of hospital stay should relapse occur.

Also see the Course and Outcomes psychotic relapse topic.

April 2016

Page last updated: 1:42  7 September 2017

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