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Medications for relapse prevention

What is relapse prevention for schizophrenia?

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?

High quality evidence shows a small benefit of specialist first-episode psychosis programs (involving both psychosocial and pharmaceutical treatments) for reducing the risk of relapse and less all-cause discontinuation of treatment compared to treatment as usual. These programs may also reduce the length of hospital stay should relapse occur.

Moderate to high quality evidence suggests a medium-sized effect of reduced risk of relapse in people receiving antipsychotics, particularly clozapine, although antipsychotics resulted in more weight gain, movement disorders and sedation than placebo. Long-acting injectable antipsychotics may be more effective than oral antipsychotics, second-generation antipsychotics may be more effective than first-generation antipsychotics, and continuous antipsychotic use may be more effective than intermittent antipsychotic use.

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.

Moderate quality evidence suggests relapse and rehospitalisation rates were higher after discontinuation of antipsychotics in people in remission following a first-episode of psychosis. Relapse rates were highest in studies with a short follow-up (<1 year), a non-targeted or non-intermittent discontinuation strategy, a lower relapse threshold, a smaller sample size, and in samples of patients with drug or alcohol dependency.

October 2020

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Last updated at: 11:56 am, 23rd February 2022
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Fact Sheet Technical Commentary
Tags:  Relapse

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