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A dose reduction/discontinuation strategy improves long-term recovery in people with remitted first-episode psychosis compared to maintenance therapy

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Question: What are the long-term effects of an antipsychotic dose-reduction/discontinuation (DR) strategy compared with maintenance treatment for people in remission from a first episode of psychosis?

Patients: One hundred and twenty-eight people with first-episode psychosis (FEP) who showed response of symptoms or sustained symptom remission during 6 months of antipsychotic treatment.

Setting: Seven mental healthcare organisations and the University Medical Center Groningen in the Netherlands.

Intervention: Antipsychotic dose DR, compared with maintenance therapy (MT) for 18 months. The DR strategy consisted of gradual symptom-guided tapering of dosage and discontinuation if feasible. MT was carried out according to the American Psychiatric Association guidelines, preferably using low-dose atypical antipsychotics.

Outcomes: Recovery at 7-year follow-up, defined as symptomatic and functional remission for at least 6 months. Symptom remission was assessed using the Positive and Negative Syndrome Scale (PANSS) and defined as a score below three on …

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