Early Dose Reduction or Discontinuation vs Maintenance Antipsychotics After First Psychotic Episode Remission

作者：Iris E. Sommer, Franciska de Beer, Shiral S. Gangadin, Lieuwe de Haan, Wim Veling, Nico van Beveren, Nynke Boonstra, Bram‐Sieben Rosema, Jim van Os, Martijn Kikkert, Sanne Koops, Jort Noorman, Frederick W. Thielen, Ben Wijnen, Marieke Begemann · 发表于：JAMA Psychiatry · 年份：2025 · DOI：10.1001/jamapsychiatry.2025.2525 · 被引用次数：16 · 研究领域：Schizophrenia research and treatment、Parkinson's Disease Mechanisms and Treatments、Healthcare Decision-Making and Restraints

Importance: Dose reduction or discontinuation (DRD) early after remission from first-episode psychosis (FEP) increases short-term relapse risk. Controversy remains regarding potential benefits in functioning over the longer term because studies with long-term outcomes show conflicting findings. Objective: To compare short- and long-term effects between DRD and maintenance medication over a 4-year period in a large sample of patients with FEP. Design, Setting, and Participants: The Handling Antipsychotic Medication Long-Term Evaluation of Targeted Treatment (HAMLETT) study is a single-blind pragmatic randomized (1:1) clinical trial conducted in 26 specialized psychosis units in the Netherlands from September 2017 to March 2023. Patients remitted for FEP from in- and outpatient services were included. Interventions: DRD within 12 months after remission compared with 12 months maintenance treatment. Main Outcomes and Measures: The primary outcome was patient-rated functioning, measured by the World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2). Secondary outcomes were researcher-rated global assessment of functioning (GAF), quality of life, relapse, symptom severity (measured by the Positive and Negative Syndrome Scale [PANSS]), serious adverse events, and adverse effects. Results: A total of 347 patients (241 male [69.5%]; mean [SD] age, 27.9 [8.7] years) were included, with 168 randomized to early DRD and 179 to maintenance. WHODAS-2 showed no time × condit...