Reducing Antipsychotics prevents cognitive impairment among refractory psychosis patients

The beneficial effects of antipsychotic dosage reduction in a long-term hospitalized forensic patient group was demonstrated as increase in competence restoration, hospital release, and community reintegration in a recent study by Mujeeb UShad and colleagues. The findings of this study were published in Primary Care Companion For CNS Disorders.

Antipsychotic medications (APMs) at high doses and polypharmacy (mega polypharmacy) are common, especially in those with schizophrenia who are resistant to therapy. Antipsychotic doses rapidly climb above the normal dosing range without waiting for the delayed antipsychotic response, despite the absence of managed care demands to swiftly discharge patients from long-term state mental facilities. In order to enable hospital discharge for long-term hospitalized forensic patients with treatment-resistant psychosis, it was decided to undertake this study to investigate the effects of antipsychotic dosage modifications (mostly reduction).

The medical records of 22 psychotic patients who were released from a long-term state mental hospital between January 2020 and August 2020 after regaining the ability to stand trial were retrospectively reviewed. The high-dose treatment was defined as a dosage  ≥ 50% over the typical package insert dose due to the absence of explicit recommendations. The main result was how soon patients were discharged following the antipsychotic dosage changes.

The key findings of this study were:

1. Sixty-eight percent of the participants, who spent a total of 11.6 ± 5.3 months in the hospital, were released after receiving a 44.4% antipsychotic dosage decrease for 2.3 ± 0.78 months.

2. Two patients who spent 14.5 ± 6.7 months in the hospital were released after 4 months of adjusting their subtherapeutic dosages.

3. After spending a total of 6.8 ± 2.17 months in the hospital, five patients who were already getting effective doses were released.

In conclusion, in a patient group with several underlying cognitive impairments and a high prevalence of medical, drug use, and psychiatric comorbidities, the lowered doses also provided a noticeably improved side effect profile, which is of great therapeutic value.

Reference:

Shad, M. U. (2022). High-Dose Therapy in Treatment-Refractory Psychosis. In The Primary Care Companion For CNS Disorders (Vol. 24, Issue 6). Physicians Postgraduate Press, Inc. https://doi.org/10.4088/pcc.21m03214