{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:44:38Z","timestamp":1791557078400,"version":"4.3.4"},"reference-count":104,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>Although maintenance treatment with antipsychotics protects against psychotic relapse, high doses may hamper recovery. Therefore, dose reduction or discontinuation may be considered in patients with chronic schizophrenia. Here, we identified risk factors for psychotic relapse when doses are reduced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through January 2021 and reviewed randomized controlled trials (RCTs) that reported relapse rates after antipsychotic dose reduction or discontinuation in patients with chronic schizophrenia. We calculated relative risks (RRs) with 95% confidence intervals (CIs) per person-year and sought to identify potential risk factors for relapse. The study is registered with PROSPERO (CRD42017058296).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Results<\/jats:title>\n                    <jats:p>Forty-seven RCTs (54 patient cohorts, 1746 person-years) were included. The RR for psychotic relapse with dose reduction\/discontinuation versus maintenance treatment was 2.3 per person-year (95% CI: 1.9 to 2.8). The RR was higher with antipsychotic discontinuation, dose reduction to less than 3\u20135 mg haloperidol equivalent (HE), or relatively rapid dose reduction (&amp;lt;10 weeks). The RR was lower with long-acting injectable agents versus oral antipsychotic dose reduction. Other factors that increased the risk of psychotic relapse were younger age and short follow-up time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinicians should take several risk factors for psychotic relapse into account when considering dose reduction in patients with chronic schizophrenia. Studies of a relatively fast reduction in antipsychotic dose support a minimum dose of 3\u20135 mg HE. However, if the dose is tapered more gradually, relapses related to medication withdrawal might be avoided, possibly enabling lower-end doses to be achieved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/schbul\/sbac138","type":"journal-article","created":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T16:49:54Z","timestamp":1662569394000},"page":"11-23","source":"Crossref","is-referenced-by-count":47,"title":["Risk Factors for Psychotic Relapse After Dose Reduction or Discontinuation of Antipsychotics in Patients With Chronic Schizophrenia. A Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1093","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7273-0027","authenticated-orcid":false,"given":"Jan P A M","family":"Bogers","sequence":"first","affiliation":[{"name":"High Care Clinics and Rivierduinen Academy, Mental Health Services Rivierduinen , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Hambarian","sequence":"additional","affiliation":[{"name":"Mental Health Services Rivierduinen , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Walburgh Schmidt","sequence":"additional","affiliation":[{"name":"Mental Health Services Rivierduinen , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jentien M","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Amsterdam University Medical Center , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieuwe","family":"de Haan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Amsterdam University Medical Center , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"2023010315543766100_CIT0001","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1016\/S0140-6736(12)60239-6","article-title":"Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis","volume":"379","author":"Leucht","year":"2012","journal-title":"Lancet."},{"key":"2023010315543766100_CIT0002","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/S0140-6736(21)01997-8","article-title":"Comparative efficacy and tolerability of 32 oral and long-acting injectable antipsychotics for the maintenance treatment of adults with 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