Abstract / Summary
Background: Psychotic disorders can confer a substantial illness burden. Whilst Antipsychotic Medications (APMs) are effective in preventing relapse, they are associated with significant adverse effects, leading some patients to consider APM dose reduction or discontinuation.
Aim: We aimed to synthesise evidence on factors associated with relapse vs no relapse following APM dose reduction or discontinuation in patients with psychotic disorders.
Methods: We searched Embase, PsycINFO, PubMed, CINAHL and grey literature sources with no date restrictions and followed PRISMA guidelines. We included evidence sources which reported on factors associated with relapse/ no relapse following APM dose reduction or discontinuation in patients with a psychotic disorder, or tools to identify patients with a lower risk of relapse. We consulted our Lived Experience Advisory Panel (LEAP) throughout the review process.
Results: 69 studies met our inclusion criteria. 60 reported empirical evidence on factors associated with relapse/ no relapse, while 8 sources provided expert opinion or guideline-based recommendations and 1 source included both empirical results and expert opinion. We identified 62 independent factors across sociodemographic, illness, treatment, and biological domains. No factor had sufficiently consistent evidence to support its use as a reliable predictor of relapse. Factors reported in expert opinion pieces and guidelines largely aligned with those in empirical studies.
Conclusions: While factors affecting relapse risk following APM dose reduction or discontinuation are increasingly being researched, current evidence does not support any specific factor as a predictor of successful APM dose reduction or discontinuation. Nevertheless, several potentially promising factors warrant further investigation.