Pub Date : 2022-08-01Epub Date: 2022-06-23DOI: 10.1016/S2215-0366(22)00158-4
Giovanni Ostuzzi, Giovanni Vita, Federico Bertolini, Federico Tedeschi, Beatrice De Luca, Chiara Gastaldon, Michela Nosé, Davide Papola, Marianna Purgato, Cinzia Del Giovane, Christoph U Correll, Corrado Barbui
Background: Although antipsychotic maintenance treatment is widely recommended to prevent relapse in chronic psychoses, evidence-based guidelines do not provide clear indications on different maintenance treatment strategies, including continuing the antipsychotic at standard doses, reducing the dose, switching to another antipsychotic, or even stopping the antipsychotic. We aimed to compare the effectiveness of these maintenance treatment strategies, hypothesising the superiority of all strategies over stopping, and of continuing at standard doses over both switching and reducing the dose.
Methods: We did a systematic review and network meta-analysis of randomized controlled trials (RCTs) that investigated antipsychotics for relapse prevention in adults with schizophrenia-spectrum disorders who were clinically stable, and which compared four treatment strategies: continuing the current antipsychotic at standard doses recommended for acute treatment; reducing the current antipsychotic dose; switching to a different antipsychotic; and stopping the antipsychotic and replacing it with placebo. We excluded RCTs with fewer than 25 individuals, a prerandomisation washout period greater than 4 weeks, a follow-up shorter than 6 weeks, and those recruiting treatment-resistant individuals. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, and online trial registers for published and unpublished RCTs from inception to Sept 1, 2021, combining terms describing all available antipsychotics, and terms describing continuation, maintenance, or long-term treatment for schizophrenia-spectrum disorders. Relative risks (RRs) and standardised mean differences were pooled using random-effects pairwise and network meta-analyses. We assessed risk of bias of each RCT with the Cochrane Risk-of-Bias 2 tool, and confidence of pooled estimates with CINeMA. The primary outcome was relapse prevention. The study protocol was registered in advance in the Open Science Forum registry.
Findings: Of 3936 records identified, 119 records, reporting on 101 RCTs, were eligible, 98 of which (including 13 988 individuals) provided data that could be meta-analysed for at least one outcome. The mean proportion of female participants per study was 38% (range 0-100; median 39%, IQR 29-50), whereas for male participants it was 62% (range 0-100; median 61%, IQR 50-71), and the overall mean age was 38·8 years (range 23·2-63·9; median 39·3, IQR 35·0-43·9). Of the 98 RCTs meta-analysed, 89·8% were done in high-income and upper-middle-income countries. The ethnic group White or so-called Caucasian was the most represented (mean 56% participants per study), although this information was relatively scarce. All continuation strategies were significantly more effective in preventing relapse than stopping antipsychotic treatment, with a large risk reduction for continuing at standard doses (RR 0·37, 95% CI 0·32-0·43; number-needed-to
{"title":"Continuing, reducing, switching, or stopping antipsychotics in individuals with schizophrenia-spectrum disorders who are clinically stable: a systematic review and network meta-analysis.","authors":"Giovanni Ostuzzi, Giovanni Vita, Federico Bertolini, Federico Tedeschi, Beatrice De Luca, Chiara Gastaldon, Michela Nosé, Davide Papola, Marianna Purgato, Cinzia Del Giovane, Christoph U Correll, Corrado Barbui","doi":"10.1016/S2215-0366(22)00158-4","DOIUrl":"10.1016/S2215-0366(22)00158-4","url":null,"abstract":"<p><strong>Background: </strong>Although antipsychotic maintenance treatment is widely recommended to prevent relapse in chronic psychoses, evidence-based guidelines do not provide clear indications on different maintenance treatment strategies, including continuing the antipsychotic at standard doses, reducing the dose, switching to another antipsychotic, or even stopping the antipsychotic. We aimed to compare the effectiveness of these maintenance treatment strategies, hypothesising the superiority of all strategies over stopping, and of continuing at standard doses over both switching and reducing the dose.</p><p><strong>Methods: </strong>We did a systematic review and network meta-analysis of randomized controlled trials (RCTs) that investigated antipsychotics for relapse prevention in adults with schizophrenia-spectrum disorders who were clinically stable, and which compared four treatment strategies: continuing the current antipsychotic at standard doses recommended for acute treatment; reducing the current antipsychotic dose; switching to a different antipsychotic; and stopping the antipsychotic and replacing it with placebo. We excluded RCTs with fewer than 25 individuals, a prerandomisation washout period greater than 4 weeks, a follow-up shorter than 6 weeks, and those recruiting treatment-resistant individuals. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, and online trial registers for published and unpublished RCTs from inception to Sept 1, 2021, combining terms describing all available antipsychotics, and terms describing continuation, maintenance, or long-term treatment for schizophrenia-spectrum disorders. Relative risks (RRs) and standardised mean differences were pooled using random-effects pairwise and network meta-analyses. We assessed risk of bias of each RCT with the Cochrane Risk-of-Bias 2 tool, and confidence of pooled estimates with CINeMA. The primary outcome was relapse prevention. The study protocol was registered in advance in the Open Science Forum registry.</p><p><strong>Findings: </strong>Of 3936 records identified, 119 records, reporting on 101 RCTs, were eligible, 98 of which (including 13 988 individuals) provided data that could be meta-analysed for at least one outcome. The mean proportion of female participants per study was 38% (range 0-100; median 39%, IQR 29-50), whereas for male participants it was 62% (range 0-100; median 61%, IQR 50-71), and the overall mean age was 38·8 years (range 23·2-63·9; median 39·3, IQR 35·0-43·9). Of the 98 RCTs meta-analysed, 89·8% were done in high-income and upper-middle-income countries. The ethnic group White or so-called Caucasian was the most represented (mean 56% participants per study), although this information was relatively scarce. All continuation strategies were significantly more effective in preventing relapse than stopping antipsychotic treatment, with a large risk reduction for continuing at standard doses (RR 0·37, 95% CI 0·32-0·43; number-needed-to","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"614-624"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-23DOI: 10.1016/S2215-0366(22)00230-9
Iris E C Sommer, Mark Horowitz, Kelly Allott, Helene Speyer, Marieke J H Begemann
{"title":"Antipsychotic maintenance treatment versus dose reduction: how the story continues.","authors":"Iris E C Sommer, Mark Horowitz, Kelly Allott, Helene Speyer, Marieke J H Begemann","doi":"10.1016/S2215-0366(22)00230-9","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00230-9","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"602-603"},"PeriodicalIF":64.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01DOI: 10.1016/S2215-0366(22)00203-6
Leila Doshmangir, Kamal Gholipour, Vladimir Sergeevich Gordeev
{"title":"Policy changes needed to address the mental health impact of COVID-19 in Iran.","authors":"Leila Doshmangir, Kamal Gholipour, Vladimir Sergeevich Gordeev","doi":"10.1016/S2215-0366(22)00203-6","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00203-6","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"e35"},"PeriodicalIF":64.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40511097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-30DOI: 10.1016/S2215-0366(22)00199-7
Claire Henderson
{"title":"Intensive home treatment in different settings.","authors":"Claire Henderson","doi":"10.1016/S2215-0366(22)00199-7","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00199-7","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"603-604"},"PeriodicalIF":64.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40472708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01DOI: 10.1016/S2215-0366(22)00233-4
Rahul Shidhaye
{"title":"Depression in Indians 45 years and older: a roadblock in healthy ageing.","authors":"Rahul Shidhaye","doi":"10.1016/S2215-0366(22)00233-4","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00233-4","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"605-606"},"PeriodicalIF":64.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40511093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-01Epub Date: 2022-06-21DOI: 10.1016/S2215-0366(22)00159-6
Victoria Haldane, Anne-Sophie Jung, Chuan De Foo, Pami Shrestha, Elena Urdaneta, Eva Turk, Juan I Gaviria, Jesus Boadas, Kent Buse, J Jaime Miranda, Steffanie A Strathdee, Ashley Barratt, Michel Kazatchkine, Martin McKee, Helena Legido-Quigley
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
{"title":"Integrating HIV and substance misuse services: a person-centred approach grounded in human rights.","authors":"Victoria Haldane, Anne-Sophie Jung, Chuan De Foo, Pami Shrestha, Elena Urdaneta, Eva Turk, Juan I Gaviria, Jesus Boadas, Kent Buse, J Jaime Miranda, Steffanie A Strathdee, Ashley Barratt, Michel Kazatchkine, Martin McKee, Helena Legido-Quigley","doi":"10.1016/S2215-0366(22)00159-6","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00159-6","url":null,"abstract":"<p><p>Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.</p>","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"676-688"},"PeriodicalIF":64.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40397444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.1016/S2215-0366(22)00152-3
J C Lokman, C L Bockting
{"title":"Pathways to depressive and anxiety disorders during and after the COVID-19 pandemic.","authors":"J C Lokman, C L Bockting","doi":"10.1016/S2215-0366(22)00152-3","DOIUrl":"https://doi.org/10.1016/S2215-0366(22)00152-3","url":null,"abstract":"","PeriodicalId":240194,"journal":{"name":"The lancet. Psychiatry","volume":" ","pages":"531-533"},"PeriodicalIF":64.3,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9212978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39991528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号