Clinical characteristics of patients with schizophrenia maintained without antipsychotics: A cross-sectional survey of a case series
HIDEAKI TANI 1, 2, MASAYUKI TOMITA 3, TAKEFUMI SUZUKI 4, MASARU MIMURA 1, HIROYUKI UCHIDA 1, 5*
1Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan, 2Kimel Family Translational Imaging-Genetics Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada, 3Department of Psychiatry, Ohizumi Hospital, Tokyo, Japan, 4Department of Neuropsychiatry, University of Yamanashi, Yamanashi Faculty of Medicine, Japan, 5Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
Received: February 19, 2021; Revised: April 30, 2021; Accepted: June 3, 2021; Published online: June 3, 2021.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective: While antipsychotics are necessary for relapse prevention in the treatment of schizophrenia in general, some minority of patients may be maintained without continuous antipsychotic treatment. However, the characteristics of such patients are not well known and previous reports have not evaluated key elements such as physical comorbidities and functioning.
Methods: Among 635 patients with schizophrenia who participated in a 12-year follow-up, those who were maintained without antipsychotic treatment for at least one year after the study were investigated. The patients underwent comprehensive assessments, including Positive and Negative Syndrome Scale (PANSS) for psychopathology, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) for physical comorbidities, and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), Barthel Index, and EuroQoL five dimensions (EQ5D) for function
Results: Six patients were included (mean±SD age, 66.8±17.4 years; 4 inpatients). The four inpatients were old (77.8±4.8 years) and chronically ill (duration of illness, 49.3±12.5 years) with a high PANSS score (total score, 118.0±9.8; negative syndrome subscale, 41.3±6.9), low functioning (FACT-Sz, 9.8±3.6; Barthel Index, 8.8±9.6), and serious physical comorbidities (CIRS-G, 15.5±1.1). By contrast, the two outpatients were relatively young (45.0±12.0 years) and clinically in good condition (PANSS total score, 44.5±0.5; Barthel Index, 100 for both; EQ5D, 0.85±0.04).
Conclusion: Although the number is limited, two types of patients with schizophrenia were identified who were free from ongoing antipsychotic treatment; 1) older chronic inpatients with serious physical comorbidities, and 2) younger outpatients with milder impairments. Future explorations are needed to identify those who will be successfully withdrawn from continuous antipsychotic treatment.
Keywords: antipsychotics, discontinuation, maintenance, schizophrenia


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