Antipsychotic dosing: still a work in progress.

摘要

It is humbling that more than 50 years after the introduction of antipsychotics we still struggle with clinical questions basic to their use. Two articles in the present issue, coming from somewhat different perspectives, address one such question, that of anti-psychotic dosing. The article by Wang et al. (1) addresses maintenance treatment in schizophrenia (N=404) by examining different dosing strategies following stabilization of an acute episode with 4-8 mg of risperidone daily. Of note, this study was carried out in China, raising the issue of ethnocultural factors in antipsychotic dosing, a topic addressed in the second article to be discussed (2). After a stabilization period of 4-8 weeks, patients were followed up while taking a dose 1) reduced by 50% at 4 weeks, 2) reduced by 50% at 26 weeks, or 3) unchanged from the previous dose. The times to relapse were 571, 615, and 683 days in the three groups, respectively, while the risks of relapse were 30.5%, 19.5%, and 9.4%, respectively. The study is not without its limitations, including an open-label design, lack of clear criteria regarding the acute episode as well as previous treatment, and rationale for the 50% dose reduction.