Uncertainty surrounds the best antipsychotic dosages for first-episode schizophrenia patients to avoid recurrence. Heidi Taipale and colleagues conducted this study to follow the development of antipsychotic doses and the risk of major relapse shown by mental rehospitalization associated with antipsychotic use and specific dose categories.

This register-based cohort study was conducted throughout Finland. Patients who were 45 years of age or younger who were hospitalized with the first episode of schizophrenia were monitored for five years or until a fifth relapse episode. The primary outcome measure was rehospitalization for psychosis, which was used as a marker of recurrence and was defined as inpatient hospital treatment with an ICD-10 code of F20-F29 diagnosis listed as the primary discharge diagnostic.

To be considered a fresh relapse, at least 30 days must intervene between relapses. Based on the prescription database, antipsychotics were used. All concomitant antipsychotics’ dosages were combined. The efficiency of antipsychotics for lowering rehospitalization was investigated using within-individual analysis to eliminate selection bias and stratifying time before and after the second relapse.

The study’s main highlights include:

1. The total number of patients in the research was 5367, with 3444 (64%) men and 1923 (35% women), and 3058 (57%) required hospitalization.

2. In these patients, the mean dosage increased during the course of the preceding relapses from 1.22 defined daily doses per day (before the first relapse) to 1.56 defined daily doses per day (1.48–1.64).

3. A considerably lower effectiveness was seen in the adjusted hazard ratio (aHR) for rehospitalization with antipsychotic use versus non-use, which increased from 0.42 before the second relapse to 0.78 (0.62-0.99) after the second relapse.

4. When specific dose categories were examined, a U-shaped curve showed that the standard dose was utilized before the second relapse but not thereafter when the risk of rehospitalization was at its lowest.

5. Because all dosages became less effective after the second relapse, reduced dosage was not associated with a noticeably higher risk of rehospitalization than the usual dose.

Source: medical dialogues

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