Effects of controlled discontinuation of long-term used antipsychotics for behavioural symptoms in individuals with intellectual disability
Effects of controlled discontinuation of long-term used antipsychotics for behavioural symptoms in individuals with intellectual disability
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DOI：
10.1111/j.1365-2788.2012.01631.x
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发表时间：
2014-01-01
影响因子：
3.6
通讯作者：
Hoekstra, P. J.
中科院分区：
文献类型：
--
作者：
de Kuijper, G.;Evenhuis, H.;Hoekstra, P. J.
背景抗精神病药物经常被用于智力残疾（ID）患者的挑战性行为，但证据基础薄弱。由于这些药物可能引起有害的副作用，应考虑停药。以往关于停用长期使用抗精神病药物的研究大多未加对照，涉及的人数较少。主要目的是调查控制性停用抗精神病药物对挑战行为的影响。次要目的是比较两种停药时间表的结果，比较已经和尚未完全停药的受试者组，并确定可能预测结局的患者和药物特征。我们的假设是，停止使用抗精神病药物的行为症状不会导致恶化behaviors.MethodsThis是一个多中心平行组研究比较两个停药时间表的14和28周。以1：1的比例分配至两个停药计划。抗精神病药物每2或4周逐渐减少，约为初始剂量的12.5%。随访时间为计划的完全停药后12周，即分别为首次减量后26周或40周。如果出现显著行为恶化，则停止停药。参与者是98名荷兰三个护理机构的ID居民，年龄在15-66岁之间，他们使用了超过1年的六种最常见的抗精神病药物中的一种或多种用于挑战行为。主要结果的措施是异常行为量表（ABC）的总评分，也ABC分量表were used.ResultsOf 98名参与者，43达到完全中止;在后续7恢复使用抗精神病药物。完全停药的患者平均ABC评分显著改善（停药后即刻，P
BackgroundAntipsychotics are frequently and often long-term used for challenging behaviour in persons with intellectual disability (ID), but the evidence base for this is meagre. As these agents may cause harmful side effects, discontinuation should be considered. Previous studies regarding discontinuation of long-term used antipsychotics mostly were uncontrolled and involved small numbers. The primary objective was to investigate the effects of controlled discontinuation of antipsychotics prescribed for challenging behaviour. Secondary objectives were to compare the results of two discontinuation time schedules, to compare groups of participants who had and had not achieved complete discontinuation, and to identify patient and medication characteristics that might predict the outcomes. Our hypothesis was that discontinuation of antipsychotics used for behavioural symptoms would not lead to worsening in behaviour.MethodsThis was a multi-centre parallel-group study comparing two discontinuation schedules of 14 and 28 weeks. Allocation to the two discontinuation schedules took place in a 1:1 ratio. Antipsychotics were tapered off every 2 or 4 weeks with approximately 12.5% of the initial dosage. Follow-up was 12 weeks after the scheduled complete discontinuation, that is, 26 or 40 weeks after the first dose reduction, respectively. Discontinuation was stopped in case of significant behavioural worsening. Participants were 98 residents with ID of three care providing organisations in the Netherlands, aged 15-66 year, who had used for more than 1 year one or more of the six most frequently prescribed antipsychotics for challenging behaviour. Main outcome measure was the total score of the Aberrant Behaviour Checklist (ABC); also ABC sub-scales were used.ResultsOf 98 participants, 43 achieved complete discontinuation; at follow-up 7 had resumed use of antipsychotics. Mean ABC ratings improved significantly for those who achieved complete discontinuation (directly after discontinuation, P