Evidence map›Paper›PMID 25522380›Full record

Trial reportThe international journal of neuropsychopharmacology2014

Evaluation of the individual safe correction of antipsychotic agent polypharmacy in Japanese patients with chronic schizophrenia: validation of safe corrections for antipsychotic polypharmacy and the high-dose method.

Yoshio Yamanouchi, Tsuruhei Sukegawa, Ataru Inagaki, Toshiya Inada, Takashi Yoshio, Reiji Yoshimura, Nakao Iwata

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The international journal of neuropsychopharmacology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 6 pooled it
0.8field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 6 syntheses or guidelines pooled it, 25 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Antipsychotic combinations for schizophrenia.The Cochrane database of systematic reviews · 2017
    Pooled it
  7. Trial
  8. Article
  9. Review
  10. Article
  11. Review
  12. Article
  13. Article
  14. Article
  15. Effectiveness in Switching from Antipsychotic Polypharmacy to Monotherapy in Patients with Schizophrenia: A Case Series.Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology · 2020
    Article
  16. Antipsychotic Polypharmacy: A Dirty Little Secret or a Fashion?The international journal of neuropsychopharmacology · 2020
    Review
  17. Use of a Spin Strategy Can Result in Unreliable Research Findings.The international journal of neuropsychopharmacology · 2017
    Article
  18. Response to Dr. Okumura.The international journal of neuropsychopharmacology · 2017
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 1 country.

Yoshio YamanouchiDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata). yamanouchi@ncnp.go.jp.
Tsuruhei SukegawaDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Ataru InagakiDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Toshiya InadaDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Takashi YoshioDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Reiji YoshimuraDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Nakao IwataDepartment of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan (Dr Yamanouchi); National Hospital Organization, Tottori Medical Center, Tottori, Japan (Dr Sukegawa); School of International Politics, Economics and Communication, Aoyama Gakuin University, Tokyo, Japan (Dr Inagaki); Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan (Dr Inada); Department of Clinical Pharmacy Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan (Dr Yoshio); Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan (Dr Yoshimura); Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan (Dr Iwata).
Toho University · JPAoyama Gakuin University · JPNational Center of Neurology and Psychiatry · JPNational Institute of Mental Health · JPUniversity of Occupational and Environmental Health Japan · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPolypharmacy for schizophrenia treatment is not justified by the available clinical evidence. We evaluated a treatment reduction approach that reduces the dose and number of antipsychotic medications simultaneously prescribed to patients.

methodsIn a randomized open study of the Safe Correction of Antipsychotic Polypharmacy and High-Dose Prescriptions program funded by the Japanese Ministry of Health, Labour, and Welfare, we evaluated a drug reduction method consisting of a dose reduction intervention performed on 163 patients with schizophrenia for twelve or 24 weeks. One antipsychotic medication was removed each week from each patient's treatment regimen by reducing the dose by 0 to 50 chlorpromazine equivalents. Data on health-related indices of quality of life, clinical symptoms, and risk of side effects were analyzed using a two-way repeated-measures mixed linear model.

resultsDespite a 23% reduction in antipsychotic dose, no differences in outcomes were observed between the dose reduction and observation groups (effect size = 0.001 - 0.085, P = .24-.97), despite high statistical power (1-β = 0.48-0.97). The findings are limited by the nonuniformity of the participants' treatment history, duration, and dose reduction amount. Dose reduction protocol patients exhibited no difference in psychotic symptoms or adverse events compared with the observation group.

conclusionsImportantly, the low dropout rate in our study (6.9% of participants withdrew because of patient factors and 23.8% for all secondary reasons) indicates that our "slowly" method is well tolerated. We hope that this approach will result in therapeutic improvements.

Indexed as

PolypharmacyAdultAntipsychotic AgentsDose-Response Relationship, DrugFemaleHumansJapanMaleMiddle AgedPsychopharmacologyQuality of LifeSchizophreniaSchizophrenic PsychologyTreatment OutcomeAntipsychotic Agentsantipsychoticsclinical trialpolypharmacypsychopharmacologyschizophrenia

Identifiers

PMID25522380
PMCPMC4376537
OpenAlexW2135450929

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.