Evidence map›Paper›PMID 31770770›Full record

SynthesisNeuropsychopharmacology : official publication of the American College of Neuropsychopharmacology2020

Factors associated with successful antipsychotic dose reduction in schizophrenia: a systematic review of prospective clinical trials and meta-analysis of randomized controlled trials.

Hideaki Tani, Shotaro Takasu, Hiroyuki Uchida, Takefumi Suzuki, Masaru Mimura, Hiroyoshi Takeuchi

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 33 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 7 pooled it
–field-weighted citation impact
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

33 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. The association between relapse and the outcome of schizophrenia and recurrent psychotic disorders.The British journal of psychiatry : the journal of mental science · 2025
    Trial
  9. Trial
  10. Trial
  11. Long-term effects of adolescent risperidone treatment on the mouse cortex.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026
    Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Helping people to discontinue antipsychotics: if, when and how.Schizophrenia (Heidelberg, Germany) · 2025
    Review
  18. Review
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Hideaki TaniDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Shotaro TakasuDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Hiroyuki UchidaDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.ORCID http://orcid.org/0000-0002-0628-7036
Takefumi SuzukiDepartment of Neuropsychiatry, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.ORCID http://orcid.org/0000-0002-5147-1684
Masaru MimuraDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Hiroyoshi TakeuchiDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. hirotak@dk9.so-net.ne.jp.ORCID http://orcid.org/0000-0002-8844-4786

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This systematic review and meta-analysis examined predictors of successful antipsychotic dose reduction in schizophrenia. Prospective clinical trials and randomized controlled trials (RCTs) investigating antipsychotic dose reduction in schizophrenia were selected for systematic review and meta-analysis, respectively. In total, 37 trials were identified. Only 8 studies focused on second-generation antipsychotics (SGAs); no studies investigated long-acting injectable SGAs. Of 24 studies evaluating relapse or symptom changes, 20 (83.3%) met the criteria for successful dose reduction. Factors associated with successful dose reduction were study duration < 1 year, age > 40 years, duration of illness > 10 years, and post-reduction chlorpromazine equivalent (CPZE) dose > 200 mg/day. Clinical deterioration was mostly re-stabilized by increasing the dose to the baseline level (N = 7/8, 87.5%). A meta-analysis of 18 RCTs revealed that relapse rate was significantly higher in the reduction group than the maintenance group (risk ratio [RR] = 1.96; 95% confidence interval [CI], 1.23-3.12), whereas neurocognition was significantly improved (standardized mean difference = 0.69; 95% CI, 0.25-1.12). A subgroup analysis indicated that only a post-reduction CPZE dose ≤ 200 mg/day was associated with an increased risk of relapse (RR = 2.79; 95% CI, 1.29-6.03). Thus, when reducing antipsychotic doses, clinicians should consider the long-term risk of relapse in younger patients with a relatively short illness duration and keep the final doses higher than CPZE 200 mg/day. Further studies, particularly those involving SGAs, are warranted to determine the optimal strategies for successful antipsychotic dose reduction in schizophrenia.

Indexed as

Drug TaperingSchizophrenic PsychologyAntipsychotic AgentsHumansProspective StudiesRandomized Controlled Trials as TopicRecurrenceSchizophreniaSecondary PreventionTreatment OutcomeAntipsychotic Agents

Identifiers

PMID31770770
PMCPMC7075912

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.