Discontinuation of antipsychotic therapy in severe mania: A six months follow-up study

Abstract

Introduction

Independently of the drug choice, antimaniac treatment has to be continued at least until full remission. Most guidelines recommend continuation therapy for 6–12 months but controlled studies are lacking.

Objectives

A six months follow-up study on a sample of 57 inpatients affected by mania at Mood Disorder Unit.

Aims

To evaluate a timeframe for the discontinuation of the antipsychotic therapy.

Methods

Fifty-seven bipolar inpatients affected by a manic episode according to DSM-5 criteria. Patients treated according to our pharmacological protocol with a mood stabilizer (lithium or valproate) and an antipsychotic (haloperidol or risperidone). Course of illness assessed with Young Mania Rating Scale (YMRS) scored at week 0, 1, 2, 4, 8, 24. Remission defined as YMRS < 12.

Results

Twenty men (35.09%) and 37 women (64.91%); mean age 43.18 ± 12.71 years. Mean YMRS basal score 38.55 ± 8.08. At 4th week, remission rate was 54.39% (31 patients); at 8th week was 80.70% (46 patients). At 8th week, 39/57 patients (68.42%) discontinued the antipsychotic. Relapse rate after 6 months was 26.32% (12 depressed, 3 manic). Multiple regression, t-test and Chi² analysis were performed: older patients (P = 0.01) and with higher number of episodes (P = 0.04) tend to relapse earlier. Neither severity of the episode (P = 0.3), nor delusional symptoms (P = 0.6) nor discontinuation of the antipsychotic (P = 0.3) correlate with relapse time.

Conclusions

Our experience suggests that an early discontinuation of antipsychotics, usually 4–8 weeks after remission, does not worsen the short-term course of illness. This approach could minimize the risk of side effects. Evidence is lacking about the duration of this therapy, long-term studies are still necessary.

Disclosure of interest

The authors have not supplied their declaration of competing interest.