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Comment & Response |

Early Medication Discontinuation on Long-term Recovery Outcome in First-Episode Psychosis—Reply

Lex Wunderink, MD, PhD1,2; Sjoerd Sytema, PhD2
[+] Author Affiliations
1Department of Research and Education, Friesland Mental Health Services, Leeuwarden, the Netherlands
2Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
JAMA Psychiatry. 2014;71(2):208-209. doi:10.1001/jamapsychiatry.2013.3530.
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In Reply Undurraga et al comment on 3 methodological issues they perceived in our article.1 First, they state that both interventions were similar because ultimately only a small number of patients discontinued treatment and the mean doses used were arguably significantly different.

  1. The aim of the study was to reduce antipsychotic dose. The ultimate form of dose reduction is discontinuation. Though maybe not impressive, it was relevant to 21.5% of patients who achieved it, against 7.9% in the control condition. Undurraga et al overlook short-term relapse rates: twice as high in the dose-reduction strategy.

  2. Apart from discontinuation, patients who did not discontinue took lower doses, too. And, we believe that the difference in mean dose is clinically significant: dopamine blockade is more pronounced at 3.6-mg than 2.2-mg haloperidol equivalents. The slightly elevated standard deviation in the maintenance treatment group is logical, compared with the smaller variance of a reduced dose.

  3. Operative guideline–recommended maintenance strategy implies lower-range dosing. Differences would have been more pronounced if the maintenance treatment group had received a higher dose, a strategy we fortunately abolished.


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February 1, 2014
Juan Undurraga, MD, PhD; Andrea Murru, MD, PhD; Eduard Vieta, MD, PhD
1Bipolar Disorders Unit, Neuroscience Institute, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Catalonia, Spain
JAMA Psychiatry. 2014;71(2):206-207. doi:10.1001/jamapsychiatry.2013.2993.
February 1, 2014
Christy L. M. Hui, PhD; Eric Y. H. Chen, MD
1Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
2State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China
JAMA Psychiatry. 2014;71(2):207-208. doi:10.1001/jamapsychiatry.2013.3697.
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