Psychiatrists' opinion towards medication discontinuation in remitted first-episode psychosis: A multi-site study of the Asian Network for Early Psychosis

Abstract

Aim:The study investigated psychiatrists' views towards the issue of medication discontinuationfor patients in remission from first-episode psychosis in four countries (Hong Kong, Korea, Sin-gapore and Japan) that are part of the Asian Network for Early Psychosis, focusing on whetherthe views of these countries differ with one another.Methods:A questionnaire was distributed to psychiatrists for completion. The questionnairecontained three sections: direct questions probing at views on medication discontinuation, casevignettes to assess applied decision-making and a checklist of criteria psychiatrists may view asnecessary for the patient to satisfy before discontinuation. Total of 484 psychiatrists (97 fromHong Kong, 88 from Korea, 64 from Singapore and 233 from Japan) completed thequestionnaire.Results:We found that (a) Asian psychiatrists believed that 1% to 19% of remitted patients candiscontinue medication, an estimation that was lower than Western psychiatrists; (b) in agree-ment with clinical guidelines, Asian psychiatrists believed that patients should remain on medi-cation for at least 1 to 2 years following the absence of psychotic symptoms; (c)“Absence ofany relapsing episode following first episode”was considered the most important criterion whenmaking a decision; and (d) there were significant differences in clinicians' perceptions across thefour countries: for instance, Korean psychiatrists were more conservative with the duration ofantipsychotics maintenance, while Singaporean psychiatrists were more open-minded towardsclinical trials.Conclusions:Culture and social norms appear to determine the relative importance of factorsthat psychiatrists might consider during the decision-making process, thereby producing varia-tions in the views held in different countries.