Perception towards medication discontinuation in remitted first-episode psychosis among clinicians

Abstract

Aim: A survey was carried out in 4 countries across Asia (Hong Kong, Singapore, Japan, and Korea) to investigate the views of clinicians towards the issue of medication discontinuation in remitted patients with first episode psychosis (FEP).The current presentation will be from the results from Singapore. Methods: An online questionnaire was sent to clinicians (Psychiatrists, Psychologists, Case Managers) in Singapore. The questionnaire contained three sections: direct questions probing at views on medication discontinuation in remitted FEP patients, case vignettes to assess decision‐making in applied situations, and a checklist of criteria for discontinuing medication. Results: 82 participants of whom 70.6% were Psychiatrists completed the questionnaire. We found that majority believed that (i) 21‐40% of remitted first episode psychosis patients can discontinue medication, (ii) patients should remain on medication for 1‐2 years following absence of psychotic symptoms, and (iii) the monitoring process after discontinuing medication should be for 12‐24 months. 47.6% of clinicians were unsure about whether quality of life is better in those symptom‐free patients who remain on antipsychotics versus those who stop. “Having good social support” and “able to cope with stressful situations” were considered the most important criteria when making a decision about medication discontinuation. Conclusions: The results reflect the ambiguity in clinicians about medication discontinuation in patients with FEP arising mainly from lack of clear guidelines on one hand, and patients’ desire to stop medication on the other.