Antipsychotic dose and side effects: implications for mitigating movement disorders and cardiometabolic dysfunction after first-episode psychosis
Antipsychotic dose and side effects: implications for mitigating movement disorders and cardiometabolic dysfunction after first-episode psychosis
People with a first experience of psychosis usually need antipsychotic medication to achieve remission, but these can cause movement and metabolic side effects. Movement side effects include shaking, stiffness, slowed and uncontrolled movements, while metabolic side effects include weight gain, high cholesterol levels, high blood pressure, and diabetes. However, it is still unclear whether reducing the antipsychotic dose sufficiently helps mitigate these side effects, and whether testing antipsychotic levels in the blood is useful for assessing the risk on side effects.
By analyzing data from nearly 300 people after a first experience of psychosis, who were followed for up to seven years, the work in this thesis of Yinzhao Liu found that reducing the antipsychotic dose may relieve both movement and metabolic side effects. In particular, shaking, slowed movement, stiffness, uncontrolled movements, obesity, and high cholesterol levels may improve following dose reduction.
Additionally, this thesis developed calculators using routinely available information, such as sex, age, and current weight, to help psychiatrists estimate the expected weight loss after reducing the antipsychotic dose, thereby supporting more precise balancing of dose versus side effects. Testing blood levels of antipsychotics may indicate the risk of shaking and slowed movement more accurately than basing this on antipsychotic dose alone, but not the risk of metabolic side effects.
Together, these findings can be used during a personalized shared-decision making process of antipsychotic dose reduction, while monitoring both side effects and risk for relapse.