The edition · Psychiatry
Rapid relapse after stopping paliperidone tracked baseline severity, not discontinuation
An individual-participant analysis of five discontinuation trials suggests quick relapses are not mainly a withdrawal effect. Also: digital placebo arms improve more than expected, a psychodynamic therapy trial in schizophrenia, and a clozapine generic supplement.
The edition in brief
A meta-analysis of individual data from five paliperidone discontinuation trials (417 participants) found two relapse patterns, rapid and delayed. Rapid relapse was no more common after stopping than during continued treatment, and was linked to higher baseline symptom scores, which argues for risk stratification and close monitoring when deprescribing. A meta-analysis of 30 trials with 5,680 participants found a pooled within-arm improvement of g 0.44 on the PHQ-9 in digital placebo arms, high enough to affect trial design and interpretation. A single-centre German randomised trial of 130 outpatients found that a manualised psychodynamic therapy added to usual care improved psychosocial functioning at 24 and 36 months, with an unblinded design. The FDA listed a supplement to a generic clozapine application; the record gives no safety content.
Digital placebo arms improve more than clinicians might expect
Weigh any digital depression tool against its control arm, because inactive apps also show improvement.
Psychodynamic therapy added to usual care in schizophrenia: better functioning at 3 years
Consider longer-term psychodynamic therapy as one add-on for functioning in schizophrenia, pending replication.
FDA lists a supplement to a generic clozapine application
No action is needed from the FDA listing alone; check the product label if you use this generic.
Before reducing an antipsychotic, agree what relapse looks like
Set up a relapse plan and early review before every antipsychotic reduction.
Rapid relapse after stopping paliperidone tracked severity, not withdrawal
Consider baseline severity when planning antipsychotic reduction, and monitor higher-risk patients more closely.
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