The edition · Psychiatry
Rapid relapse after stopping paliperidone tracked severity, not withdrawal
Trial data on paliperidone discontinuation point to who needs closest watching, psychodynamic therapy shows a functioning gain in schizophrenia, and digital placebos turn out to be far from inert.
The edition in brief
An individual participant data analysis of five paliperidone discontinuation trials found two relapse patterns, rapid and delayed. Rapid relapse was no more common after switching to placebo than on continued treatment, and was linked to higher baseline severity, which argues against a pure withdrawal effect and for stratifying monitoring by severity when deprescribing. A German single-centre randomised trial in 130 outpatients with schizophrenia-spectrum disorders found that at least 30 sessions of a modified psychodynamic psychotherapy added to usual care improved psychosocial functioning at 24 and 36 months. A meta-analysis of 30 trials showed digital placebo arms improved PHQ-9 scores by a moderate amount (Hedges g 0.44), so app trials need sham controls and readers should judge them against those, not waiting lists. On the regulatory side, the FDA recorded a supplement to a generic clozapine application, an administrative step rather than a safety signal. The pearl covers the questions to ask before cutting an antipsychotic dose.
Psychodynamic psychotherapy improved functioning in schizophrenia over three years
Structured psychodynamic therapy is now a reasonable option to discuss for functioning in stable schizophrenia, alongside better-established psychological treatments.
Digital placebos improved depression scores by a moderate amount
Judge any depression app by its difference from a sham app, not from a waiting list.
FDA records a supplement to a generic clozapine application
An administrative FDA supplement to one generic clozapine; no change to prescribing or monitoring.
Before reducing an antipsychotic, set the relapse plan first
Agree the early warning signs and the contact plan before the first dose reduction, not after the first missed appointment.
Rapid relapse after paliperidone discontinuation reflects severity, not withdrawal
When reducing an antipsychotic, plan the closest monitoring for patients whose illness was most severe at baseline.
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