ABSTRACT
BACKGROUND: Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice. METHOD: A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP. RESULTS: Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis. CONCLUSIONS: There is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies. DECLARATION OF INTEREST: A.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.
ABSTRACT
AIM: To conduct a systematic review of longitudinal studies that examined the association between childhood socioeconomic status (SES) and illegal drug use in later life. DESIGN AND METHODS: Systematic search with an agreed list of search items was used to identify all longitudinal population-based studies that examined the association between childhood SES and later drug use. These included MEDLINE (1966-2005), EMBASE (1990-2005), CINAHL (1982-2005) and PsychInfo (1806-2005), and specialist databases of the Lindesmith Library, Drugscope and Addiction Abstracts. Foreign-language papers were included. Abstracts were screened independently by two reviewers. If there was disagreement to accept or reject the abstract, then a third reviewer acted as arbiter. Data were extracted by one of the authors. RESULTS: Eleven relevant papers were identified (two birth cohorts and nine papers on school-aged cohorts). There was consistent evidence to support an association between lower childhood SES and later drug use, primarily cannabis use. However, few studies examined cannabis dependence, and studies of more problematic forms of drug use gave contradictory results. DISCUSSION AND CONCLUSIONS: We found consistent, though weak, evidence to support the assumption that childhood disadvantage is associated with later cannabis use. Further research is needed to clarify this issue and to inform future policies and public health messages.