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Cognitive functioning following discontinuation of antipsychotic medication. A naturalistic sub-group analysis from the OPUS II trial

Published online by Cambridge University Press:  30 July 2018

Nikolai Albert Open the ORCID record for Nikolai Albert [Opens in a new window] ,
Lasse Randers ,
Kelly Allott ,
Heidi Dorthe Jensen ,
Marianne Melau ,
Carsten Hjorthøj  and
Merete Nordentoft
Nikolai Albert*
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark
Lasse Randers
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark
Kelly Allott
Affiliation:
Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
Heidi Dorthe Jensen
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark
Marianne Melau
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark
Carsten Hjorthøj
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark
Merete Nordentoft
Affiliation:
Copenhagen University Hospital, Mental Health Centre Copenhagen, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
*
Author for correspondence: Nikolai Albert, E-mail: [email protected]
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Abstract

Background

The effect of antipsychotics medication on cognitive functioning in patients diagnosed with schizophrenia is poorly understood. Some studies of second generation antipsychotics indicated that they improved cognitive functioning while other studies have found that they decrease the level of cognitive functioning.

Method

We included patients with schizophrenia who were in treatment with antipsychotics 1.5 years (baseline) after initiation of treatment and followed them up 3.5 years later (n = 189). At follow-up 60 (32%) had discontinued their antipsychotic treatment and 129 (68%) were still taking antipsychotics. Using the Brief Assessment of Cognition in Schizophrenia (BACS) we assessed cognition at baseline and follow-up.

Results

The patients who discontinued their medication had a higher level of cognitive functioning in all domains at baseline, as well as Global cognitive function [mean z-score −1.50 (s.d. 1.24) v. −2.27 (s.d. 1.30), p = 0.00015]. After controlling for relevant confounders those who discontinued antipsychotic medication improved significantly more than those who remained on antipsychotic medication during the course of the follow-up on the Token Motor task [estimated mean change difference −0.46 (95% CI −0.89 to −0.04)], the Speed of Processing Domain [estimated mean change difference −0.38 (95% CI −0.68 to −0.08)] and global cognition [estimated mean change difference −0.36 (95% CI −0.66 to −0.07)].

Conclusion

Due to the naturalistic design, we cannot conclude on the direction of the relationship between antipsychotics and cognition. There is no evidence that discontinuation of medication had a negative effect on cognitive functioning. Rather, we found that that discontinuation of medication was associated with better cognitive functioning.

Keywords

Antipsychoticscognitive functioningpsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 7 , May 2019 , pp. 1138 - 1147
Copyright
Copyright © Cambridge University Press 2018 

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