Extrait

Background and study aims Psychosis and schizophrenia are common and costly mental health problems. Psychosis is the name given to a group of mental conditions in which cause people to perceive or interpret things differently from those around them. One of the most common causes of psychosis is schizophrenia, a condition that causes a range of psychological symptoms, including hallucinations (hearing and/or seeing things) and delusions (believing something that is not true). One of the main treatment options for psychosis and schizophrenia is long-term treatment with antipsychotic medication, but many patients still find life difficult. Antipsychotic drugs can also have dangerous and unpleasant side effects. Finding alternatives to long-term drug treatment is a priority for patients and services. This study is testing the effects of gradually reducing antipsychotic medication in people with schizophrenia, psychosis or similar conditions in order to see if it can help improve day-to-day functioning and how it affects their chance of suffering a relapse (worsening of their condition). Who can participate? Adults who have been diagnosed with schizophrenia, psychosis or a similar condition and are taking antipsychotic medication. What does the study involve? Once a person agrees to take part, they are randomly selected to receive either the ‘antipsychotic reduction programme’ or ‘maintenance treatment’. The ‘antipsychotic reduction programme’ involves reducing the participant’s dose of antipsychotic medication gradually over several months. Participants are seen regularly by a psychiatrist to review and adjust their antipsychotic medication and to monitor their mental health. Some participants are recommended to try and stop their antipsychotic medication. Other participants are supported to maintain as low a dose as possible. Participants who are selected for ‘maintenance treatment’ are recommended to stay on roughly the same dose of antipsychotics throughout the study. Small adjustments can be made as required to reduce side effects or for other reasons. All participants complete assessments at the start of the study and then again after 6, 12 and 24 months to assess their social functioning, symptoms and medication side effects. Some participants and clinicians involved in the study are also invited to be interviewed in more detail to explore how they found the antipsychotic reduction programme and their experience of being in the study. What are the possible benefits and risks of participating? As this is a trial of a new approach to antipsychotic treatment, it is not yet clear if participants will receive any direct benefit from taking part. Previous research suggests participants who receive support to reduce antipsychotics have improved social functioning, but it is not known whether this will be the case in the current study. Previous research has shown that some people may experience increased symptoms of psychosis or schizophrenia as their medication is lowered, and there may be an increased risk of having a relapse. Participants receiving the antipsychotic reduction programme will be monitored regularly to prevent this. If participants experience increased symptoms or relapse, they will be given additional treatment, as they would receive if they were having their usual care. The reduction of antipsychotic medication will be halted if necessary, and antipsychotics may be re-started if they have been stopped. Where is the study run from? 1. North East London NHS Foundation Trust (UK) 2. East London NHS Foundation Trust (UK) 3. Camden and Islington NHS Foundation Trust (UK) 4. Barnet, Enfield & Haringey Mental Health Trust (UK) When is the study starting and how long is it expected to run for? January 2016 to January 2022 Who is funding the study? National Institute for Health Research (UK) Who is the main contact? Dr Nadia Crellin [email protected]

Critère d'inclusion

• Specialty: Mental Health, Primary sub-specialty: Psychosis - schizophrenia; UKCRC code/ Disease: Mental Health/ Schizophrenia, schizotypal and delusional disorders

Liens

• isrctn