High doses of antipsychotics in patients with chronic schizophrenia might lead to more severe side effects and possibly hamper recovery, but dose reduction carries the risk of psychotic relapse. It would be helpful to establish risk factors for relapse during dose reduction. We systematically searched MEDLINE, EMBASE, and PsycINFO from January 1950 through June 2019 and reviewed studies that reported on relapse rates (event rates; ERs) after dose reduction or discontinuation of antipsychotics in cohorts of patients with chronic schizophrenia. We calculated ERs (with 95% confidence intervals) per person-year and sought to identify potential risk factors, such as patient characteristics, dose reduction/discontinuation characteristics, and study characteristics. Of 165 publications, 40 describing dose reduction or discontinuation in 46 cohorts (1677 patients) were included. The pooled ER for psychotic relapse was 0.55 (95%CI 0.46-0.65) per person-year. The ER was significantly higher in: inpatients, patients with a shorter duration of illness, patients in whom antipsychotics were discontinued or in whom the dose was reduced to less than 5 mg haloperidol equivalent (HE), studies with a short follow-up or published before 1990, and studies in which relapse was based on clinical judgment (i.e. rating scales were not used). Clinicians should consider several robust risk factors for psychotic relapse in case of dose reduction in chronic schizophrenia.

中文翻译：

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慢性精神分裂症患者减少剂量或停用抗精神病药后精神病复发的危险因素。系统的审查和荟萃分析。

慢性精神分裂症患者使用高剂量的抗精神病药可能会导致更严重的副作用，并可能阻碍康复，但降低剂量会带来精神病复发的风险。建立减少剂量期间复发的危险因素将是有帮助的。我们对1950年1月至2019年6月的MEDLINE，EMBASE和PsycINFO进行了系统搜索，并回顾了研究报告，这些研究报告了在慢性精神分裂症患者中减少剂量或停用抗精神病药后复发率（事件发生率; ER）。我们计算每人年的ER（置信区间为95％），并试图确定潜在的危险因素，例如患者特征，剂量减少/停药特征和研究特征。在165种出版物中，包括40个描述了46个队列（1677例患者）的剂量减少或停药的信息。精神病复发的总ER为每人年0.55（95％CI 0.46-0.65）。在以下患者中，ER明显更高：住院患者，病程较短的患者，停用抗精神病药或剂量降至氟哌啶醇当量（HE）小于5 mg的患者，短期随访研究或已发表的患者在1990年之前，并且其中复发是基于临床判断的研究（即未使用评分量表）。在减少慢性精神分裂症患者的剂量时，临床医生应考虑几种强有力的精神病复发危险因素。病程较短的患者，停用抗精神病药或剂量降至氟哌啶醇当量（HE）低于5 mg的患者，随访时间较短或在1990年前发表的研究以及复发的研究根据临床判断（即未使用等级量表）。在减少慢性精神分裂症患者的剂量时，临床医生应考虑几种强有力的精神病复发危险因素。病程较短的患者，停用抗精神病药或剂量降至氟哌啶醇当量（HE）低于5 mg的患者，随访时间较短或在1990年前发表的研究以及复发的研究根据临床判断（即未使用等级量表）。在减少慢性精神分裂症患者的剂量时，临床医生应考虑几种强有力的精神病复发危险因素。