Guided tapering of antipsychotics in patients with Schizophrenia: Relapse-status and cognition

Guided tapering/discontinuation of antipsychotics in patients with schizophrenia has received increasing attention; however, this is not without risks of relapse. Identifying patients who can safely taper would be of high clinical relevance. We aimed to examine if cognition is associated with relapse rates and tapering.

88 patients attending a specialized clinic for antipsychotic dose reduction were followed for six months during guided tapering. Relapse was monitored and reassessed after 12 months. Cognition was examined at baseline using the Wechsler Adult Intelligence Scale -fourth edition, and at baseline and six months using the Trail Making Test and Brief Assessment of Cognition in Schizophrenia. Subjective cognitive complaints and cognitive insight were also recorded. Linear mixed modelling (LMM) was applied to examine changes in cognition according to relapse status.

22 patients relapsed during the tapering period and 29 by 12-month. There were no baseline differences in cognition, cognitive insight or subjective cognitive complaints between patients who experienced relapse and those who did not. LMM further revealed no significant time by group interactions for cognition or cognitive insight. Medication use decreased during the guided tapering period (Z = -6.68, p < .001). Higher antipsychotic dose at baseline was associated with lower General Ability Index (r_S(79) = -.255, p = .022). No associations were found between baseline cognition or changes in cognition and percentage medication reduction.

Cognition, cognitive insight or subjective cognitive complaints were not associated with relapse status after guided tapering of antipsychotics. Although some patients experienced relapse, this was not associated with a worsening of cognition.