Prof Liu Chen Chung

Plenary Speaker

From 2006 to 2010, Dr Liu Chen-Chung worked with Professor Hwu Hai-Gwo in a prospective follow-up study of the psychopathological progress of early schizophrenia-like disorder (SOPRES). He has published a series of papers regarding early detection, screening tool, transitioning from ultra-high risk (UHR) to psychosis, pharmacotherapy for prodromal psychosis, changes in neurocognitive functioning at early stage of psychosis, and even longer-term follow-up of initial non-converters as well as the 10-year outcomes of first episode psychosis of this cohort.

Since 2017, his clinical research mainly focused on a guided antipsychotic reduction to reach the minimum effective dose (GARMED) trial for patients who have remitted from psychosis and wished to reduce and even discontinue antipsychotics. He proposed his rationale of creating a compromised solution for optimising risk-to-benefit ratio of antipsychotic treatment in remitted psychosis, developed a dose reduction algorithm and a study protocol to be tested on this population in real world practice. The results of GARMED trial are encouraging, published in a series of papers on this topic and he gave talks about this topic on 2023 IEPA and 2024 SIRS conferences.

He has been a visiting scholar/clinical observer at the Orygen Youth Health Center, Melbourne, Australia in 2012. He received 3 Dr Paul Janssen Schizophrenia Research Paper Awards presented by the Taiwanese Society of Psychiatry in 2011, 2014, 2016. He is the former president of the Taiwanese Society of Schizophrenia Research (TSSR) from 2019 to 2023, and is currently an executive board member of ACSR (Asian College of Schizophrenia Research), as well as a member of TAPER (Tapering AntiPsychotics and Evaluating Recovery) International Research Consortium.

Abstract

Plenary Title: Maintenance of Patients with Remitted Psychosis: Is it Possible to Reduce or Discontinue Antipsychotics?

Date: 19 November 2024, Tuesday
Time: 10.45 AM

Patients in a remitted state of schizophrenia face a dilemma: should they improve their quality of life by reducing antipsychotics or should they maintain on stable dose to prevent a relapse. Clinical guidelines suggest a chance to stop antipsychotics after remitted from first episode psychosis for a period of time, but provide no guidance regarding how to discontinue medications safely. We tested in real world practice if an operationalised exponential guided-dose-reduction algorithm can help patients reach a lower effective dose, not at the expense of increased risks of relapse (the GARMED trial). We also depicted and examined dose-tapering trajectories as to explore factors associated with different tapering patterns and provide insights for re-evaluating the risk-to-benefit balance.

We found that guided dose reduction seems to be an approach applicable to patients who were cooperative and conscious during dose reduction. The relapse rates of dose reduction group and maintenance group were less than 20% in 2 years. A substantial proportion of patients could successfully reduce up to 60% of their baseline doses and experience better functioning and quality of life by the end of 2 years. Moreover, we collected blood samples under different daily doses to verify if patient’s stable condition could be maintained not only under an antipsychotic dose much lower than the generally recommended level (chlorpromazine equivalent (CPZE) 200 mg/d), but also a minimal plasma drug concentration of aripiprazole (120 ng/mL) in a subset of this cohort.

However, even though the relapse risk of our dose-reduction group is comparable to their maintenance counterparts, a quarter of patients in the dose-reduction group failed to decrease any dose by the end of 2 years. This fact should be taken into account when considering whether tapering antipsychotics should be attempted. A balanced view regarding the pros and cons and a shared decision-making process is pivotal. Moreover, a guided dose reduction comprises dynamic processes with differences between individual trajectories. Longer term observations, more flexible tapering processes, and a closer monitoring of factors related to successful or failed tapering, are anticipated to improve outcomes of dose-reduction trials. The lessons to be learned from GARMED trial are not about how low the absolute dosage you can attain, but how to reach a relatively lower dosage safely.

Track Session: Asian Perspective of Long-Term Antipsychotics Maintenance Strategies Following First Episode Psychosis
Date: 19 November 2024, Tuesday
Time: 3.45 PM
Breakout Session: Track 3B – Relapse Prevention