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SO372

Optimizing psychopharmacotherapy toward the minimum effective dose in patients with severe mental illness in institutional care: clinical implications of a two-year observational study

OPTIMIZING PSYCHOPHARMACOLOGY TOWARD MINIMUM EFFECTIVE DOSE IN INSTITUTIONALIZED SEVERE MENTAL ILLNESS PATIENTS: CLINICAL IMPLICATIONS OF A 2-YEAR OBSERVATIONAL STUDY

Antipsychotic and benzodiazepine burden was significantly reduced over two years in patients with severe mental illness in institutional care, and this reduction was not associated with deterioration in overall functioning or an increase in emergency department visits or hospitalizations.

The aim was to examine the feasibility, predictors, and clinical outcomes of reducing medication burden to the minimum effective dose in patients with severe mental illness (SMI) in a psychiatric residential care setting, while balancing efficacy, relapse prevention, and side effect reduction. Thirty-three adults with SMI residing in a psychiatric care institution were followed longitudinally for two years, with assessments conducted at two time points; antipsychotic and benzodiazepine doses were converted to chlorpromazine (CPZ) and diazepam equivalents; analyses used Student’s t-test, Pearson’s chi-square test, and repeated-measures ANOVA, with significance set at p<0.05 and a trend at p<0.1. Antipsychotic burden decreased from 455±285 mg to 403±265 mg CPZ equivalents (F=3.888, p=0.025), with dose reductions in 33% of patients. Benzodiazepine burden decreased from 26±26 mg to 14±17 mg diazepam equivalents (F=14.440, p=0.001), with dose reductions in 54% of patients. Dose reduction was not associated with changes in overall functioning, acute psychotic episodes requiring emergency department visits, or hospitalization. Among potential predictors, a longer duration of institutional care was associated with antipsychotic reduction (p=0.092), while mood stabilizer use (p=0.049) and female sex (p=0.066) were associated with benzodiazepine reduction. The reduction in antipsychotic burden showed an inverse association with a lower monocyte-to-lymphocyte ratio at the two-year follow-up (r=-0.359, p=0.056, R²=0.129). The authors state that moving toward the minimum effective dose through individualized prescribing is feasible in this setting, may reduce side effects, long-term physical comorbidities, and treatment burden, and that the favorable trend in inflammatory markers suggests the possibility of systemic benefits.

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