Metabolic parameters as a predictor of relapse in patients with schizophrenia undergoing tapering of antipsychotics

Identifying patients at high risk of relapse during antipsychotic tapering remains a significant clinical challenge. This study aims to investigate whether a higher metabolic baseline is associated with increased risk of relapse in a cohort of 83 patients with schizophrenia undergoing tapering of antipsychotic medication. We used data from a tapering program that tapered antipsychotics in patients with schizophrenia during a period of six months, and patients were invited for a re-examination 12 months after baseline. We only collected blood samples at baseline. Mean age was 38.6 (SD 11.63) years. Baseline Positive and Negative Syndrome Scale total score was 62 (SD 14.6) and baseline mean antipsychotic dose was 403 mg (SD 307.8 mg) chlorpromazine equivalent. After 12 months, 29 (35%) patients had experienced relapse which was associated with a higher LDL baseline (3.16 mmol/L ±0.94 [122 mg/dL]) than stable patients (2.56 mmol/L ±0.80 [99 mg/dL] P = 0.001). In a binary logistic regression, increased LDL was associated with an increased risk of developing relapse during tapering (adjusted odds ratio 2.09, [1.11, 3.93], p = 0.022). The underlying mechanism behind an association between plasma-lipids and clinical stability remains largely unknown, indicating that new hypotheses are called for.