Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis

• Published in: Schizophrenia research Vol. 150; no. 1; pp. 297 - 302
• Main Authors: Hui, Christy L.M, Wong, Gloria H.Y, Tang, Jennifer Y.M, Chang, W.C, Chan, Sherry K.W, Lee, Edwin H.M, Lam, May M.L, Chiu, Cindy P.Y, Law, C.W, Chung, Dicky W.S, Tso, Steve, Pang, Edwin P.F, Chan, K.T, Wong, Y.C, Mo, Flora Y.M, Chan, Kathy P.M, Hung, S.F, Honer, William G, Chen, Eric Y.H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01-10-2013; Elsevier
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Aged; Antipsychotic Agents - administration & dosage; Biological and medical sciences; Dibenzothiazepines - administration & dosage; Double blind; Double-Blind Method; Drug Administration Schedule; Female; First-episode schizophrenia; Follow-Up Studies; Humans; Maintenance; Male; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Predictive Value of Tests; Psychiatric Status Rating Scales; Psychiatry; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychoses; Psychotic Disorders - drug therapy; Quetiapine Fumarate; Randomized controlled trial; Relapse prevention; Schizophrenia; Secondary Prevention; Treatment Outcome; Young Adult; First-episode schizophrenia; Maintenance; Double blind; Relapse prevention; Randomized controlled trial; Human; Relapse; Atypical antipsychotic; Neuroleptic; Psychotropic; Schizophrenia; Controlled therapeutic trial; Hypnotic; Prevention; Psychosis; Tranquillizer; First episode; Risk factor; Double blind study; Remission; Dibenzothiazepine derivatives; Quetiapine; Public health
• ISSN: 0920-9964; 1573-2509
• DOI: 10.1016/j.schres.2013.08.010

Abstract Objective Relapse is common among patients with psychotic disorders. Identification of relapse predictors is important for decision regarding maintenance medication. Naturalistic studies often identify medication non-adherence as a dominant predictor. There are relatively few studies for predictors where adherence is already known. It is this situation i.e., discontinuation of medication that predictors will be most useful. We identify predictors for relapse in situations of (i) discontinuation and (ii) continuation of maintenance medication. Method Analysis of relapse predictors is based on a randomized controlled study ( n = 178) comparing relapse rates between patients who discontinued or continued medication for at least 1 year following first-episode psychosis. Demographic, clinical and neurocognitive variables were assessed at baseline as predictors of relapse within 1 year. Results Risk of relapse was 79% in the discontinuation group and 41% in the maintenance group. Predictors in the discontinuation group were diagnosis of schizophrenia, poorer semantic fluency performance, and higher blink rate. Predictors in the continuation group were disinhibition soft signs and more general psychopathology symptoms. Conclusion Different predictors of relapse were identified for first episode psychosis patients who discontinued and continued maintenance medication. Neurocognitive dysfunctions are important predictors for both groups. While signs of frontal dysfunction and dopamine hyperactivity predict relapse in the discontinuation group, sign of cognitive disinhibition predicts relapse in the continuation group.