O8.4. the effect of early medication discontinuation on long-term clinical outcome in first episode psychosis

We examined the long-term effect of early medication discontinuation in year 2 following first-episode remission for patients with no residual psychotic symptoms.MethodsWe followed-up 178 first-episode psychosis patients who participated in a 1-year randomized controlled trial (RCT) on medication discontinuation. Patients were randomized into receiving either a medication maintenance group or a placebo discontinuation group. After the RCT, all patients received usual psychiatric care. Poor long-term clinical outcome was defined as a composite of persistent psychotic symptoms, a requirement for clozapine, or suicide.ResultsThere were no differences between patients who were included (n=142) and excluded (n=36) from the study with regard to their baseline demographics, clinical and functioning. At 10 years, more patients in the early discontinuation group (35/89, 39%) had poor clinical outcome than patients in the maintenance group (19/89, 21%) (P<0.01). Relapse during the RCT has partly mediated the significant relationship between early medication discontinuation and poor outcome at 10-year.DiscussionWhether to discontinue medication following successful treatment of first episode psychosis is a difficult clinical decision. In first episode psychosis with a full initial response to antipsychotic treatment, continued need for medication is important for the first three years after starting treatment, to prevent relapse, and decrease the risk for a poor long-term outcome.
Source: Schizophrenia Bulletin - Category: Psychiatry Source Type: research