Predictors of Relapse Following Response From a First Episode of Schizophrenia or Schizoaffective Disorder
Abstract
Background We examined relapse after response to a first episode of schizophrenia or schizoaffective disorder. Methods Patients with first-episode schizophrenia were assessed on measures of psychopathologic variables, cognition, social functioning, and biological variables and treated according to a standardized algorithm. The sample for the relapse analyses consisted of 104 patients who responded to treatment of their index episode and were at risk for relapse. Results Five years after initial recovery, the cumulative first relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second relapse rate was 78.0% (95% CI, 46.5%-100.0%). By 4 years after recovery from a second relapse, the cumulative third relapse rate was 86.2% (95% CI, 61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI, 2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]). Subsequent analyses controlling for antipsychotic drug use showed that patients with poor premorbid adaptation to school and premorbid social withdrawal relapsed earlier. Sex, diagnosis, obstetric complications, duration of psychotic illness before treatment, baseline symptoms, neuroendocrine measures, methylphenidate hydrochloride challenge response, neuropsychologic and magnetic resonance imaging measures, time to response of the initial episode, adverse effects during treatment, and presence of residua…
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Patients with schizophrenia often have poor adherence to oral antipsychotics, and high relapse rates pose challenges to both patients and clinicians in the management of the disease.
“Patients with schizophrenia often have poor adherence to oral antipsychotics, and high relapse rates pose challenges to both patients and clinicians in the management of the disease [94–97].”
From Pharmacokinetic Characteristics of Long-Acting Injectable Antipsychotics for Schizophrenia: An Overview (2021) · cites this paper as [94]
Schizophrenia pathology worsens over time, as supported by studies suggesting that long-term morbidity increases in the absence of any treatment.
“The notion that schizophrenia pathology worsen over time is supported by studies that suggest that long-term morbidity increases in the absence of any treatment 45,46 .”
From Developmental timing and critical windows for the treatment of psychiatric disorders (2016) · cites this paper as [46]
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- Authors
- Robinson, D., Woerner, M. G., Alvir, J. M. J., Bilder, R., Goldman, R., Geisler, S., Koreen, A., Sheitman, B., Chakos, M., Mayerhoff, D., & Lieberman, J. A.
- Affiliations
- Long Island Jewish Medical Center (US)
- Yeshiva University (US)
- Stony Brook University (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1999-03-01
- Volume
- 56
- Issue
- 3
- Pages
- 241
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2154849243
- Cited by
- 1,327
- References
- 0
- Citations by year
- 2026: 40 · 2025: 38 · 2024: 41 · 2023: 32 · 2022: 45 · 2021: 81 · 2020: 57 · 2019: 49 · 2018: 44 · 2017: 44 · 2016: 67 · 2015: 62 · 2014: 66 · 2013: 75 · 2012: 74
- FWCI
- 14.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh041646-07)
- National Institute of Mental Health (MH41960, MH00537, MH41646)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia, schizoaffective disorder, first-episode psychosis, relapse, relapse risk factors, long-term antipsychotic treatment, residual symptoms, treatment response
- MeSH terms
- Adolescent, Adult, Female, Fluphenazine, Follow-Up Studies, Hallucinations, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Neuropsychological Tests, Patient Compliance, Pregnancy, Pregnancy Complications, Probability, Psychiatric Status Rating Scales, Psychotic Disorders, Risk Factors, Schizophrenia, Schizophrenic Psychology, Severity of Illness Index, Sex Factors, Antipsychotic Agents, Cohort Studies, Treatment Outcome, Secondary Prevention
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