Cited by 200Schizophrenia research and treatmentBipolar Disorder and TreatmentMental Health and Psychiatry

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Does relapse contribute to treatment resistance? antipsychotic response in first- vs. second-episode schizophrenia.

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Takeuchi, Hiroyoshi, Siu, Cynthia, Remington, Gary, Fervaha, Gagan, Zipursky, Robert B., Foussias, George, Agid, Ofer·2019·Neuropsychopharmacology

DOI 10.1038/s41386-018-0278-3PMC PMC6462044

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Abstract

Although some studies have suggested that relapse may be associated with antipsychotic treatment resistance in schizophrenia, the number and quality of studies is limited. The current analysis included patients with a diagnosis of first-episode schizophrenia or schizoaffective disorder who met the following criteria: (1) referral to the First-Episode Psychosis Program between 2003 and 2013; (2) treatment with an oral second-generation antipsychotic according to a standardized treatment algorithm; (3) positive symptom remission; (4) subsequent relapse (i.e., second episode) in association with non-adherence; and (5) reintroduction of antipsychotic treatment with the same agent used to achieve response in the first episode. The following outcomes were used as an index of antipsychotic treatment response: changes in the brief psychiatric rating scale (BPRS) total and positive symptom scores and number of patients who achieved positive symptom remission and 20 and 50% response. A total of 130 patients were included in the analyses. Although all patients took the same antipsychotic in both episodes, there were significant episode-by-time interactions for all outcomes of antipsychotic treatment response over 1 year in favor of the first episode compared to the second episode (50% response rate: 48.7 vs. 10.4% at week 7; 88.2 vs. 27.8% at week 27, respectively). Although antipsychotic doses in the second episode were significantly higher than those in the first episode, results remained unchanged after adjusting for antipsychotic dose. The present findings suggest that antipsychotic treatment response is reduced or delayed in the face of relapse following effective treatment of the first episode of schizophrenia.

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Authors: Takeuchi, H., Siu, C., Remington, G., Fervaha, G., Zipursky, R. B., Foussias, G., & Agid, O.
Affiliations: Centre for Addiction and Mental Health (CA)
Corresponding author: Agid, Ofer
ORCID: Takeuchi, Hiroyoshi
Remington, Gary
Fervaha, Gagan
Zipursky, Robert B.
Foussias, George
Agid, Ofer
Venue: Neuropsychopharmacology
Publisher: Springer Science and Business Media LLC
Published: 2018-11-22
Volume: 44
Issue: 6
Pages: 1036-1042
ISSN: 0893-133X (ISSN-L)
1740-634X
DOI: 10.1038/s41386-018-0278-3
PMC: PMC6462044
OpenAlex: W2901006613
Cited by: 200
References: 31
Citations by year: 2026: 21 · 2025: 31 · 2024: 27 · 2023: 25 · 2022: 31 · 2021: 36 · 2020: 16 · 2019: 12 · 2018: 1
FWCI: 12.79
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Neuropsychopharmacology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Pfizer
F. Hoffmann-La Roche
Japanese Society of Clinical Neuropsychopharmacology
Sunovion
Neurocrine Biosciences
Mylan
Dainippon Sumitomo Pharma
Chinese University of Hong Kong
Astellas Pharma
Astellas Foundation for Research on Metabolic Disorders
H. Lundbeck A/S
Canadian Institutes of Health Research
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, relapse, treatment resistance, antipsychotic treatment response, first-episode psychosis, schizoaffective disorder, atypical antipsychotics, medication adherence, antipsychotic dosing
MeSH terms: Adult, Female, Follow-Up Studies, Humans, Male, Brief Psychiatric Rating Scale, Psychotic Disorders, Recurrence, Remission Induction, Schizophrenia, Antipsychotic Agents, Outcome Assessment, Health Care, Disease Progression, Young Adult

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Does relapse contribute to treatment resistance? antipsychotic response in first- vs. second-episode schizophrenia.

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