Clinical Outcome After Antipsychotic Treatment Discontinuation in Functionally Recovered First-Episode Nonaffective Psychosis Individuals: A 3-Year Naturalistic Follow-Up Study
Abstract
OBJECTIVE: The timing of antipsychotic discontinuation in patients who have fully recovered from their initial episode of psychosis is still open to discussion. We aimed to evaluate the risk of symptom recurrence during the 3 years after antipsychotic discontinuation in a sample of functionally recovered first-episode nonaffective psychosis (FEP) patients (DSM-IV criteria) with schizophrenia spectrum disorder. METHOD: Participants in this open-label, nonrandomized, prospective study were drawn from an ongoing longitudinal intervention program of FEP from a university hospital setting in Spain. From July 2004 to February 2011, functionally recovered FEP individuals were eligible if they met the inclusion criteria of (1) a minimum of 18 months on antipsychotic treatment, (2) clinical remission for at least 12 months, (3) functional recovery for at least 6 months, and (4) stabilization at the lowest effective doses for at least 3 months. Forty-six individuals who were willing to discontinue medication were included in the discontinuation group (target group). Twenty-two individuals opted to stay on the prescribed antipsychotic medication and therefore were included in the maintenance group (control group). Primary outcome measures were relapse rate at 18 and 36 months and time to relapse. RESULTS: The rates of relapse over the 3-year period were 67.4% (31 of 46) in the discontinuation group and 31.8% (7 of 22) in the maintenance group. The mean time to relapse was 209 (median = 122) days and 608 (median = 607) days, respectively (log rank = 10.106, P = .001). The resumption of antipsychotic medication after the relapse occurred was associated with clinical stability and lack of further relapses. When the overall group of relapsed individuals from the 2 conditions (N = 38) was compared to those who remained asymptomatic after 3 years (N = 30), there were significant differences (P < .05) in total scores on the Scale for the Assessment of Negative Symptoms, the Clinical Global Impressions scale, and the Disability Assessment Schedule. CONCLUSIONS: Antipsychotic treatment discontinuation in individuals who had accomplished a functional recovery after a single psychotic episode was associated with a high risk of symptom recurrence. Relapsed individuals had a greater severity of symptoms and lower functional status after 3 years. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02220504.
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Relapse rates are raised in the discontinuation group for 1-3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.
“It appears that relapse rates are raised in the discontinuation group for 1–3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.3,56–59”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [58]
Relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.
“That is, relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [58]
In another study with more than 2 years follow-up, 56.5% of patients relapsed in the first year (41.3% in the first 6 months), 8.7% in the second year, and 2.2% per year thereafter.
“the other found that 56.5% of patients relapsed in the first year (41.3% in the first 6 months), 8.7% in the second year, and 2.2% per year thereafter.58”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [58]
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- Authors
- Mayoral-van Son, J., de la Foz, V. O.-G., Martinez-Garcia, O., Moreno, T., Parrilla-Escobar, M., Valdizan, E. M., & Crespo-Facorro, B.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2015-12-08
- Volume
- 77
- Issue
- 04
- Pages
- 492-500
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2295354447
- Cited by
- 60
- References
- 0
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 7 · 2020: 8 · 2019: 7 · 2018: 9 · 2017: 9 · 2016: 4
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
- 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
- first-episode psychosis, non-affective psychosis, schizophrenia spectrum disorders, relapse risk, functional recovery, clinical remission, long-term antipsychotic treatment, negative symptoms, disability, time to relapse, relapse prevention, treatment planning
- MeSH terms
- Adult, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Psychotic Disorders, Recurrence, Schizophrenia, Schizophrenic Psychology, Substance Withdrawal Syndrome, Antipsychotic Agents, Risk Assessment
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