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Schizophr Res. 2017 Jul;185:130-136. doi: 10.1016/j.schres.2016.12.029. Epub 2017 Jan 6.

Predictors of favourable outcome in young people with a first episode psychosis without antipsychotic medication.

Author information

Treatment and Early Intervention in Psychosis Program (TIPP), Service de Psychiatrie Générale, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland. Electronic address:
Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia.
University Hospital of Child and Adolescent Psychiatry, University of Bern, Switzerland.
Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.



Data from the literature suggests that some first episode psychosis (FEP) patients may recover without antipsychotic medication. There is however no reliable way to identify them. In a previous paper we found, in a cohort of 584 FEP patients, that those consistently refusing medication had poorer pre-morbid functioning, less insight, higher rate of substance use and poorer outcome. However, some medication refusers, had a favourable outcome. The study aim was to identify predictors of good short term outcome despite non-exposure to medication.


The Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 FEP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. Data on medication adherence was available in 584 patients. Among the 17.9% of patients who consistently refused medication over the entire treatment phase we compared patients who had a favourable symptomatic and functional outcome with those who did not.


Among patients who consistently refused medication, 41% achieved symptomatic remission and 33% reached functional recovery. Predictors of symptomatic remission were a better premorbid functioning level, higher education and employment status at baseline. Predictors of functional recovery were a shorter duration of the prodrome phase, less severe psychopathology at baseline and lower cannabis use.


Despite limitations mainly linked to the fact that non-exposure to antipsychotic medication was based on patient's treatment refusal, this study identified some characteristics which may contribute to the identification of a sub-group of FEP patients who may have good short term outcome without antipsychotic treatment.


Antipsychotic medication; Psychosis; Recovery; Schizophrenia

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