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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

1
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: philippe.conus@chuv.ch.
2
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.
3
Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia.
4
University Hospital of Child and Adolescent Psychiatry, University of Bern, Switzerland.
5
Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Antipsychotic medication; Psychosis; Recovery; Schizophrenia

PMID:
28065484
DOI:
10.1016/j.schres.2016.12.029
[Indexed for MEDLINE]

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