Format

Send to

Choose Destination
Schizophr Res. 2019 Dec 19. pii: S0920-9964(19)30571-7. doi: 10.1016/j.schres.2019.12.001. [Epub ahead of print]

Negative symptoms predict high relapse rates and both predict less favorable functional outcome in first episode psychosis, independent of treatment strategy.

Author information

1
Department of Research and Education, Friesland Mental Health Care Services, Sixmastraat 2, 8932 PA Leeuwarden, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen University, PO Box 30.001, 9700 RB Groningen, the Netherlands. Electronic address: lexwunderink@gmail.com.
2
Department of Psychiatry, University Medical Center Groningen, Groningen University, PO Box 30.001, 9700 RB Groningen, the Netherlands.
3
Department of Research and Education, Friesland Mental Health Care Services, Sixmastraat 2, 8932 PA Leeuwarden, the Netherlands; NHL Stenden University of Applied Science, Leeuwarden, the Netherlands.
4
Department of Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands.

Abstract

BACKGROUND:

In first episode psychosis (FEP) baseline negative symptoms (BNS) and relapse both predict less favorable functional outcome. Relapse-prevention is one of the most important goals of treatment. Apart from discontinuation of antipsychotics, natural causes of relapse are unexplained. We hypothesized that BNS, apart from predicting worse functional outcome, might also increase relapse risk.

METHODS:

We performed a post-hoc analysis of 7-year follow-up data of a FEP cohort (n = 103) involved in a dose-reduction/discontinuation (DR) vs. maintenance treatment (MT) trial. We examined: 1) what predicted relapse, 2) what predicted functional outcome, and 3) if BNS predicted relapse, whether MT reduced relapse rates compared to DR. After remission patients were randomly assigned to DR or MT for 18 months. Thereafter, treatment was uncontrolled.

OUTCOMES:

BNS and duration of untreated psychosis (DUP) predicted relapse. Number of relapses, BNS, and treatment strategy predicted functional outcome. BNS was the strongest predictor of relapse, while number of relapses was the strongest predictor of functional outcome above BNS and treatment strategy. Overall and within MT, but not within DR, more severe BNS predicted significantly higher relapse rates. Treatment strategies did not make a difference in relapse rates, regardless of BNS severity.

INTERPRETATION:

BNS not only predicted worse functional outcome, but also relapses during follow-up. Since current low dose maintenance treatment strategies did not prevent relapse proneness in patients with more severe BNS, resources should be deployed to find optimal treatment strategies for this particular group of patients.

KEYWORDS:

Antipsychotic; First episode psychosis; Maintenance; Negative symptoms; Recovery; Relapse

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center