The 10-year clinical outcome of early medication discontinuation in remitted first episode psychosis

Abstract

Whether to discontinue or continue antipsychotics medication in remitted first-episode psychosis is a difficult clinical decision. Consistent short-term evidence suggests that maintenance medication is effective in relapse prevention. However, long-term outcome data are lacking; with only one open-label study suggesting better recovery outcome in patients who had early dose reduction/discontinuation. We examined the long-term effect of early medication discontinuation in a remitted first-episode psychosis cohort in Hong Kong. We followed-up 178 first-episode psychosis patients who had previously participated in a 12-month randomized controlled trial on medication discontinuation (placebo) or continuation (quetiapine). Following the trial, all patients received usual psychiatric care. Poor clinical outcome was defined as a composite of persistent psychotic symptoms, a requirement for clozapine, or suicide at 10 years. We found no significant differences between patients who were successfully traced after 10 years (n=142) and those who were not (n=36) in terms of their basic demographics, symptoms and functioning at baseline. At 10 years, more patients in the early discontinuation group (35 of 89, 39%) had poor clinical outcome than patients in the maintenance group (19 of 89, 21%) (P<0.01). Relapse during the randomized trial had partly mediated the significant relationship between early medication discontinuation and poor outcome (P=0.003). In first episode psychosis with a full initial response to antipsychotic treatment, continued need for maintenance medication is important for the first three years after starting treatment, so as to prevent relapse, and to decrease the risk for a poor long-term outcome.