Relapse prevention in first-episode psychosis patients with stable maintenance medication for at least one year

Abstract

Clinically there is a strong expectation from first-episode psychosis patients and their carers to discontinue with maintenance medication after a period of remission. However, there is so far no consensus regarding how long maintenance medication should be continued. The current study aims to assess whether this point in time is reached after at least 1 year of maintenance medication. Following a first-episode of schizophrenia and non-affective psychosis (DSM-IV), patients who were remitted well and on maintenance medication for at least 12 months were randomized to receive either maintenance medication (quetiapine 400mg/day) or placebo. Relapse was defined as the re-emergence of positive symptoms. In the overall sample of 178, 83 patients relapsed during the study. Fewer patients relapsed in the quetiapine maintenance group (27 of 89, 30%) compared with the placebo group (56 of 89, 63%). The Kaplan-Meier estimate of the proportion of relapse at 11 months after randomization was 41 percent (95% CI, 29 to 53%) in the quetiapine maintenance group and 76 percent (95% CI, 66 to 86%) in the placebo group (log-rank test, v2 = 15.65, P < .001). New data for relapse risks in remitted first-episode psychosis patients is provided. The risk of relapse after medication discontinuation is still substantial after receiving maintenance medication for a mean of 22 months following first-episode psychosis. Supported by investigator initiated trial award from AstraZeneca and the Research Grants Council Hong Kong (Project number: 765505).