Predictors of relapse in early psychosis: a 3-year retrospective chort study in Hong Kong

Abstract

OBJECTIVE: Relapse prevention is one of the most important and challenging targets in the treatment of psychotic disorders. However, apart from medication discontinuation, consistent relapse predictor has not been identified. We aimed to investigate relapse predictors in a large cohort of patients with first-episode psychosis. METHOD: This was a retrospective cohort study designed to evaluate relapses in first-episode psychosis patients in 3 years. A total of 1,400 patients’ case records were retrieved from a hospital database. Potential relapse predictors including demographic variables, baseline clinical measures, medication adherence, and residual positive symptoms upon clinical stabilisation were collected. RESULTS: The cumulative relapse rates were 19.3% by year 1, 38.4% by year 2, and 48.1% by year 3. Multivariate Cox-proportional hazards regression analysis revealed that medication non-adherence, smoking, schizophrenia diagnosis, younger age, and shorter baseline hospitalization were associated with an increased risk of relapse in 3 years. CONCLUSIONS: Nearly half of the patients relapsed after 3 years following their first-episode psychosis. Smoking as a predictor of relapse is an intriguing new finding supportive of a link between nicotinic receptors and the dopamine system. Their relationship deserves further investigations with potential clinical implications for relapse prevention in psychosis.