Impacts of medication discontinuation on clinical and functional outcomes in remitted first-episode psychosis : a prospective 9-year follow-up study

Abstract

Given the costs and benefits associated with antipsychotic medication, the clinical decision to continue or discontinue antipsychotics treatment is very important, especially for patients remitted from their first episode psychosis for a period of time. To date, no universal guidelines have been proposed to address this issue as the solid empirical data are limited. Existing short-term evidence seems to suggest that patients who discontinued their antipsychotics experienced higher relapse rates. However, data on the long-term outcomes are lacking. The present study aimed to compare remitted first-episode psychosis patients who had discontinued their antipsychotic medications and those who continued to take antipsychotic medication in the early stage of their illness in terms of their long-term clinical and functional outcomes at 9 years.

This study attempted to follow up 178 first-episode psychosis patients who participated in an earlier randomized controlled trial. In the original trial, patients were randomized into either a medication maintenance group or a medication discontinuation group for 12 months after having achieved full symptomatic remission for at least 1 year. In this study, subjects were interviewed at 9 years to assess their clinical profiles, functioning profiles, medication compliance, and subjective quality of life.

Interviews were undertaken with 142 patients (79.8% of the original cohort). No significant differences were found between the medication maintenance group and the discontinuation group in terms of all domains of outcomes, including symptomatic remission, functional remission, recovery, relapse, hospitalization, functioning measures, subjective quality of life, medication compliance and medication intake. Compared to the discontinuation group, more patients in the medication maintenance group fulfilled the criteria for symptomatic remission (75.4% vs. 67.2% in the discontinuation group), functional remission (36.1% vs. 24.1% in the discontinuation group), and recovery (21.3% vs. 15.5% in the discontinuation group) at 9 years.

Similar long-term clinical and functional outcomes were found between the medication maintenance and discontinuation groups, which differs from the results of existing short-term outcomes studies in which the discontinuation group had poorer outcomes and higher relapse rates. Although not statistically significant, the study found that remission (both symptomatic and functional) and recovery rates in the maintenance group were higher than those of the discontinuation group.

The present study is one of the first studies to examine the long-term impact of medication discontinuation in the early phase of schizophrenia. The findings suggest that the long-term costs and outcomes are independent to an earlier decision to stop medication in first-episode psychosis. As the evidence that long-term outcomes may differ from those in short-term studies on medication discontinuation, more long-term studies are required to confirm our current findings.