Five-fold increased risk of relapse following breaks in antipsychotic treatment of first episode psychosis

- Non adherence with anti-psychotic medication once positive symptoms have improved in first episode psychosis is common; clinicians may trial a break in treatment
- However in this 18 month follow-up study when medication was interrupted remission took longer and relapses were five times commoner
- Clinicians should carefully consider the cost of relapse when advising patients and carers on the length of treatment following first episode psychosis

BackgroundA key problem in the management of first episode psychosis is that patients are often reluctant to take antipsychotic medication, especially once their presenting symptoms have resolved. Clinicians may be tempted to trial a 'break in treatment' in such patients.AimTo assess the impact of interruptions in the antipsychotic treatment of first episode psychosis.MethodTreatment adherence and clinical course were assessed during the 18 months following presentation in 136 consecutive patients with a first episode of psychosis in 2003-2005 by a systematic retrospective casenote review. Regression analyses were used to examine the time to remission and the risk of relapse in patients who had stopped antipsychotics for one month or more.ResultsThere were breaks in antipsychotic treatment of ≥ 1 month in more than half of the patients (n = 73; 58%). When these occurred before they had recovered (n = 22; 17%), the time to remission was almost twice as long as in patients in whom treatment was continuous (t = 2.9, P = 0.01). Patients in whom treatment was interrupted were 5 times more likely to have relapsed than those in whom it was continuous (p = 0.0001, 95%CI 2.1-11). The mean time to relapse following an interruption in treatment was 3 months.ConclusionIf the treatment of first episode psychosis with antipsychotic medication is stopped for a month or more, remission may be delayed and the risk of relapse following remission may be substantially increased.