Clinical course and predictors of antipsychotic treatment resistance in a 10 year follow up first episode psychosis study

Presentation First Author: 
Arsime Demjaha

Background It is unclear whether antipsychotic treatment resistance in schizophrenia manifests at the outset of illness, or becomes apparent over time. We examined this issue in a large cohort of first episode psychosis (FEP) patients followed up for 10-years. We hypothesised that treatment resistance would already be apparent at illness outset and characterized by a different oetiological profile, thus representing a distinct subtype of illness. Method The analytical cohort comprised 323 FEP patients who were studied at first contact and at 10-year follow up. Rigorous examination of clinical information including information on presence and severity of symptoms and medication data during the follow up period was performed to determine the course of treatment resistance. Logistic regression analyses were conducted to assess the effect of clinical and demographic factors on subsequent treatment resistance. Results Seventy-four (83% of treatment resistant; 13% of the total samples) of the FEP patients were found to be resistant to antipsychotic treatment. The majority of these patients (84%) were unresponsive from the outset and remained resistant throughout the illness. Negative symptoms and a younger age of onset were significant predictors of subsequent treatment resistance (OR=1.2, p = 0.01 and OR = 0.9, p= 0.04 respectively). Conclusion The findings demonstrate that majority of FEP patients do not respond to antipsychotic treatment right from first presentation and initiation of treatment, indicating that treatment resistant schizophrenia constitutes an enduring and distinct subtype of psychotic illness

Conference Name: 
Presentation Date: 
January, 2015
Additional Authors: 
Julia Lappin - James MacCabe - Maxine Patel - Kevin Morgan - Ulrich Reininghaus - Oliver Howes - Peter Jones - Robin Murray - Craig Morgan - Paola Dazzan
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