Remission, Relapse And Recovery Following Early Guided Discontinuation Of Antipsychotics Vs. Maintenance Treatment In FEP: Outcome At 7 Years Follow-Up.
Objective: Comparing 7-year outcome of early antipsychotic discontinuation strategy on remission, relapse and recovery in remitted first episode psychosis (FEP). Method FEP patients (N=128) symptomatically remitted for 6m during their first treatment year who completed an 18 months trial comparing maintenance treatment (MT) and guided discontinuation (GD) were followed-up at 7 years. Symptomatic remission criteria were adopted from Andreasen et al., functional remission criteria were based on a functioning scale. Recovery was defined as meeting both criteria sets. MT or GD strategy, and baseline parameters were entered in a logistic regression analysis with symptom and functional remission and recovery at 7-years follow-up as dependent variables. Results 103 patients were traced. GD-patients showed twice the recovery-rate of MT-patients (40% against 18%) while symptomatic remission-rates were equal (69% and 67%). Better GD recovery-rates were attributable to higher functional remission-rates (46% vs. 20%) in GD. Predictors of recovery were GD, living together and less negative symptoms. Most patients who discontinued antipsychotics successfully (n=13) were still off meds after 7 years; only one restarted. Relapse-rates were initially higher in GD but leveled at 3 years; 61.5% relapsed in GD and 68.6% in MT in 7 years. Conclusion Guided discontinuation of antipsychotics during early stages of remitted FEP significantly improved 7-years outcome in terms of recovery and functional remission compared to maintenance treatment. Baseline living together and less severe negative symptoms also predicted recovery. Though initially relapse-rates in GD were higher, these equaled those in MT from 3 years to the end of the study.