Risk Factors For And Rates Of Relapse In First Episode Psychosis: A Systematic Review And Meta-Analysis

Presentation First Author: 
Mario Alvarez-Jimenez

Preventing relapse is an essential element of early intervention in psychosis, however relevant risk factors and precise relapse rates remain to be clarified. The aim of this study was to systematically compile and analyze risk factors for and rates of relapse in first episode psychosis (FEP). To this end, we systematically reviewed and meta-analysed FEP longitudinal studies with a minimum 12-month follow-up that reported on risk factors for relapse. Twenty-nine articles were included. Pooled prevalence of relapse was 28% (range = 12-47%), 43% (35-54%), 54% (40-63%) at 1, 1.5-2, and 3 years follow-up, respectively. Studies recruiting incidence samples reported lower relapse rates compared with those which included convenience samples. Exploratory analysis revealed lower relapse rates in studies conducted in the context of specialised FEP services. A total of 109 predictors were analysed, with 24 assessed in at least 3 studies. Medication non-adherence, persistent substance use disorder, carers critical comments and poorer premorbid adjustment, increased the risk for relapse 4-fold, 3-fold, 2.3-fold and 2.2-fold, respectively. Conversely, clinical and general demographic variables had little impact on relapse rates. Only 1 study examined the role of protective factors in preventing relapse. To advance the field, it is essential that future studies address the methodological limitations of the extant research (e.g. definition of relapse, assessment and analysis of predictors, recruitment procedures), focus on the identification of protective factors and evaluate theoretically derived models of relapse. These findings will be discussed in light of new data on theoretically driven predictors of relapse in FEP.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Mario Alvarez-Jimenez, Amador Priede, Sarah Hetrick, Sarah Bendall, Patrick D McGorry, John F Gleeson
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