Abstract

OBJECTIVE
An unanswered question in the management of schizophrenia is how long antipsychotic treatment should be continued after a single psychotic episode. In this study, we assessed the rates of symptom recurrence with intermittent treatment in patients with a first episode of DSM-IV-defined schizophrenia or related illness after 2 years of successful continuous treatment. We also investigated antecedents of recurrence, as well as demographic and baseline clinical predictors of early recurrence, and we compared the psychopathology of the recurrence episode with that of the first episode.
METHOD
Outpatients in an academic psychiatric hospital setting (single site) who had responded well in an open-label study with risperidone long-acting injection were recruited for this intermittent treatment trial, and those who participated had their treatment tapered and discontinued over a period of up to 6 weeks, with follow-up for 3 years or until reemergence of symptoms. Open-label treatment with oral risperidone and risperidone long-acting injection was immediately reinstituted in the event of recurrence of symptoms. The study was conducted between February 2004 and March 2010. The primary outcome measure was symptom recurrence rate at 3 years.
RESULTS
Participants (N = 33) had a mean age ± SD of 28 ± 7.9 years and a mean baseline Positive and Negative Syndrome Scale total score ± SD of 44.8 ± 7.4 at study entry. Symptom recurrence rates were 79% at 12 months, 94% at 24 months, and 97% at 36 months. Onset of recurrence symptoms was fairly abrupt, and symptom severity returned to levels close to those of the first episode. No significant predictors of early recurrence were identified.
CONCLUSIONS
Intermittent antipsychotic treatment, even after 2 years of successful treatment, may not be in the best interest of patients who have experienced a single psychotic episode.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT00378092.

Links

Publisher Full Text

Authors

Emsley R, Oosthuizen PP, Koen L, Niehaus DJ, Martinez G

Institution

Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa. rae@sun.ac.za

Source

The Journal of clinical psychiatry 73:4 2012 Apr pg e541-7

MeSH

Adult
Antipsychotic Agents
Delayed-Action Preparations
Female
Humans
Male
Psychiatric Status Rating Scales
Recurrence
Risperidone
Schizophrenia
Time Factors
Treatment Outcome

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22579160