F121. DOES RELAPSE CONTRIBUTE TO TREATMENT RESISTANCE? ANTIPSYCHOTIC RESPONSE IN FIRST- VS. SECOND-EPISODE SCHIZOPHRENIA

Hiroyoshi Takeuchi,Gagan Fervaha,Gary Remington,George Foussias,Ofer Agid,Cynthia Siu,Robert Zipursky

doi:10.1093/schbul/sby017.652

Abstract

BackgroundThe objective of this study was to compare trajectories of antipsychotic response before and after relapse following response from a first episode of schizophrenia or schizoaffective disorder.MethodsThe current analysis included patients with a diagnosis of first-episode schizophrenia or schizoaffective disorder who met the following criteria: (1) referral to the First-Episode Psychosis Program between 2003 and 2013; (2) treatment with an oral second-generation antipsychotic according to a standardized treatment algorithm; (3) positive symptom remission; (4) subsequent relapse (i.e., second episode) in association with non-adherence; and (4) reintroduction of antipsychotic treatment. The following outcomes were used as an index of antipsychotic treatment response: change in the Brief Psychiatric Rating Scale (BPRS) total score and number of patients who achieved positive symptom remission, including 20% and 50% response improvement.ResultsA total of 130 patients were included in the analyses. All patients took the same antipsychotic in both episodes. Antipsychotic doses in the second episode were significantly higher than those in the first episode (P=0.03). There were significant episode-by-time interactions for all outcomes of antipsychotic treatment response over 1 year (all Ps<0.001) in favor of the first episode compared to the second episode. Results remained unchanged after adjusting for antipsychotic dose.DiscussionThe present findings suggest that antipsychotic treatment response is reduced or delayed in the face of relapse following effective treatment of the first episode of schizophrenia.

Highlights

Identifying and engaging youth with early stage psychotic disorders in order to facilitate timely treatment initiation remains a major public health challenge
Besides the bias generated by data collection, the clinical staging is a potential source of variability to consider in schizophrenia dimensional structure
A landing page was developed with the primary goal of encouraging help seeking individuals in New York City to contact their local early psychosis intervention clinic

Summary

Poster Session II

WRMR = 1.531; iii) clinical stage: RMSEA = 0.052 (90% CI: 0.046 – 0.058; CFit = 0.274), CFI = 0.988, NNFI = 0.985, and WRMR = 2.433. Discussion: Good CFA model fits were only achieved when the multilevel structure was applied. Besides the bias generated by data collection (i.e., local of data collection and raters), the clinical staging is a potential source of variability to consider in schizophrenia dimensional structure. As dimensional approaches gain relevance to reduce heterogeneity in schizophrenia and to investigate their biological substrates, reliable methods to address latent dimensions are required. Michael Birnbaum*,1, Chantel Garrett, Amit Baumel, Asra Rizvi, Whitney Muscat, John Kane1 1Northwell Health; 2Strong 365 (One Mind)

Background

Findings