Rate and predictors of interrupted patient follow-up after first-episode psychosis - a retrospective cohort study in France.

Abstract

Patient adherence to follow-up after a first episode of psychosis (FEP) is currently a major challenge. Patient's early adherence reduces the risk of relapse and improves their prognosis in the short and long term. The primary goal of our study was to determine the incidence of treatment disengagement at 1-year follow-up in patients with first-episode schizophrenia, schizophreniform or schizoaffective disorder. The secondary goal was to assess the factors associated with treatment disengagement in this patient population. We conducted a monocentric retrospective study of 136 patients in France. Relevant information was collected on sociodemographic, pre-morbidities and co-morbidities data, as well as the management and treatment characteristics at 1.3 and 12 months. Survival analysis was used to assess the association between clinical variables, management and treatment disengagement. Eighty-four patients (62%) have interrupted their medical follow-up at 1 year, 16% at 1 month and 34% at 3 months. A higher number of out-patient appointments after a FEP was associated with better adherence (HR:0.85 p < .0001 95% IC = [0.0-0.9]). Initial management seems to play an important role. Involuntary admissions (HR:7.14 p = .015 95% IC = [1.48-34.52]) and total number of admissions (HR:6.86 p < .0001 95% IC = [2.47-19.05]) predict disengagement at 1 month while an increased number of out-patient appointments at 3 months predicts adherence (HR:0.60 p < .0001 95% IC = [0.00-0.74]). Being a single parent is associated with disengagement at 3 months (HR:15.51 p = .022 95% IC = [1.49-161.65]). Incidence of disengagement is high. It might be necessary to change our management in order to develop out-patient or day-admission care and intensify care for patients at risk.