Abstract
BackgroundThe aim of this study is to examine the one-year outcome in a cohort of patients with a first-episode core schizophrenia diagnosis (schizophrenia, schizophreniform psychosis, schizoaffective disorder) and the use of clozapine in the non-remitted patients at one-year control.MethodsThe population studied is the patients who were included with a first-episode psychosis in the TIPS project in the period 01.01.2002-31.12.2010 and had a core schizophrenia diagnosis. We divided the patients into two groups according to their remission status at one-year follow up and compared their main characteristics. We then performed a digital search in the hospitaĹs journal of the non-remitted group for the words “clozapine” and “Leponex”.ResultsOut of the 78 patients with first-episode core schizophrenia diagnosis included in the TIPS project during the examined period, 53 were continuously psychotic at one-year follow up. The one-year remission rate for our sample was therefore 32%. All of the non-remitted patients during the first year could be eligible for clozapine, but clozapine was considered to only 3 of them (5.7 %) and only two of them were offered clozapine. The mean number of periods with antipsychotic treatment in this group was four (4).DiscussionThe findings in our study show firstly a surprisingly low one-year remission rate for first-episode schizophrenia (32 %). This is much lower than what corresponding studies of the last years show. Our results also prove the underutilization of clozapine in non-remitted patients with a first-episode core schizophrenia diagnosis. Therefore, the clinicians did not follow the recommended guidelines for the treatment of schizophrenia. The possible reasons for this low use of clozapine will be discussed, but it was not possible to verify them as there was not found any relevant information in the patients’ files.
Highlights
Patients with first-episode schizophrenia usually respond well to treatment, but relapse is frequent during the first years of the illness and may be associated with clinical deterioration A major concern in treating patients with schizophrenia is non-adherence with medication, with approximately 40% stopping within 1 year and 75% by 2 years
The correct adherence to medication is associated with an adecuated functioning Poor adherence to treatment is a recognised is predictive of poor outcomes and increased risk of hospitalisation Guidelines suggest that long-acting antipsychotic medicines may be offered to people who would prefer such treatment or in cases where avoiding covert non-adherence to antipsychotic medication is a clinical priority within the treatment plan
The population studied is the patients who were included with a first-episode psychosis in the TIPS project in the period 01.01.200231.12.2010 and had a core schizophrenia diagnosis
Summary
Debate continues about how long maintenance treatment should be continued following a first episode of psychosis (FEP). The majority of FEP patients will receive the diagnosis of schizophrenia or bipolar disorder for which the 1- year risk of illness recurrence is estimated at 77% and 41%, respectively. The risk of developing a primary psychotic disorder following a first episode of substance-induced psychosis has been investigated in three studies which reported rates of conversion to a primary psychotic disorder of 25% at one year, 25% at 10 years and 32% at 20 years. Substance-induced psychosis and other unspecified psychoses were all associated with either substantial risks of illness recurrence or development of a primary psychotic disorder. Patients with a FEP and their family members should be fully informed about the risk of illness recurrence and development of a primary psychotic disorder when considering any trial of medication discontinuation
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