Abstract
BackgroundThere is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. Robust predictors of relapse after discontinuation are yet to be identified. The present study aimed to determine the proportion of young people who discontinue their antipsychotic medication after a first episode of psychosis, the proportion who experience relapse, and predictors of relapse.MethodsA retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 01/01/11 and 31/12/13 was conducted. A Cox regression analysis was conducted to identify predictors of relapse.ResultsA total of 544 young people with a FEP were included. A trial of discontinuation was undertaken by 61% of the cohort. Median duration of antipsychotic medication prior to first trial of discontinuation was 174.50 days. Amongst those trialing discontinuation, 149 (45.8%) experienced relapse in a median follow-up time post discontinuation of 372 days. On multivariate analysis, predictors of relapse were a diagnosis of cannabis abuse disorder (HR: 1.40), and longer duration of antipsychotic medication (HR: 1.05).DiscussionAntipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.
Highlights
To examine the predictive effect of dysfunctional metacognitions and trait worry on change in paranoia over one year within a large university sample
While antipsychotic medication (AP) is a very effective treatment for positive psychotic symptoms in first-episode psychosis (FEP), it is associated with risks
Due to advances in the detection of, and psychosocial treatments for FEP, it is ethically feasible to study the relative risks and benefits of offering AP as a first line treatment, and of withholding it, on a background of comprehensive evidence-based psychosocial care. This non-inferiority design randomised double blind placebo controlled study examines whether a subgroup of people with FEP can recover without AP, and considers the effects on functioning, physical health, cognition, and brain structure of AP versus withholding AP
Summary
Aims: To examine the predictive effect of dysfunctional metacognitions and trait worry on change in paranoia over one year within a large university sample. Methods: An online survey encompassing measures of metacognitions, trait worry, and paranoia was conducted at baseline (valid N=2291) and one year (N=1746). A series of longitudinal structural equation models were tested, with baseline level of metacognitions as latent variable, baseline trait worry and paranoia at both time points as observed variables. Results: A final trimmed model with the best goodness-of-fit (χ2=82.78, p
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