The impact of treatment and duration of psychosis on residual symptoms

Abstract

Introduction: Literature data suggest that a longer duration of untreated psychosis or discontinuities in antipsychotic treatment impair the disorder's prognosis resulting in residual symptoms and treatment resistance. Objective: To assess the impact of treatment and duration of psychosis on remission quality in outpatients receiving long acting injectable (LAI) antipsychotics. Methods: This double center prospective study included outpatients with schizophrenia, schizoaffective disorder, and bipolar disorder, currently in remission. The subjects received the following LAI antipsychotics: aripiprazole, olanzapine, risperidone or paliperidone for at least 3 months. The quality of remission was assessed using BPRS-E. Total duration of psychosis, the time interval from disorder's onset to LAI treatment, and duration of LAI treatment were measured. Results: We assessed 90 patients with psychosis receiving LAI antipsychotics. 47(52.2%) patients were men and 43 (47.8%) were women. The mean age of the subjects was 42.61 (SD±11.74). The sample consisted of 10 (11.1%) patients on aripiprazole, 41 (45.6%) on olanzapine, 3 (3.3%) on paliperidone, and 36 (40.0%) patients on risperidone. In 55 (61.1%) patients a mood stabilizer was associated. The mean BPRS-E in the sample was 39.15 (SD±13.91). The total BPRS-E score was significantly higher in patients with early age at onset (r=0.245; p=0.029) and where the LAI antipsychotic medication was introduced later in the disorder's evolution (r=0.276; p=0.013). Nevertheless, the use of the LAI antipsychotic treatment did not seem to influence significantly the BPRSE score (r=0.087; p=0.44). We found no significant differences in BPRS-E scores between patients who received only LAI antipsychotics and those who had an adjunctive mood stabilizer. Conclusions: An earlier onset of psychosis and a longer duration of uncertain treatment adherence results in incomplete remission reflected by higher BPRS-E scores. LAI treatment may help in diminishing some residual symptoms.