In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.

Objective To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment.Design 12 month randomised, double blind, placebo controlled trial.Setting Early psychosis outpatient clinics in Hong Kong.Participants 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis.Interventions Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred.Main outcome measure Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds.Results 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; χ 2 =3.20, df=1; P=0.07).Conclusion In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year.Trial registration Clinical trials NCT00334035. INTRODUCTIONPrevention of relapse is an important target in the treatment of schizophrenia and related psychotic conditions.1 In first episode psychosis, more than 80% of patients treated achieve a full response in psychotic symptoms, 2 yet as many as 80% have a relapse within five years.3 Relapse compromises the outcome of psychotic disorders and is associated with substantial risks and costs. 4 With each relapse, the response of symptoms to treatment seems to take approximately 50% longer and is increasingly difficult to reestablish.5 Prevention of relapse is particularly important in the early course of illness, when symptoms and disabilities may be less entrenched. Strategies to improve adherence and minimise early relapses are major focuses in treatment programmes and clinical research.1 For chronic psychotic illness, maintenance antipsychotic drug treatment is efficacious for preventing relapse. The rate of relapse after discontinuation of drug treatment in chronic schizophrenia is approximately 53% compared with 16% for patients maintained on antipsychotic drugs.6 Atypical antipsychotic drugs may have some benefits compared with typical antipsychotics in preventing relapse in chronic illness.7 8 The biological mechanism underlying relaps...

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Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types of exercise improved overall and depressive symptoms (all P⩽0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.