Predictors of Relapse Following Response From a First Episode of Schizophrenia or Schizoaffective Disorder

Abstract

Background:We examined relapse after response to a first episode of schizophrenia or schizoaffective disorder.

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

“…It remains, however, unknown whether these patients are treatment resistant from the illness onset (TRO), or whether they gradually become resistant as illness progresses in the context of multiple episodes, chronic exposure to medication or neurochemical sensitization. We have previously demonstrated that dopamine dysfunction is not evident in treatment-resistant patients (Demjaha et al 2012(Demjaha et al , 2014 and this, together with the evidence linking various underlying neurodevelopmental factors to treatment resistance (McCreadie et al 1989;Robinson et al 1999), may suggest that in this distinct subgroup, dopamine-blocking antipsychotics are ineffective right from the beginning of illness. In support of this, first-episode psychosis (FEP) studies have established that even during the first episode of illness where treatment response to antipsychotic medication tends to be greater; up to one-quarter of patients continue to have persistent symptoms despite adequate treatment (Lieberman et al 1993;Agid et al 2011;Schennach et al 2012).…”

Predictors of engagement in first-episode psychosis

“…Recent reviews suggest that approximately 30% of patients eventually disengage from care (Kreyenbuhl et al, 2009;O'Brien et al, 2009). The problem is particularly severe for patients experiencing a first-episode of psychosis (FEP), where early disengagement is associated with poor patient outcomes (Robinson et al 1999(Robinson et al , 2002Ruggeri et al 2007;Schimmelmann et al 2006;Turner et al 2009). …”

Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy

“…This suggests that factors other than treatment are associated with admission to hospital with a psychotic relapse. For example, numerous factors have been found to be associated with relapse including early adolescent adjustment (Robinson et al 1999), duration of untreated psychosis (Crow et al 1986), non-adherence with medication (Kemp et al 1998), expressed emotion (Kavanagh, 1992) and coping style (Hultman et al 1997). In addition, there is evidence to suggest that patients themselves monitor and regulate their symptoms in order to prevent relapse (Breier & Strauss, 1983;McCandless-Glimcher et al 1986 ;Hultman et al 1997).…”