Psychotic disorders are characterized by a relapsing course of illness, poor recovery and even treatment resistance. Although maintenance treatment can help prevent relapse, the long-term use of antipsychotics carries substantial side effects. Without much empirical data on the long-term effects of medication discontinuation and relapse, the decision to discontinue or continue medication in first-episode psychosis (FEP) patients who have been free of positive symptoms for a period of time poses a clinical dilemma. Using long-term follow-up data in patients with FEP from The Netherlands and Hong Kong, important questions on factors leading to poor outcome will be examined. The first speaker will discuss what predicted relapse; the relationship of relapse and 7-year outcome; and if negative symptoms predicted relapse, whether medication strategies would make a difference in reducing relapse rates, in FEP involved in a dose-reduction/discontinuation trial. The second speaker will investigate the effect of early medication discontinuation on 10-year clinical outcome in FEP who were previously involved in a medication discontinuation (placebo) trial. The role of early relapse in mediating discontinuation and outcome will also be discussed. Using a case-control first episode cohort followed up for 12 years, the third speaker will examine how the early clinical characteristics such as early relapse and planned medication discontinuation would affect the long-term outcome of recovery, treatment resistance, and suicide. The last speaker will present data from a survey in Singapore, looking at clinicians’ views on medication discontinuation in remitted FEP.
