Lex Wunderink1,2, Jan van Bebber2, Sjoerd Sytema2, Nynke Boonstra1, Rob Meijer3, Hanneke Wigman2; 1Friesland Mental Health Services, Leeuwarden, The Netherlands, 2University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, 3Dept of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
Relapse of psychosis indicates worse functional outcome. The aim of current treatment strategies is relapse-prevention, though neither predictors of relapse nor causation of functional decline have been established. If relapse were a consequence of a decline-related confounder, preventing relapse might only partly impact upon decline. We hypothesized baseline negative symptoms to predict both functional deficits and relapse risk. Analyzing 7-years follow-up data of a first episode cohort involved in a dose-reduction/discontinuation trial, we examined: 1) what predicted relapse, 2) what predicted functional outcome and 3) if baseline negative symptoms (BNS) predicted relapse, whether medication strategies would make a difference reducing relapse rates. Relapse was predicted by baseline negative symptoms and duration of untreated psychosis. The more relapses, the less recovery. No relapses yielded recovery in 18/36 patients, 1 relapse: 8/32, 2 relapses: 4/21 and ≥3 relapses: 0/14. However, baseline negative symptoms were a better predictor of functional outcome (pseudo partial correlation [pr]=.90) than number of relapses (pr=.64) or treatment strategy (pr=.57), although all predictors had unique contributions. Within maintenance treatment more negative symptoms showed higher relapse rates. Within high or low negative symptom groups, relapse rates were equal across both treatment strategies. Negative symptoms not only predicted non-recovery, but also relapses during 7-years follow-up. Apparent consequences of relapse, mainly non-recovery, have to be partially attributed to baseline negative symptoms. Relapse prevention by (low-dose) maintenance treatment does not seem effective, since relapse rates were equal across arms and mainly dependent on negative symptoms.
