Brian O'Donoghue1,2,3, Meghan Bowtell1,2, Aswin Ratheesh1,2,3, Eoin Killackey1,2, Patrick McGorry1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 2Centre for Youth Mental Health, University of Melbourne, Australia, 3Orygen Youth Health, Melbourne, Australia
Background: There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis (FEP). While clinical guidelines recommend at least one year of maintenance treatment, individuals often cease their medication prior to this. Reliable predictors of outcome following discontinuation could assist clinicians in advising individuals about maintenance treatment. Findings on the predictors of outcome following discontinuation from a systematic review and a cohort study will be presented. Methods: A systematic review on predictors of outcome following discontinuation was performed with PubMed, CINAHL and PsychInfo databases. For the cohort study, a retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 01/01/11 and 31/12/13 was conducted. A Cox regression analysis was conducted to identify predictors of relapse. Results For the systematic review, a total of eleven studies fulfilled the inclusion criteria and a range of predictors of relapse were identified, including male sex, unemployment, a diagnosis of schizophrenia and more negative symptoms. In the cohort study, 544 young people with a FEP were included and 61% underwent a trial of discontinuation was undertaken. Amongst those trialing discontinuation, 113 (34%) experienced relapse in a median follow-up time post discontinuation of 372 days. Predictors of relapse were cannabis abuse disorder and longer duration of antipsychotic medication. Conclusions: Antipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.
