Amal Abdel-Baki1, Sofia Medrano1, Catherine Maranda1, Martin Ladouceur2, Ramzan Tahir1, Emmanuel Stip1, Stéphane Potvin3; 1Centre Hospitalier Université de Montréal, 2Jewish General Hospital, 3Institut universitaire en santé mentale de Montréal
Background: Early relapse is frequent in first-episode psychosis (FEP), mainly because of poor adherence to medication. Previous studies have shown positive impacts of long-acting injectable antipsychotics (LAI-AP) on relapse rates, while others have discerned no differences. This discrepancy can be explained by dissimilar methodologies and non-representative samples (e.g. exclusion of substance use disorder (SUD)). Objectives: To describe the impact of early LAI-AP utilization on relapse and re-hospitalization rates in FEP. Methods: A 3-year, longitudinal, prospective, naturalistic study of all admissions of psychosis patients for early intervention services was conducted. In total, 416 patients were subdivided into 4 groups according to the route of antipsychotic administration. Results: Patients who received LAI-AP at first were more likely to be affected by poor prognostic factors (lower pre-morbid functioning, homelessness, SUD and schizophrenia spectrum diagnoses). However, their relapse rate over time was similar to those with good prognostic factors who only received oral antipsychotics (OAP). Patients who were initially prescribed OAP and eventually switched to LAI-AP were more likely to relapse and to be re-hospitalized (in a larger proportion and more rapidly), even if they manifested better functioning at baseline than those started on LAI-AP. However, they were younger and more likely to have SUD. Conclusion: Patients with poor prognosis and younger patients in the early stage of their disease seem to benefit from early prescription of LAI-AP. Since the latter are often still at school or at work at admission, relapse prevention seems particularly relevant to avoid functional deterioration.
