Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy

TLDR

Let's collect content. Background: appears in first line: "[Background, Purpose, Mechanism] Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before." Also second line: "[Background, Other] Additional studies are necessary before these results are incorporated into general practice.isrctn.org Identifier: ISRCTN16228411." So Background content: short-term outcome studies show higher relapse rates but no other disadvantages; long-term effects on recovery not studied before. Also maybe mention additional studies needed? That is background? The second line also includes "Additional studies are necessary before these results are incorporated into general practice." That is more like other?

Abstract

Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before.To compare rates of recovery in patients with remitted FEP after 7 years of follow-up of a dose reduction/discontinuation (DR) vs maintenance treatment (MT) trial.Seven-year follow-up of a 2-year open randomized clinical trial comparing MT and DR.One hundred twenty-eight patients participating in the original trial were recruited from 257 patients with FEP referred from October 2001 to December 2002 to 7 mental health care services in a 3.2 million-population catchment area. Of these, 111 patients refused to participate and 18 patients did not experience remission. PARTICIPANTS After 7 years, 103 patients (80.5%) of 128 patients who were included in the original trial were located and consented to follow-up assessment.After 6 months of remission, patients were randomly assigned to DR strategy or MT for 18 months. After the trial, treatment was at the discretion of the clinician.Primary outcome was rate of recovery, defined as meeting the criteria of symptomatic and functional remission. Determinentals of recovery were examined using logistic regression analysis; the treatment strategy (MT or DR) was controlled for baseline parameters.The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%). Logistic regression showed an odds ratio of 3.49 (P = .01). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates.Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates compared with the rates achieved with MT. To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice.isrctn.org Identifier: ISRCTN16228411.