Karin Landolt1, Wulf Rössler2, Vladeta Ajdacic-Gross3, Eske M Derks4, Jan Libiger5, René S Kahn6, W Wolfgang Fleischhacker7. 1. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich. Electronic address: klandolt@dgsp.uzh.ch. 2. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil. Electronic address: roessler@dgsp.uzh.ch. 3. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich. Electronic address: vajdacic@dgsp.uzh.ch. 4. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: e.m.derks@amc.uva.nl. 5. Psychiatric Clinic, Faculty Hospital Hradec Králové, Charles University Medical School, Hradec Králové, Czech Republic. Electronic address: libigerj@lfhk.cuni.cz. 6. Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, The Netherlands. Electronic address: r.kahn@umcutrecht.nl. 7. Biological Psychiatry Division, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria. Electronic address: wolfgang.fleischhacker@i-med.ac.at.
Abstract
BACKGROUND: This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. METHODS: We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). RESULTS: Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. CONCLUSIONS: Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation.
BACKGROUND: This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. METHODS: We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). RESULTS:Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. CONCLUSIONS: Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation.
Authors: Mark Abie Horowitz; Sameer Jauhar; Sridhar Natesan; Robin M Murray; David Taylor Journal: Schizophr Bull Date: 2021-07-08 Impact factor: 7.348