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Randomized Controlled Trial
. 2013 Sep;70(9):913-20.
doi: 10.1001/jamapsychiatry.2013.19.

Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-Up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-Term Follow-Up of a 2-year Randomized Clinical Trial

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Randomized Controlled Trial

Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-Up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-Term Follow-Up of a 2-year Randomized Clinical Trial

Lex Wunderink et al. JAMA Psychiatry. .

Abstract

Importance: 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.

Objective: 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.

Design: Seven-year follow-up of a 2-year open randomized clinical trial comparing MT and DR.

Setting: 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.

Intervention: 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.

Main outcomes and measures: Primary outcome was rate of recovery, defined as meeting the criteria of symptomatic and functional remission. Determinants of recovery were examined using logistic regression analysis; the treatment strategy (MT or DR) was controlled for baseline parameters.

Results: 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.

Conclusions and relevance: 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.

Trial registration: isrctn.org Identifier: ISRCTN16228411.

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