title: Comparison of treatment response in second-episode versus first-episode schizophrenia.
abstract: This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with risperidone long-acting injection (RLAI) for a first episode of schizophrenia; (2) underwent an intermittent treatment extension phase up to 3 years or until recurrence, and (3) entered a further 2-year treatment phase with RLAI for a recurrence episode. For the patients who remained in treatment (n = 14 [45%]), Positive and Negative Syndrome Scale score reductions, response rates, remission rates, time to response, time to remission, functional outcome scores, and modal RLAI doses were similar for the 2 treatment periods. However, 17 (55 %) of the 31 patients discontinued the study in the second episode compared with 14 (28%) of 50 patients in the first episode, suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence. Most notably, emergent treatment nonresponsiveness was observed in 5 participants (16%), consistent with the hypothesis that relapse may be biologically harmful in a subset of patients.
authors.affiliation: Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, Cape Town, South Africa. rae@sun.ac.za
authors.forename: Robin
authors.initials: R
authors.lastname: Emsley
authors.forename: Petrus
authors.initials: P
authors.lastname: Oosthuizen
authors.forename: Liezl
authors.initials: L
authors.lastname: Koen
authors.forename: Dana
authors.initials: D
authors.lastname: Niehaus
authors.forename: Lupe
authors.initials: L
authors.lastname: Martinez
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012074:Remission Induction; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D013812:Therapeutics; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations; D018967:Risperidone