title: A 3-year retrospective cohort study of predictors of relapse in first-episode psychosis in Hong Kong.
abstract: OBJECTIVE
  Relapses in psychosis are costly and may have irreversible consequences. Relapse prevention is thus critical in the treatment of schizophrenia. Apart from medication discontinuation, a consistent relapse predictor has not been identified due to limitations in previous studies. We aim to investigate relapse predictors in a large cohort of patients with first-episode psychosis.
  
  
  METHODS
  This is a retrospective cohort study designed to evaluate relapses in first-episode psychosis patients in 3 years. A total of 1400 patients' case records were retrieved from a hospital database. Potential relapse predictors including demographic variables, baseline clinical measures, medication adherence, and residual positive symptoms upon clinical stabilization were collected.
  
  
  RESULTS
  The cumulative relapse rates were 19.3% by year 1, 38.4% by year 2, and 48.1% by year 3. Multivariate Cox-proportional hazards regression analysis revealed that medication non-adherence, smoking, schizophrenia diagnosis, younger age, and shorter baseline hospitalization were associated with an increased risk of relapse in 3 years.
  
  
  CONCLUSIONS
  Nearly half of patients relapsed after 3 years following their first-episode psychosis. Smoking as a predictor of relapse is an intriguing new finding supportive of a link between nicotinic receptors and the dopamine system. Their relationship deserves further investigations with potential clinical implications for relapse prevention.
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong. christy@lmhui.com
authors.forename: Christy L-M
authors.initials: CL
authors.lastname: Hui
authors.forename: Jennifer Y-M
authors.initials: JY
authors.lastname: Tang
authors.forename: Chung-Ming
authors.initials: CM
authors.lastname: Leung
authors.forename: Gloria H-Y
authors.initials: GH
authors.lastname: Wong
authors.forename: Wing-Chung
authors.initials: WC
authors.lastname: Chang
authors.forename: Sherry K-W
authors.initials: SK
authors.lastname: Chan
authors.forename: Edwin H-M
authors.initials: EH
authors.lastname: Lee
authors.forename: Eric Y-H
authors.initials: EY
authors.lastname: Chen
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Early psychosis; predictors; rehospitalization; relapse; schizophrenia