title: Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis.
abstract: OBJECTIVE
  Relapse is common among patients with psychotic disorders. Identification of relapse predictors is important for decision regarding maintenance medication. Naturalistic studies often identify medication non-adherence as a dominant predictor. There are relatively few studies for predictors where adherence is already known. It is this situation i.e., discontinuation of medication that predictors will be most useful. We identify predictors for relapse in situations of (i) discontinuation and (ii) continuation of maintenance medication.
  
  
  METHODS
  Analysis of relapse predictors is based on a randomized controlled study (n=178) comparing relapse rates between patients who discontinued or continued medication for at least 1 year following first-episode psychosis. Demographic, clinical and neurocognitive variables were assessed at baseline as predictors of relapse within 1 year.
  
  
  RESULTS
  Risk of relapse was 79% in the discontinuation group and 41% in the maintenance group. Predictors in the discontinuation group were diagnosis of schizophrenia, poorer semantic fluency performance, and higher blink rate. Predictors in the continuation group were disinhibition soft signs and more general psychopathology symptoms.
  
  
  CONCLUSIONS
  Different predictors of relapse were identified for first episode psychosis patients who discontinued and continued maintenance medication. Neurocognitive dysfunctions are important predictors for both groups. While signs of frontal dysfunction and dopamine hyperactivity predict relapse in the discontinuation group, sign of cognitive disinhibition predicts relapse in the continuation group.
authors.affiliation: Department of Psychiatry, University of Hong Kong, Hong Kong, China. Electronic address: christy@lmhui.com.
authors.forename: Christy L M
authors.initials: CL
authors.lastname: Hui
authors.forename: Gloria H Y
authors.initials: GH
authors.lastname: Wong
authors.forename: Jennifer Y M
authors.initials: JY
authors.lastname: Tang
authors.forename: W C
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: May M L
authors.initials: MM
authors.lastname: Lam
authors.forename: Cindy P Y
authors.initials: CP
authors.lastname: Chiu
authors.forename: C W
authors.initials: CW
authors.lastname: Law
authors.forename: Dicky W S
authors.initials: DW
authors.lastname: Chung
authors.forename: Steve
authors.initials: S
authors.lastname: Tso
authors.forename: Edwin P F
authors.initials: EP
authors.lastname: Pang
authors.forename: K T
authors.initials: KT
authors.lastname: Chan
authors.forename: Y C
authors.initials: YC
authors.lastname: Wong
authors.forename: Flora Y M
authors.initials: FY
authors.lastname: Mo
authors.forename: Kathy P M
authors.initials: KP
authors.lastname: Chan
authors.forename: S F
authors.initials: SF
authors.lastname: Hung
authors.forename: William G
authors.initials: WG
authors.lastname: Honer
authors.forename: Eric Y H
authors.initials: EY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003987:Dibenzothiazepines / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D000069348:Quetiapine Fumarate
keywords: Double blind; First-episode schizophrenia; Maintenance; Randomized controlled trial; Relapse prevention