title: Rate and predictors of non-response to first-line antipsychotic treatment in first-episode schizophrenia.
abstract: OBJECTIVE
  The goals of this study were to (i) estimate the rate of non-response to first-line treatment in first-episode schizophrenia, (ii) evaluate other outcomes associated with symptom non-response and (iii) identify demographic, baseline clinical and early treatment response predictors of non-response.
  
  
  METHODS
  This was a single-site, longitudinal cohort study assessing the effects of treatment with flupenthixol decanoate according to a standardised protocol over 12 months in patients with schizophrenia, schizophreniform and schizo-affective disorders.
  
  
  RESULTS
  Of 126 patients who received at least one dose of study medication, 84 (67%) completed the study. Fifteen (12%) met our predefined criteria for non-response. Non-responders were younger and at baseline had more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS) and lower body mass index. At endpoint, the non-responders were characterised by higher levels of symptomatology in all domains, poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and lower body mass index. The strongest predictors of non-response were more prominent baseline NSS and poor early (7 weeks) treatment response.
  
  
  CONCLUSIONS
  Results are consistent with a lower rate of refractoriness to treatment in first-episode schizophrenia compared with multi-episode samples.
authors.affiliation: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Bonginkosi
authors.initials: B
authors.lastname: Chiliza
authors.forename: Laila
authors.initials: L
authors.lastname: Asmal
authors.forename: Sanja
authors.initials: S
authors.lastname: Kilian
authors.forename: Lebogang
authors.initials: L
authors.lastname: Phahladira
authors.forename: Robin
authors.initials: R
authors.lastname: Emsley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005475:Flupenthixol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000503:physiopathology; D011788:Quality of Life; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; C007761:flupenthixol decanoate; D005475:Flupenthixol
keywords: first-episode psychosis; neurological soft signs; non-response; outcome; predictors