title: Predictors for symptom re-exacerbation after targeted stepwise drug discontinuation in first-episode schizophrenia: Results of the first-episode study within the German research network on schizophrenia.
abstract: BACKGROUND
  After a first episode in schizophrenia guidelines recommend antipsychotic maintenance treatment (MT) for at least 1year. Recent RCTs on subsequent targeted intermittent treatment (IT) after stepwise drug discontinuation yielded noticeably higher relapse rates than during MT also in first-episode patients. Nevertheless, about 50% of patients remain stable under IT. Given the potential adverse effects of antipsychotics and the preference of many patients to discontinue drugs, valid predictors for the feasibility of IT are urgently needed to support decision making.
  
  
  METHODS
  Based on a one-year RCT phase comparing MT with IT in first-episode patients after 1year of MT, conducted within the German Research Network on Schizophrenia (GRNS), predictors for deterioration under IT in 19 feasible patients were identified by logistic regression analysis.
  
  
  RESULTS
  Deterioration occurred in 10 patients (52.6%). Univariate analyses indicated a lower PANSS positive score after acute treatment as well as after one year of MT as significant predictors; in multivariate logistic regression, in addition to the lower PANSS positive score after acute treatment, reaching enduring remission and having had a deterioration both during MT evolved as significant predictors and indicate a higher risk for deterioration.
  
  
  CONCLUSIONS
  Although limited by the small sample size, our findings suggest that patients who show a favorable response and full and enduring symptom remission during antipsychotic treatment, as well as those with marked deterioration despite MT should rather be recommended to remain on treatment because they are at higher risk for symptom re-exacerbation after (stepwise) drug discontinuation.
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany. Electronic address: wolfgang.gaebel@uni-duesseldorf.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Gaebel
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Riesbeck
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wölwer
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry and Psychotherapy, Vitos Waldkrankenhaus Köppern, Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Klimke
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany; Department of Psychiatry, Westfalia Clinics, Warstein/Lippstadt, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eickhoff
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: von Wilmsdorff
authors.affiliation: Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus CharitéMitte, Berlin, Germany.
authors.forename: Walter
authors.initials: W
authors.lastname: de Millas
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Falkai
authors.affiliation: Department of Psychiatry and Psychotherapy, Jena-University-Hospital, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Sauer
authors.affiliation: Central Institute of Mental Health, Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schmitt
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany; Vinzenz von Paul Hospital, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Riedel
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Tübingen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Klingberg
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
mesh_terms: D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D015999:Multivariate Analysis; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents
keywords: Drug discontinuation; First episode; Predictors; Schizophrenia; Symptom re-exacerbation