title: Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST).
abstract: BACKGROUND
  This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation.
  
  
  METHODS
  We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%).
  
  
  RESULTS
  Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries.
  
  
  CONCLUSIONS
  Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich. Electronic address: klandolt@dgsp.uzh.ch.
authors.forename: Karin
authors.initials: K
authors.lastname: Landolt
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil. Electronic address: roessler@dgsp.uzh.ch.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland, Militärstrasse 8, PO Box 1930, 8021 CH-Zurich. Electronic address: vajdacic@dgsp.uzh.ch.
authors.forename: Vladeta
authors.initials: V
authors.lastname: Ajdacic-Gross
authors.affiliation: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: e.m.derks@amc.uva.nl.
authors.forename: Eske M
authors.initials: EM
authors.lastname: Derks
authors.affiliation: Psychiatric Clinic, Faculty Hospital Hradec Králové, Charles University Medical School, Hradec Králové, Czech Republic. Electronic address: libigerj@lfhk.cuni.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Libiger
authors.affiliation: Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center, Utrecht, The Netherlands. Electronic address: r.kahn@umcutrecht.nl.
authors.forename: René S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Biological Psychiatry Division, Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria. Electronic address: wolfgang.fleischhacker@i-med.ac.at.
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D007557:Israel; D016015:Logistic Models; D008297:Male; D010352:Patient Dropouts; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic medication; First episode; Predictors; Prospective studies; Schizophrenia