title: Five-fold increased risk of relapse following breaks in antipsychotic treatment of first episode psychosis.
abstract: A key problem in the management of first episode psychosis is that patients are often reluctant to take antipsychotic medication, especially once their presenting symptoms have resolved. Clinicians may be tempted to trial a 'break in treatment' in such patients.
  
  
  
  To assess the impact of interruptions in the antipsychotic treatment of first episode psychosis.
  
  
  
  Treatment adherence and clinical course were assessed during the 18months following presentation in 136 consecutive patients with a first episode of psychosis in 2003-2005 by a systematic retrospective casenote review. Regression analyses were used to examine the time to remission and the risk of relapse in patients who had stopped antipsychotics for one month or more.
  
  
  
  There were breaks in antipsychotic treatment of ≥1month in more than half of the patients (n=73; 58%). When these occurred before they had recovered (n=22; 17%), the time to remission was almost twice as long as in patients in whom treatment was continuous (t=2.9, P=0.01). Patients in whom treatment was interrupted were 5 times more likely to have relapsed than those in whom it was continuous (p=0.0001, 95%CI 2.1-11). The mean time to relapse following an interruption in treatment was 3months.
  
  
  
  If the treatment of first episode psychosis with antipsychotic medication is stopped for a month or more, remission may be delayed and the risk of relapse following remission may be substantially increased.
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Toby T
authors.initials: TT
authors.lastname: Winton-Brown
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Elanjithara
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Paddy
authors.initials: P
authors.lastname: Power
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Coentre
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Blanco-Polaina
authors.affiliation: Institute of Psychiatry, Box P0 67, De Crespigny Park, London SE5 8AF, UK. Electronic address: Philip.McGuire@kcl.ac.uk.
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000188:drug therapy*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents