title: Rates and predictors of relapse in first-episode non-affective psychosis: a 3-year longitudinal study in a specialized intervention program (PAFIP).
abstract: Relapses may represent a critical hazard in schizophrenia spectrum disorders as they are associated with an increased risk of a clinical and functional deterioration. Preventing relapse after recovering from a first psychotic episode has become a major challenge due to its critical impact on lifelong functionality. This study explored the rate of first and second relapses and the predictors associated with these relapses in a large cohort of non-affective psychosis patients during a period of 3 years after the first break of the illness. From February 2001 to May 2014, sociodemographic and clinical data from an epidemiological cohort of 341 non-affective first-episode psychosis patients at risk of relapse were analysed at a specialized early intervention service. Logistic regression, Cox regression, and Kaplan-Meier survival analyses were performed to compare non-relapsed and relapsed patients. One hundred and sixty-six (48.7%) individuals relapsed at least once. Median time to relapse was 17.0 months in non-adherent patients and 40.0 months in adherent patients (log-rankχ2: 51.36; p < 0.001). Non-adherence to medication (odds ratio-OR 2.979; p < 0.001), schizophrenia diagnosis (OR 2.173; p = 0.002), and age of onset (OR 1.020; p = 0.033) were the main predictors of the first relapse. Fifty-six subjects experienced a second relapse (33.73%) predicted by diagnosis (OR 1.975; p = 0.074), age of onset (OR 1.078; p = 0.003), and positive symptoms (OR 0.863; p = 0.03), but not adherence. Non-adherence is the main predictive factor of first relapse after a first episode of psychosis. Second relapses were not often and not related to modifiable factors, suggesting that multiple relapsed patients may comprise a subgroup with a higher biological risk.
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain. pelayoteran@gmail.com.|Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain. pelayoteran@gmail.com.
authors: José María
authors: http://orcid.org/0000-0001-9711-2874
authors: JM
authors: Pelayo-Terán
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain.|Complejo Hospitalario Universitario Infanta Cristina, Badajoz, Spain.
authors: Virginia Gajardo
authors: VG
authors: Gajardo Galán
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain.|Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain.
authors: Víctor
authors: V
authors: de la Ortiz-García de la Foz
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain.|Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain.
authors: Obdulia
authors: O
authors: Martínez-García
authors: Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain.|Department of Medicine, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
authors: Rafael
authors: R
authors: Tabarés-Seisdedos
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain.|Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain.
authors: Benedicto
authors: B
authors: Crespo-Facorro
authors: Department of Medicine and Psychiatry, University Hospital Marques de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain.|Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Santander, Spain.
authors: Rosa
authors: R
authors: Ayesa-Arriola
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; First-episode psychosis; Longitudinal studies; Relapse; Schizophrenia