title: Predictors of favourable outcome in young people with a first episode psychosis without antipsychotic medication.
abstract: Data from the literature suggests that some first episode psychosis (FEP) patients may recover without antipsychotic medication. There is however no reliable way to identify them. In a previous paper we found, in a cohort of 584 FEP patients, that those consistently refusing medication had poorer pre-morbid functioning, less insight, higher rate of substance use and poorer outcome. However, some medication refusers, had a favourable outcome. The study aim was to identify predictors of good short term outcome despite non-exposure to medication.
  
  
  
  The Early Psychosis Prevention and Intervention Centre (EPPIC) admitted 786 FEP patients between 1998 and 2000. Data were collected from patients' files using a standardized questionnaire. Data on medication adherence was available in 584 patients. Among the 17.9% of patients who consistently refused medication over the entire treatment phase we compared patients who had a favourable symptomatic and functional outcome with those who did not.
  
  
  
  Among patients who consistently refused medication, 41% achieved symptomatic remission and 33% reached functional recovery. Predictors of symptomatic remission were a better premorbid functioning level, higher education and employment status at baseline. Predictors of functional recovery were a shorter duration of the prodrome phase, less severe psychopathology at baseline and lower cannabis use.
  
  
  
  Despite limitations mainly linked to the fact that non-exposure to antipsychotic medication was based on patient's treatment refusal, this study identified some characteristics which may contribute to the identification of a sub-group of FEP patients who may have good short term outcome without antipsychotic treatment.
authors.affiliation: Treatment and Early Intervention in Psychosis Program (TIPP), Service de Psychiatrie Générale, Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland. Electronic address: philippe.conus@chuv.ch.
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
authors.forename: Sue M
authors.initials: SM
authors.lastname: Cotton
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia.
authors.forename: Shona M
authors.initials: SM
authors.lastname: Francey
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Donoghue
authors.affiliation: University Hospital of Child and Adolescent Psychiatry, University of Bern, Switzerland.
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkivlle, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia; Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic medication; Psychosis; Recovery; Schizophrenia