Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

Richard Whale, Michael Harris, Gail Kavanagh, Vijitha Wickramasinghe, Christopher I Jones, Steven Marwaha, Ketan Jethwa, Nirmalan Ayadurai, Andrew Thompson

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BACKGROUND: One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).

AIMS: To investigate the effectiveness of commonly used antipsychotic medications in FEP.

METHOD: A retrospective cohort study of naturalistic treatment of patients (N=460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.

RESULTS: Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.

CONCLUSIONS: Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.

DECLARATION OF INTEREST: R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.

COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Original languageEnglish
Pages (from-to)323-329
Number of pages7
JournalBritish Journal of Psychiatry Open
Issue number5
Publication statusPublished - Sept 2016


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