The relapse rate and predictors of relapse in patients with first-episode psychosis following discontinuation of antipsychotic medication

Aims: To determine the “real world” relapse rate in patients with first-episode psychosis who had discontinued antipsychotic medication and identify socio-demographic and clinical factors associated with the risk of relapse.

Methods: Quantitative data were obtained via case-note review on 63 patients with first-episode psychosis who had discontinued antipsychotic medication from Birmingham Early Intervention Service between 2012 and 2015. The follow-up period was until either: an occurrence of a relapse; end of 12 month study period; end of patient’s case-note record. Relapse was defined as a return of symptoms requiring: home treatment, hospital admission or was based on clinical teams’ decision as having a relapse. A pro-forma targeted pre-defined socio-demographic and clinical factors. Survival analysis was undertaken to estimate the 12 month relapse rate following discontinuation of antipsychotics and Cox regression performed to identify relapse predictors.

Results: The Kaplan-Meier 12 month relapse estimate was 67% (95% confidence interval, 54%, 80%). Significant factors (P <0.05) independently associated with an increased risk of relapse following discontinuation of antipsychotic medication were: male gender, not being in education, employment or training (NEET) and number of previous psychiatric hospital admissions.

Conclusions: Relapse is common after discontinuation of antipsychotic medication following recovery from a first-episode psychosis. It is important patients who wish to discontinue their medication are informed of the high relapse rates and the associated risks.