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Stability and development of psychotic symptoms and the use of antipsychotic medication – long-term follow-up

Published online by Cambridge University Press:  06 April 2017

D. R. Gotfredsen ,
R. S. Wils ,
C. Hjorthøj ,
S. F. Austin ,
N. Albert ,
R. G. Secher ,
A. A. E. Thorup ,
O. Mors  and
M. Nordentoft
D. R. Gotfredsen*
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
R. S. Wils
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
C. Hjorthøj
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
S. F. Austin
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
N. Albert
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
R. G. Secher
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
A. A. E. Thorup
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
O. Mors
Affiliation:
The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
M. Nordentoft
Affiliation:
Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
*
*Address for correspondence: D. R. Gotfredsen, M.D., Mental Health Centre Copenhagen, Kildegårdsvej 28, opg. 15, 2900 Hellerup, Denmark. (Email: [email protected])
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Abstract

Background

Few studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-year period in a cohort of patients with first-episode psychosis.

Method

The study is a longitudinal prospective cohort study over 10 years with follow-ups at years 1, 2, 5 and 10. A total of 496 patients with first-episode psychosis were included in a multi-centre study initiated between 1998 and 2000 in Copenhagen and Aarhus, Denmark.

Results

At all follow-ups, a large proportion (20–30%) of patients had remission of psychotic symptoms without use of antipsychotic medication at the time of the follow-up. Patients who were in this group at the 5-year follow-up had an 87% [95% confidence interval (CI) 77–96%] chance of being in the same group at the 10-year follow-up. This stability was also the case for patients who had psychotic symptoms and were treated with antipsychotic medication at year 5, where there was a 67% (95% CI 56–78%) probability of being in this group at the consecutive follow-up.

Conclusions

A large group of patients with psychotic illness were in remission without the use of antipsychotic medication, peaking at year 10. Overall there was a large degree of stability in disease courses over the 10-year period. These results suggest that the long-term outcome of psychotic illness is heterogeneous and further investigation on a more individualized approach to long-term treatment is needed.

Keywords

Schizophreniapsychotic illnessmedicationlong-term outcome.
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 12 , September 2017 , pp. 2118 - 2129
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

†

These authors contributed equally to this work.

References

Andreasen, N, Carpenter, T, Kane, J, Robert, A, Marder, S, Weinberger, D (2005). Remission in schizophrenia: proposed criteria and rationale for consensus. American Journal of Psychiatry 162, 441–449.Google Scholar
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, le Quach, P, Christensen, TØ, Krarup, G, Jørgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Archives of General Psychiatry 65, 762–771.CrossRefGoogle ScholarPubMed
Boonstra, G, Burger, H, Grobbee, DE, Kahn, R (2011). Antipsychotic prophylaxis is needed after remission from a first psychotic episode in schizophrenia patients: results from an aborted randomised trial. International Journal of Psychiatry in Clinical Practice 15, 128–134.Google Scholar
Cassidy, CM, Norman, R, Manchanda, R, Schmitz, N, Malla, A (2010). Testing definitions of symptom remission in first-episode psychosis for prediction of functional outcome at 2 years. Schizophrenia Bulletin 36, 1001–1008.Google Scholar
Chen, EY, Hui, CL, Lam, MM, Chiu, C, Law, CW, Chung, DW, Tso, S, Chan, KT, Yao, TJ, Hung, SF, Honer, WG (2010). Maintenance treatment with quetiapine versus remitted first episode psychosis: randomised controlled trial. British Medical Journal 341, c4024.CrossRefGoogle ScholarPubMed
Ciompi, L, Clemens, S (1980). Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophrenia Bulletin 6, 606–618.CrossRefGoogle ScholarPubMed
Dold, M, Leucht, S (2014). Pharmacotherapy of treatment-resistant schizophrenia: a clinical perspective. Evidence-based Mental Health 17, 33–37.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976). The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.Google Scholar
Fenton, WS, Blyler, CR, Heinssen, RK (1997). Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophrenia Bulletin 23, 637–651.Google Scholar
Gitlin, M, Nuechterlein, K, Subotnik, KL, Ventura, J, Mintz, J, Fogelson, DL, Bartzokis, G, Aravagiri, M (2001). Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. American Journal of Psychiatry 158, 1835–1842.Google Scholar
Häfner, H, Riecher-Rössler, A, Hambrecht, M, Maurer, K, Meissner, S, Schmidtke, A, Fätkenheuer, B, Löffler, W, van der Heiden, W (1992). IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research 6, 209–223.Google Scholar
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J, Dube, K, Ganev, K, Giel, R, an der Heiden, W, Holmberg, S, Janca, A, Lee, P, Leon, C, Malhotra, S, Marsella, A, Nakane, Y, Sartorius, N, Shen, Y, Skoda, C, Thara, R, Tsirkin, S, Varma, V, Walsh, D, Wiersma, D (2001). Recovery from psychotic illness: a 15-and 25-year international follow-up study. British Journal of Psychiatry 178, 506–517.CrossRefGoogle Scholar
Harrow, M, Jobe, TH (2010). How frequent is chronic multiyear delusional activity and recovery in schizophrenia: a 20-year multi-follow-up. Schizophrenia Bulletin 36, 192–204.Google Scholar
Harrow, M, Jobe, TH, Faull, RN (2012). Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study. Psychological Medicine 42, 2145–2155.Google Scholar
Hasan, A, Falkai, P, Wobrock, T, Lieberman, J, Glenthoj, B, Gattaz, WF, Thibaut, F, Möller, H-J (2013). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects. World Journal of Biological Psychiatry 14, 2–44.Google Scholar
Hegelstad, WTV, Larsen, TK, Auestad, B, Evensen, J, Haahr, U, Joa, I, Johannesen, JO, Langeveld, J, Melle, I, Opjordsmoen, S, Rossberg, JI, Rund, BR, Simonsen, E, Sundet, K, Vaglum, P, Friis, S, McGlashan, T (2012). Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. American Journal of Psychiatry 169, 374–380.Google Scholar
Hjorthøj, CR, Vesterager, L, Nordentoft, M (2013). Test–retest reliability of the Danish Adult Reading Test in patients with comorbid psychosis and cannabis-use disorder. Nordic Journal of Psychiatry 67, 159–163.Google Scholar
Køster, A, Lajer, M, Lindhardt, A, Rosenbaum, B (2008). Gender differences in first episode psychosis. Social Psychiatry and Psychiatric Epidemiology 43, 940–946.Google Scholar
Leucht, S, Pitschel-Walz, G, Abraham, D, Kissling, W (1999). Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo. A meta-analysis of randomized controlled trials. Schizophrenia Research 35, 51–68.Google Scholar
Leucht, S, Tardy, M, Komossa, K, Heres, S, Kissling, W, Salanti, G, Davis, JM (2012). Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 379, 2063–2071.Google Scholar
Mitchell, AJ, Vancampfort, D, Sweers, K, van Winkel, R, Yu, W, De Hert, M (2013). Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders – a systematic review and meta-analysis. Schizophrenia Bulletin 39, 306–318.Google Scholar
Moilanen, J, Haapea, M, Miettunen, J, Jääskeläinen, E, Veijola, J, Isohanni, M, Koponen, H (2013). Characteristics of subjects with schizophrenia spectrum disorder with and without antipsychotic medication – a 10-year follow-up of the Northern Finland 1966 Birth Cohort study. European Psychiatry 28, 53–58.CrossRefGoogle ScholarPubMed
Morgan, C, Lappin, J, Heslin, M, Donoghue, K, Lomas, B, Reininghaus, U, Onyejiaka, A, Croudace, T, Jones, PB, Murray, RM, Fearon, P, Doody, GA, Dazzan, P (2014). Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychological Medicine 44, 2713–2726.Google Scholar
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Øhlenschlaeger, J, Christensen, TØ, Krarup, G, Jørgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patient with a first episode of psychotic illness. British Medical Journal 331, 602. Google Scholar
Riecher-Rössler, A, Häfner, H (2000). Gender aspects in schizophrenia: bridging the border between social and biological psychiatry. Acta Psychiatrica Scandinavica. Supplementum 102, 58–62.CrossRefGoogle Scholar
Secher, RG, Hjorthøj, CR, Austin, SF, Thorup, A, Jeppesen, P, Mors, O, Nordentoft, M (2015). Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophrenia Bulletin 41, 617–626.Google Scholar
Takeuchi, H, Suzuki, T, Uchida, H, Watanabe, K, Mimura, M (2012). Antipsychotic treatment for schizophrenia in the maintenance phase: a systematic review of the guidelines and algorithms. Schizophrenia Research 134, 219–225.Google Scholar
Wils, RS, Gotfredsen, DR, Hjorthøj, C, Austin, SF, Albert, N, Secher, RG, Thorup, AAE, Mors, O, Nordentoft, M (2016). Antipsychotic medication and remission of psychotic symptoms 10years after a first-episode psychosis. Schizophrenia Research, E-pub ahead of print.Google Scholar
Wing, J, Babor, T, Brugha, T, Burke, J, Cooper, J, Giel, R, Jablenski, A, Regier, D (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 2190539.CrossRefGoogle ScholarPubMed
Wunderink, L, Nieboer, RM, Wiersma, D, Sytema, S, Nienhuis, FJ (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry 70, 913–920.Google Scholar
Wunderink, L, Nienhuis, FJ, Sytema, S, Slooff, CJ, Knegtering, R, Wiersma, D (2007). Guided discontinuation versus maintenance treatment in remitted first-episode psychosis: relapse rates and functional outcome. Journal of Clinical Psychiatry 68, 654–661.Google Scholar
Zipursky, RB, Menezes, NM, Streiner, DL (2014). Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review. Schizophrenia Research 152, 408–414.Google Scholar
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