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Factors influencing relapse during a 2-year follow-up of first-episode psychosis in a specialized early intervention service

Published online by Cambridge University Press:  21 January 2008

A. Malla ,
R. Norman ,
L. Bechard-Evans ,
N. Schmitz ,
R. Manchanda  and
C. Cassidy
A. Malla*
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
R. Norman
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada Department Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
L. Bechard-Evans
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
N. Schmitz
Affiliation:
Department of Psychiatry, McGill University, Montreal, Quebec, Canada Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada
R. Manchanda
Affiliation:
Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
C. Cassidy
Affiliation:
Division of Clinical Research, Douglas Mental Health University Institute, Montreal, Quebec, Canada PEPP Montreal, Douglas Hospital, Montreal, Quebec, Canada
*
*Address for correspondence: A. Malla, Professor of Psychiatry, McGill University, Director, Division of Clinical Research, Douglas Mental Health University Institute, 6875 Boul. Lasalle, Montreal, Qc, Canada H4H 1R3. (Email: ashok.malla@douglas.mcgill.ca)
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Abstract

Background

Differential association of risk factors associated with relapse following treatment of first-episode psychosis (FEP) have not been studied adequately, especially for patients treated in specialized early intervention (SEI) services, where some of the usual risk factors may be ameliorated.

Method

Consecutive FEP patients treated in an SEI service over a 4-year period were evaluated for relapse during a 2-year follow-up. Relapse was based on ratings on the Scale for Assessment of Positive Symptoms (SAPS) and weekly ratings based on the Life Chart Schedule (LCS). Predictor variables included gender, duration of untreated psychosis (DUP), total duration of untreated illness (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse during follow-up and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with the Cox proportional-hazards regression model for time to relapse as the dependent variables.

Results

Of the 189 eligible patients, 145 achieved remission of positive symptoms. A high rate of medication adherence (85%) and relatively low relapse rates (29.7%) were observed over the 2-year follow-up. A higher relapse rate was associated with a co-morbid diagnosis of substance abuse assessed during the follow-up period [odds ratio (OR) 2.84, 95% confidence interval (CI) 1.24–6.51]. The length of time to relapse was not associated with any single predictor.

Conclusions

Specialized treatment of substance abuse may be necessary to further reduce risk of relapse even after improving adherence to medication.

Keywords

First-episode psychosisrelapsesubstance abuse
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 11 , November 2008 , pp. 1585 - 1593
Copyright
Copyright © 2008 Cambridge University Press

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