Four predictors for relapse in FEP patients identified

By Mark Cowen, Senior MedWire Reporter

Medication non-adherence, persistent substance use disorder, carers' critical comments, and poorer premorbid adjustment are significant predictors for relapse in patients treated for a first episode of psychosis (FEP), a review and meta-analysis of published studies shows.

However, the team found no evidence to suggest that clinical and general demographic variables influence relapse rates in such patients.

"These findings have direct clinical implications for preventing relapse during the early course of psychosis, when intervention may improve long-term outcomes," comment Mario Alvarez-Jimenez (University of Melbourne, Australia) and team.

The team searched the literature for longitudinal studies, with at least 12 months of follow up, that examined sociodemographic, clinical, psychologic, biologic, and treatment predictors for relapse in patients treated for a FEP.

In total, 29 studies involving 3978 participants met criteria for inclusion in the final analysis. Of these, 12 trials (n=1550) were conducted in Europe, five (n=636) in Asia, eight (n=1147) in North America, and four (n=645) in Australia.

Examination of the pooled data showed that mean relapse rates for positive symptoms among the FEP patients were 28% at 1 year, 43% at 1-1.5 years, and 54% at 3 years of follow up.

Out of a total 109 predictors for relapse, only 24 were assessed in three or more studies, and of these, data could be extracted for just 20.

The researchers found that medication nonadherence, persistent substance use disorder, carers' critical comments, and poorer premorbid adjustment were associated with a respective 4.0-, 3.0-, 2.3-, and 2.2-fold increased risk for relapse among treated FEP patients.

However, duration of untreated illness, lower insight, positive psychotic symptoms, negative psychotic symptoms, age at onset, gender, marital status, education, employment, and cognitive variables were not significantly associated with relapse risk.

Alvarez-Jimenez and team conclude in Schizophrenia Research: "Future research should focus on the identification of protective and modifiable factors, address the significant methodological shortcomings of previous studies, and evaluate theoretically derived models which integrate the bio-psycho-social factors involved in the aetiology of relapse."

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