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Not All First-episode Patients Relapse • 207 persons with first-episode schizophrenia 100 • 24 had only a single episode in 7.5 years 75 • Predictors* of a single episode included shorter duration of untreated psychosis and more rapid time to response to medication 50 25 • Single-episode patients all stopped taking antipsychotic medication during follow-up period** 0 Single Episode Multiple Episode *Including only predictors that survived adjustment for multiple testing; **Personal communication Alvarez-Jimenez Alvarez-Jimenez M, et al. Schizophr Res. 2011;125:236-246. 26
Are Some Patients Harmed by Antipsychotics? • Subjects: 7-year follow-up of 128 subjects, 103 agreed to participate • Following initial remission, half randomized to dose reduction, half to maintenance treatment • ~10% on typical antipsychotic • Outcomes • DR group had less overall exposure to antipsychotics • Relapse rates similar, most patients in both groups had trial off of antipsychotic • Symptom remission at 7 years similar in both groups • Functional remission* 46% DR vs 20% MT (P=.01) • Full recovery 40% DR vs 18% MT (P=.004) • 8 DR and 3 MT did not relapse after stopping antipsychotics Wunderink L, et al. JAMA Psychiatry. 2013 Sep;70(9):913-20. Cumulative Survival 0.9 0.6 0.3 0 DR MT 500 Days 3000 Days Time to Relapse from t6, d *Groningen Social Disability Schedule
Page 1 and 2: Across the Spectrum: Managing First
Page 3 and 4: Diana O. Perkins, MD, MPH Professor
Page 5 and 6: Outline • Achieving Appropriate a
Page 7 and 8: When to Diagnose? Progressive Stage
Page 9 and 10: When to Diagnose? Progressive Stage
Page 11 and 12: How to Diagnose? Domains of Psychos
Page 13 and 14: Treatment of First-episode Schizoph
Page 15 and 16: Stage-based Interventions Early Rec
Page 17 and 18: N-Acetyl Cysteine: Clinical Trial
Page 19 and 20: L-Theanine: Clinical Trial • Rati
Page 21 and 22: Cariprazine: Clinical Trial • Rat
Page 23 and 24: Paliperidone Palmitate versus Place
Page 25: Meta-analysis: Relapse Rates First
Page 29 and 30: Do Antipsychotics Contribute to Gra
Page 31 and 32: Outline • Adherence in Schizophre
Page 33 and 34: Clinical Consequences of Nonadheren
Page 35 and 36: Suicide Attempts Increase When Ther
Page 37 and 38: Unfortunately, We Overestimate Adhe
Page 39 and 40: Reverberations from Adverse Effects
Page 41 and 42: Long-acting Injectable Antipsychoti
Page 43 and 44: Impact of Collaborative Care • Re
Page 45 and 46: Choosing an Antipsychotic: Switch o

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