Symptom Recurrence Following Intermittent Treatment in First-Episode Schizophrenia Successfully Treated for 2 Years: A 3-Year Open-Label Clinical Study

Objective: An unanswered question in the management of schizophrenia is how long antipsychotic treatment should be continued after a single psychotic episode. In this study, we assessed the rates of symptom recurrence with intermittent treatment in patients with a first episode of DSM-IV-defined schizophrenia or related illness after 2 years of successful continuous treatment. We also investigated antecedents of recurrence, as well as demographic and baseline clinical predictors of early recurrence, and we compared the psychopathology of the recurrence episode with that of the first episode.

Method: Outpatients in an academic psychiatric hospital setting (single site) who had responded well in an open-label study with risperidone long-acting injection were recruited for this intermittent treatment trial, and those who participated had their treatment tapered and discontinued over a period of up to 6 weeks, with follow-up for 3 years or until reemergence of symptoms. Open-label treatment with oral risperidone and risperidone long-acting injection was immediately reinstituted in the event of recurrence of symptoms. The study was conducted between February 2004 and March 2010. The primary outcome measure was symptom recurrence rate at 3 years.

Results: Participants (N = 33) had a mean age ± SD of 28 ± 7.9 years and a mean baseline Positive and Negative Syndrome Scale total score ± SD of 44.8 ± 7.4 at study entry. Symptom recurrence rates were 79% at 12 months, 94% at 24 months, and 97% at 36 months. Onset of recurrence symptoms was fairly abrupt, and symptom severity returned to levels close to those of the first episode. No significant predictors of early recurrence were identified.

Conclusions: Intermittent antipsychotic treatment, even after 2 years of successful treatment, may not be in the best interest of patients who have experienced a single psychotic episode.

Trial Registration: ClinicalTrials.gov identifier: NCT00378092

J Clin Psychiatry 2012;73(4):e541-e547

© Copyright 2012 Physicians Postgraduate Press, Inc.

Submitted: May 10, 2011; accepted October 14, 2011(doi:10.4088/JCP.11m07138).

Corresponding author: Robin Emsley, MB, Department of Psychiatry, PO Box 19063, Tygerberg 7505, Cape Town, South Africa (rae@sun.ac.za).