K Chan

Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial

Objective To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment. Design 12 month randomised, double blind, placebo controlled trial. Setting Early psychosis outpatient clinics in Hong Kong. Participants 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis. Interventions Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred. Main outcome measure Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds. Results 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; χ2=3.20, df=1; P=0.07). Conclusion In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year. Trial registration Clinical trials NCT00334035.

Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis.

OBJECTIVE Relapse is common among patients with psychotic disorders. Identification of relapse predictors is important for decision regarding maintenance medication. Naturalistic studies often identify medication non-adherence as a dominant predictor. There are relatively few studies for predictors where adherence is already known. It is this situation i.e., discontinuation of medication that predictors will be most useful. We identify predictors for relapse in situations of (i) discontinuation and (ii) continuation of maintenance medication. METHOD Analysis of relapse predictors is based on a randomized controlled study (n=178) comparing relapse rates between patients who discontinued or continued medication for at least 1 year following first-episode psychosis. Demographic, clinical and neurocognitive variables were assessed at baseline as predictors of relapse within 1 year. RESULTS Risk of relapse was 79% in the discontinuation group and 41% in the maintenance group. Predictors in the discontinuation group were diagnosis of schizophrenia, poorer semantic fluency performance, and higher blink rate. Predictors in the continuation group were disinhibition soft signs and more general psychopathology symptoms. CONCLUSION Different predictors of relapse were identified for first episode psychosis patients who discontinued and continued maintenance medication. Neurocognitive dysfunctions are important predictors for both groups. While signs of frontal dysfunction and dopamine hyperactivity predict relapse in the discontinuation group, sign of cognitive disinhibition predicts relapse in the continuation group.

A case-controlled study on the outcome of an early intervention programme for psychosis (EASY)

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

Determinants of subjective quality of life in first-episode psychosis patients receiving specialized early intervention service in Hong Kong

IEPA 10th International Conference on Early Intervention in Mental Health – “Looking Back, Moving Forward” Milan, Italy, 20th – 22nd October 2016

Differential prediction profiles of amotivation and diminished expression in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong

IEPA 10th International Conference on Early Intervention in Mental Health – “Looking Back, Moving Forward” Milan, Italy, 20th – 22nd October 2016

Relapse predictors for discontinuing and continuing maintenance medication in remitted first-episode psychosis patients

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

The first three years of pharmacotherapy in patients with psychotic disorders: a comparison between the early intervention programme and standard care service in Hong Kong

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

Relapse prevention in first-episode psychosis patients with stable maintenance medication for at least one year

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

Outcome of an early intervention programme for psychosis (EASY)

and Magical Thinking = 90%. In comparison, using the Comprehensive Assessment of At-Risk Mental States (CAARMS), less than half the sample (46%) rated for subthreshold psychotic symptoms. When looking at the specific subscales of the CAARMS, ‘Disorders of Thought’ was the most frequently endorsed scale (25%), followed by ‘Perceptual Abnormalities’ (24%) and ‘Disorders of Speech’ (10%). A clear discrepancy therefore exists between self-report vs. interview-report PLEs. It may be that young people under-report their unusual and potentially frightening experiences in an interview format. It is also possible that the questionnaire content is being frequently misinterpreted. Given the high reported frequency of selfreport PLEs, the latter is likely to be the case. The present study therefore aimed to determine the extent to which young people correctly interpret psychotic symptom items.

The naturalistic use of antipsychotics in early psychosis in Hong Kong

and Magical Thinking = 90%. In comparison, using the Comprehensive Assessment of At-Risk Mental States (CAARMS), less than half the sample (46%) rated for subthreshold psychotic symptoms. When looking at the specific subscales of the CAARMS, ‘Disorders of Thought’ was the most frequently endorsed scale (25%), followed by ‘Perceptual Abnormalities’ (24%) and ‘Disorders of Speech’ (10%). A clear discrepancy therefore exists between self-report vs. interview-report PLEs. It may be that young people under-report their unusual and potentially frightening experiences in an interview format. It is also possible that the questionnaire content is being frequently misinterpreted. Given the high reported frequency of selfreport PLEs, the latter is likely to be the case. The present study therefore aimed to determine the extent to which young people correctly interpret psychotic symptom items.