Ten-Year Follow-Up After First Episode Psychosis: Focused On Low Dose Antipsychotic Maintenance And Functioning

Abstract Background Patients’ long-term phenomenology and outcomes after first episode psychosis are of great interest to patients, their caregivers and care providers. Contradictory messages regarding the necessity of long-term antipsychotic treatment and the factors affecting outcomes warrant careful examination. Methods We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special focus on patients maintaining very low dose antipsychotics and their functioning. Results Of the 81 patients with first episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n=46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit and 10 patients (18.2%) received very low dose antipsychotics (chlorpromazine equivalent [CPZE] dose < 50 mg/d) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization and being on clozapine therapy were correlated to poorer functioning. Fifteen of the 20 good-functioning patients received dosage of antipsychotics no more than the reported minimum effective dose (CPZE 200 mg/d). Antipsychotic-free status was achieved only in two non-psychotic patients. Discussion A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first episode psychosis, even if they cannot successfully discontinue antipsychotic treatment in the long run. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.