Early identification of treatment non-response in first-episode psychosis

Abstract

Background Approximately one-third of patients with psychotic disorders does not respond to standard antipsychotic treatments. Consensus criteria for treatment resistance (TR) may aid the identification of non-response and subsequent tailoring of treatments. Since consensus criteria require stability of clinical status, they are challenging to apply in first-episode psychosis (FEP). This study aims to investigate (a) if an adaptation of consensus criteria can be used to identify FEP patients with early signs of TR (no early clinical recovery—no-ECR) after 1 year in treatment and (b) to what extent differences in antipsychotic treatments differentiate between outcome groups. Methods Participants with FEP DSM-IV schizophrenia spectrum disorders were recruited during their first treatment. A total of 207 participated in the 1-year follow-up. Remission and recovery definitions were based on adaptations of the “Remission in Schizophrenia Working Group” criteria and TR on adaptations of the “Treatment Response and Resistance in Psychosis” (TRRIP) working group criteria. Results 97 participants (47%) could be classified as no-ECR, 61 (30%) as ECR, and 49 (23%) as with partial ECR (P-ECR). Statistically significant baseline predictors of no-ECR matched previously identified predictors of long-term TR. Only 35 no-ECR participants had two adequate treatment trials and met the full TRRIP criteria. 21 no-ECR participants were using the same medication over the follow-up year despite the lack of significant effects. Conclusion The difference in the percentage of FEP participants classified as no-ECR versus TR indicates that we may underestimate the prevalence of early TR when using consensus criteria.

Incidence and factors associated of early non-response in first-treatment and drug-naïve patients with schizophrenia: a real-world study

“…Two clinical studies, which strictly limited prescribed medications, reported differing results from ours, finding that the early non-response subgroup had significantly higher disease severity at baseline (based on total PANSS scores rather than CGI-SI) in first-episode schizophrenia patients ( 9 , 16 ). However, two other studies reported findings highly consistent with ours; specifically, early non-responders exhibited more severe psychopathological symptoms, including higher PANSS total scores and its three subscale scores ( 17 , 18 ). The contradictory results may stem from strict restrictions on prescribed medications and enrollment criteria.…”

“Why shouldn’t I expect a lot from life?” – a qualitative study of what facilitates long-term recovery in first-episode psychosis

“…Participants in this interview study were all part of the completed TOP 10-year (30) (Thematically Organized Psychosis, TOP-10) and TIPS 20-year (14) (The Treatment and Intervention in Psychosis, TIPS-20) follow-ups of two catchment area-based FEP studies in Oslo, Norway (see cited studies for further information). Both cohorts were recruited from the majority of in-and outpatient mental health services in the urban Oslo area, with the catchment area covering about 90% of the Oslo population.…”