A 20-Year Follow-up of First Episode Psychosis: Longitudinal Effects of Early Treatment Strategies and Relapse

The study aims to address the following questions: 1. Do subgroups defined by early medication choices, relapse, and medication taken over 20 years differ in clinical, cognitive, and functional outcomes? 2. What are the long-term cognitive functioning trajectories, what factors predict these trajectories, and how do they relate to outcomes? 3. What might be the mechanisms behind medication discontinuation and poor long-term outcome, including the roles of multiple relapses and treatment resistance after first-episode psychosis? Eligible patients will be invited to a one-time face-to-face interview. A trained research assistant will guide the participants through questions about their background, clinical symptoms, daily functioning, cognitive abilities, and psychological well-being.

Participants were individuals who previously participated in a randomized controlled trial investigating medication continuation/discontinuation on relapse during first episode psychosis (ClinicalTrials.gov NCT00334035). The trial included specific inclusion and exclusion criteria, detailed as follows: Inclusion Criteria: * A diagnosis of schizophrenia or non-affective psychosis (schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, or psychosis not otherwise specified) (DSM-IV) * Aged 18 to 65 years at the time of original enrolment * Had been treated with antipsychotic drugs for at least 12 months * No history of relapse or exacerbation or had to be asymptomatic (free of positive symptoms of psychosis) at study entry. Exclusion Criteria: * A diagnosis of drug-induced psychosis * Current treatment with clozapine, with mood stabilizing medications (lithium, valproate or carbamazepine) or with depot medication * Had high risk of suicide or violence * Inability to provide informed consent at recruitment