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Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

  • Richard Whale (a1), Michael Harris (a2), Gail Kavanagh (a2), Vijitha Wickramasinghe (a3), Christopher I. Jones (a4), Steven Marwaha (a5), Ketan Jethwa (a5), Nirmalan Ayadurai (a6) and Andrew Thompson (a5)...
Abstract
Background

One year of antipsychotic treatment from symptom remission is recommended following a first episode of psychosis (FEP).

Aims

To investigate the effectiveness of commonly used antipsychotic medications in FEP.

Method

A retrospective cohort study of naturalistic treatment of patients (N = 460) accepted by FEP services across seven UK sites. Treatment initiation to all-cause discontinuation determined from case files.

Results

Risk of treatment discontinuation is greatest within 3 months of treatment initiation. Risperidone had longest median survival time. No significant differences were observed in time to discontinuation between commonly used antipsychotics on multivariable Cox regression analysis. Poor adherence and efficacy failure were the most common reasons for discontinuation.

Conclusions

Effectiveness differences appear not to be a current reason for antipsychotic choice in FEP. Adherence strategies and weighing up likely adverse effects should be the clinical focus.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Corresponding author
Dr Richard Whale, Division of Medical Education, Brighton and Sussex Medical School, Mayfield House, Falmer, Brighton BN1 9PH, UK. Email: richard.whale@brighton.ac.uk
Footnotes
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Declaration of interest

R.W., A.T. and S.M. have received research grant, speaker honoraria and conference attendance funding from all companies marketing antipsychotics.

Footnotes
References
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Effectiveness of antipsychotics used in first-episode psychosis: a naturalistic cohort study

  • Richard Whale (a1), Michael Harris (a2), Gail Kavanagh (a2), Vijitha Wickramasinghe (a3), Christopher I. Jones (a4), Steven Marwaha (a5), Ketan Jethwa (a5), Nirmalan Ayadurai (a6) and Andrew Thompson (a5)...
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