This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with risperidone long-acting injection (RLAI) for a first episode of schizophrenia; (2) underwent an intermittent treatment extension phase up to 3 years or until recurrence, and (3) entered a further 2-year treatment phase with RLAI for a recurrence episode. For the patients who remained in treatment (n = 14 [45%]), Positive and Negative Syndrome Scale score reductions, response rates, remission rates, time to response, time to remission, functional outcome scores, and modal RLAI doses were similar for the 2 treatment periods. However, 17 (55 %) of the 31 patients discontinued the study in the second episode compared with 14 (28%) of 50 patients in the first episode, suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence. Most notably, emergent treatment nonresponsiveness was observed in 5 participants (16%), consistent with the hypothesis that relapse may be biologically harmful in a subset of patients.
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From the *Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Tygerberg, Cape Town, South Africa; and †Janssen Medical Affairs EMEA, Beerse, Belgium.
Received September 21, 2011; accepted after revision May 14, 2012.
Reprints: Robin Emsley, MD, Department of Psychiatry, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa (e-mail: firstname.lastname@example.org).
This study was sponsored by Janssen-Cilag Medical Affairs Europe, Middle East and Africa (EMEA), a division of Janssen Pharmaceutica NV.
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