The MESIFOS-trial: Treatment strategies in remitted first episode psychosis

Abstract

Background and Aims

Objective is to compare the consequences of guided discontinuation strategy and maintenance treatment in remitted first episode psychosis in terms of relapse, symptomatic and social remission and recovery.

Methods

The study was conducted in seven mental health care organizations, covering a catchment area of 3.1 million inhabitants. A sample of 131 remitted first episode patients, aged 18 to 45 years, with a diagnosis of schizophrenia or related psychotic disorder was included. After six months of positive symptom remission they were randomly and openly assigned to discontinuation strategy or maintenance treatment. Maintenance treatment was carried out according to APA-guidelines, preferably using low dose atypical antipsychotics. Discontinuation strategy was carried out by gradual symptom-guided tapering of dosage and discontinuation if feasible. Follow-up was eighteen months.

Results

Twice as many relapses occurred in discontinuation strategy (43% vs. 21%, P = 0.007). Of patients who received the strategy 20% were successfully discontinued. Recurrent symptoms caused another 30% to restart antipsychotic treatment, while in the remaining patients discontinuation was not feasible at all. Although no advantages of discontinuation strategy regarding functional outcome at follow-up, remission and recovery status over the last nine months were better.

Conclusions

A limited number of patients can be successfully discontinued. Although high relapse rates do not allow discontinuation strategy to be universal practice, it has nevertheless a favourable influence on remission and recovery during follow-up. Further research is needed to find predictors of successful discontinuation.