TY - JOUR
T1 - Predicting relapse with residual symptoms in schizophrenia
T2 - A secondary analysis of the PROACTIVE trial
AU - Saito, Yuta
AU - Sakurai, Hitoshi
AU - Kane, John M.
AU - Schooler, Nina R.
AU - Suzuki, Takefumi
AU - Mimura, Masaru
AU - Uchida, Hiroyuki
N1 - Funding Information:
Data and/or research tools used in the preparation of this manuscript were obtained and analyzed from the controlled access datasets distributed from the NIMH-supported National Database for Clinical Trials (NDCT). NDCT is a collaborative informatics system created by the National Institute of Mental Health to provide a national resource to support and accelerate discovery related to clinical trial research in mental health. Dataset identifier: NIMH Data Repositories Study identification number #2154. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIMH or of the submitters submitting original data to NDCT. Data used in the preparation of this article were obtained from the limited access datasets from the Preventing Relapse Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2020/1
Y1 - 2020/1
N2 - Introduction: Little attention has been paid to the contribution of individual residual symptom to predict relapse in patients with schizophrenia receiving oral or long-acting injectable (LAI) antipsychotics. Method: We used the data from the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study, in which 305 outpatients with schizophrenia were randomly allocated to either biweekly LAI-risperidone (LAI-R) or daily oral second-generation antipsychotics (SGA) and assessed for up to 30 months. Baseline individual symptoms that could predict subsequent relapse were identified, using a Cox proportional hazards model. Moreover, among those who relapsed during the study (n = 73), individual symptoms were compared between baseline and biweekly ratings 8 to 2 weeks before relapse, using the linear mixed model. Results: A greater score in grandiosity at baseline was significantly associated with subsequent relapse (adjusted HR = 1.24, p = 0.006). When the two treatment groups were separately analyzed, more severe grandiosity (adjusted HR = 1.43, p = 0.003) and less severe hallucinatory behavior (adjusted HR = 0.70, p = 0.013) at baseline were significantly associated with relapse in the oral SGA group, but none was identified in the LAI-R group. Emotional withdrawal was significantly worse 8 and 2 weeks before relapse compared to the baseline (p = 0.032 and p = 0.043, respectively). Discussion: More severe grandiosity and less hallucination may have led to more frequent relapses in patients with schizophrenia receiving oral antipsychotics, which was not a case in those receiving LAI-R. The exploratory analysis indicates an increase in emotional withdrawal before relapse may be a useful marker for earlier interventions to possibly avert relapse.
AB - Introduction: Little attention has been paid to the contribution of individual residual symptom to predict relapse in patients with schizophrenia receiving oral or long-acting injectable (LAI) antipsychotics. Method: We used the data from the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study, in which 305 outpatients with schizophrenia were randomly allocated to either biweekly LAI-risperidone (LAI-R) or daily oral second-generation antipsychotics (SGA) and assessed for up to 30 months. Baseline individual symptoms that could predict subsequent relapse were identified, using a Cox proportional hazards model. Moreover, among those who relapsed during the study (n = 73), individual symptoms were compared between baseline and biweekly ratings 8 to 2 weeks before relapse, using the linear mixed model. Results: A greater score in grandiosity at baseline was significantly associated with subsequent relapse (adjusted HR = 1.24, p = 0.006). When the two treatment groups were separately analyzed, more severe grandiosity (adjusted HR = 1.43, p = 0.003) and less severe hallucinatory behavior (adjusted HR = 0.70, p = 0.013) at baseline were significantly associated with relapse in the oral SGA group, but none was identified in the LAI-R group. Emotional withdrawal was significantly worse 8 and 2 weeks before relapse compared to the baseline (p = 0.032 and p = 0.043, respectively). Discussion: More severe grandiosity and less hallucination may have led to more frequent relapses in patients with schizophrenia receiving oral antipsychotics, which was not a case in those receiving LAI-R. The exploratory analysis indicates an increase in emotional withdrawal before relapse may be a useful marker for earlier interventions to possibly avert relapse.
KW - Antipsychotics
KW - Early warning signs
KW - Relapse
KW - Residual symptoms
KW - Schizophrenia
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U2 - 10.1016/j.schres.2019.10.037
DO - 10.1016/j.schres.2019.10.037
M3 - Article
C2 - 31672387
AN - SCOPUS:85074422161
SN - 0920-9964
VL - 215
SP - 173
EP - 180
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -
