Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study

Schizophrenia is a psychiatric disorder with an estimated lifetime prevalence of approximately 1% and leads to cognitive devastation and social maladjustment. Antipsychotic drug plays a crucial role in the treatment of schizophrenia. Previous studies have reported that after the stabilization of symptoms for 1–2 years, 57%–98% of the patients with firstepisode schizophrenia experience relapse after discontinuation or reduction in dose of antipsychotics. Relapse is associated with an increased risk of self-harm or violence and poses a detrimental effect on interpersonal relationships and occupational function. Recurrent relapses, usually defined as aggravation of psychotic symptoms, may indicate progression of the disease and hinder patients from recovering to their previous level of functioning. Therefore, several studies have been conducted to prevent relapse and identify risk factors associated with relapse, including caregiver criticism, substance use disorder, low treatment compliance, and poor premorbid adjustment. Many studies have reported that the continuation of antipsychotic treatment is essential to prevent relapse and improve long-term outcomes in first-episode schizophrenia, along with inadequate effectiveness of intermittent treatment. Although it has been well acknowledged that the discontinuation of antipsychotic treatment is highly predictive of relapse in first-episode schizophrenia, the optimal maintenance period in terms of a balance between the prevention of relapse and adverse effects owing to a long-term use of antipsychotics, such as obesity and metabolic syndrome remains unclear. A recent systematic review including six randomized control trials (RCTs) showed no correlation of the duration of maintenance treatment with relapse rate in firstepisode schizophrenia. However, the findings need to be replicative and verified because of the limitations which were different treatment durations and short observation periods Received: August 22, 2021 / Revised: September 23, 2021 Accepted: September 29, 2021 Address for correspondence: Sung Woo Joo, Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympicro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 02-3010-3410, Fax: 02-485-8381 E-mail: jootak01@gmail.com Association of the First Antipsychotic Treatment Duration With the Re-Initiation of Treatment in Schizophrenia: A National Health Insurance Data-Based Study