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Psychosis breakthrough on antipsychotic maintenance: results from a nationwide study

Published online by Cambridge University Press:  13 June 2019

Jose M. Rubio Open the ORCID record for Jose M. Rubio [Opens in a new window] ,
Heidi Taipale ,
Christoph U. Correll ,
Antti Tanskanen ,
John M. Kane  and
Jari Tiihonen
Jose M. Rubio*
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY11004, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY11550, USA The Feinstein Institute for Medical Research, Manhasset, NY11030, USA
Heidi Taipale
Affiliation:
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, FI-70240Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 5th floor, SE-171 77Stockholm, Sweden School of Pharmacy, University of Eastern Finland, PO Box 1627, SE-70211Kuopio, Finland
Christoph U. Correll
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY11004, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY11550, USA The Feinstein Institute for Medical Research, Manhasset, NY11030, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
Antti Tanskanen
Affiliation:
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, FI-70240Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 5th floor, SE-171 77Stockholm, Sweden
John M. Kane
Affiliation:
Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY11004, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY11550, USA The Feinstein Institute for Medical Research, Manhasset, NY11030, USA
Jari Tiihonen
Affiliation:
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Niuvankuja 65, FI-70240Kuopio, Finland Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18A, 5th floor, SE-171 77Stockholm, Sweden Stockholm County Council, Stockholm Health Care Services, Norra Stationsgatan 69, SE-113 64Stockholm, Sweden
*
Author for correspondence: Jose M. Rubio, E-mail: jrubio13@northwell.edu
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Abstract

Background

There is uncertainty about the incidence of breakthrough psychosis in treatment adherent patients, and the role that factors, such as cumulative antipsychotic exposure, play in this phenomenon.

Methods

In a nationwide cohort of individuals treated for schizophrenia-spectrum disorders in Finland between 1 January 1996 and 31 December 2015, ‘Breakthrough Psychosis on Antipsychotic Maintenance Medication’ (BAMM) was defined as hospitalization for psychosis despite ongoing continuous treatment with long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs) for ⩾8 weeks. Incidence rates, survival curves, and risk factors were presented.

Results

In a cohort of 16 031 continuous LAI treatment episodes with virtually assured adherence [median duration = 441 days, interquartile range (IQR) = 155–1277], BAMM incidence was 31.5%. For 42 867 OAPs treatment episodes (median duration = 483 days, IQR = 167–1491), for whom adherence was modeled by the PRE2DUP method, BAMM incidence was 31.1%. Factors related to illness instability at treatment onset were associated with BAMM, although median time to BAMM was 291 days (IQR = 121–876) for LAIs and 344 days (IQR = 142–989) for OAPs, and 27.4% (N = 1386) of the BAMM events in the LAI, and 32.9% (N = 4378) in the OAP group occurred despite >1 year since last hospitalization at treatment onset. Cumulative antipsychotic exposure was not a consistent risk factor.

Conclusion

BAMM was relatively common even when adherence was confirmed with LAIs. Illness instability at treatment onset accounted for most cases, but relapse after years of continuous treatment was still prevalent. There was insufficient evidence to support causality between cumulative antipsychotic exposure and BAMM. Future research needs to address the role of symptom severity and neurobiology in BAMM.

Keywords

Adherencelong-acting injectablerelapseschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 8 , June 2020 , pp. 1356 - 1367
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

Equal contribution.

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