# Medication- and Non-Medication-Related Causes of Relapse in First-Episode Psychosis Patients Admitted to Sultan Qaboos University Hospital

## TL;DR

This study identifies factors linked to relapse in first-episode psychosis patients in Oman, emphasizing medication noncompliance and sociodemographic factors like place of residence.

## Contribution

The study provides region-specific insights into relapse factors for first-episode psychosis patients in the Middle East, highlighting medication adherence and sociodemographic variables.

## Key findings

- Place of residence and leaving against medical advice (LAMA) were significantly associated with relapse.
- Medication noncompliance was linked to a shorter average relapse time (12 months) compared to compliant patients (17.22 months).
- Regular follow-ups were strongly associated with medication adherence and lower relapse rates.

## Abstract

Background

First-episode psychosis (FEP) patients often respond well to treatment; however, they remain at high risk of relapse. The factors contributing to relapse have been understudied, particularly in the Middle East.

Aim

This study aimed to identify both medication- and non-medication-related factors associated with relapse in FEP patients admitted to the Department of Behavioral Medicine (inpatient or outpatient) at Sultan Qaboos University Hospital (SQUH).

Methods

This retrospective cohort study included 213 Omani FEP patients aged 12-55 years who were treated at the inpatient or outpatient clinic of the Department of Behavioral Medicine at SQUH. Medical records from June 2006 to December 2019 were reviewed to assess relapse rates and associated sociodemographic and clinical factors.

Results

The average relapse rate among FEP patients was 14.28 months. Place of residence and left against medical advice (LAMA) were significantly associated with relapse, whereas factors such as seeking traditional healing, follow-up patterns, substance abuse, life events, and hospitalization status did not show a significant impact. Medication noncompliance was prevalent among nearly half of the patients, with an average relapse rate of 12 months - significantly shorter than the 17.22-month relapse rate observed in compliant patients. Regular follow-up was strongly linked to medication adherence, with patients who maintained consistent follow-ups demonstrating significantly higher compliance rates.

Conclusions

This study highlights key factors influencing relapse in FEP patients in Oman. Place of residence and LAMA were significantly associated with increased relapse risk. Medication adherence played a critical role, with noncompliance notably accelerating relapse. Regular follow-ups emerged as a crucial factor in maintaining medication adherence. Our findings emphasize the need for targeted interventions that consider the unique sociodemographic and clinical characteristics of FEP patients in Oman. The study cohort included 213 patients, predominantly female (57.3%, n = 122) and single (65.7%), with a mean age of 25 years (range: 12-55 years). Addressing these demographic factors can help develop strategies to reduce relapse rates and improve long-term outcomes.