# Is it Possible To Identify Patients After Their First Hospitalization for a Psychotic Disorder Who Do Not Use Anti-Psychotics and are Not Later Rehospitalized?

## TL;DR

This study explores whether patients with psychotic disorders who stop using anti-psychotics after their first hospitalization can avoid relapse or rehospitalization.

## Contribution

The study identifies risk factors for rehospitalization or death in patients who discontinue antipsychotics after a first psychotic episode.

## Key findings

- Male gender and a diagnosis of narrowly defined schizophrenia were linked to higher risk of rehospitalization or death.
- No sociodemographic or clinical factors were found to decrease the risk of rehospitalization or death.
- It was not possible to clinically characterize patients who can safely discontinue antipsychotics without relapse.

## Abstract

Guidelines issued by professional organizations recommend that all patients with psychotic disorders who have had several psychotic relapses, continue maintenance anti-psychotic treatment. However, some patients discontinue anti-psychotics and do not later relapse. This study attempted to characterize those patients with psychotic disorders early in their disease not taking maintenance antipsychotics, who were not later hospitalized.

This population-based cohort study combined registry data on patients diagnosed in their first psychotic episode (ICD 10 code: F20-29) from Sweden (n = 20 848), and Israel (n = 10 045), and followed them for up to 7 years for re-hospitalization or death. Multivariate analyses assessed sociodemographic and clinical risk factors predicting rehospitalization or death in patients with one hospitalization and did not fill prescriptions for antipsychotics; results from Sweden and Israel were then meta-analyzed.

The main analysis of this paper included 1611 patients from Sweden and 1607 from Israel. Male gender (adjusted hazard ratio [aHR], 1.57; 95% confidence interval [CI], 1.16-2.13) and a diagnosis of narrowly defined schizophrenia (F20.0-F20.9; aHR, 1.85; 95% CI, 1.55-2.2) were associated with increased risk of a second hospitalization or death among those who did not use antipsychotics. No sociodemographic or clinical characteristics were associated with a decreased risk of a second hospitalization or death.

Based on registry data, it was not possible to characterize, in a clinically meaningful way, those patients who can safely discontinue anti-psychotic medications and not be re-hospitalized or die. Male gender and a diagnosis of narrowly defined schizophrenia were associated with an increased risk of later relapse.