A 20-Year Follow-up of First Episode Psychosis: Longitudinal Effects of Early Treatment Strategies and Relapse

Schizophrenia and related psychotic disorders are highly heterogeneous, with long-term outcomes shaped by early treatment decisions. Antipsychotic medications are effective in preventing relapse, but prolonged use carries substantial side effects, and many patients discontinue in real-world settings. Evidence on the long-term impact of early discontinuation remains scarce. This project is a 20-year follow-up of a uniquely well-characterized cohort of 178 individuals with first episode psychosis (FEP), originally enrolled in a randomized controlled trial (RCT) of antipsychotic maintenance versus discontinuation after achieving sustained remission (ClinicalTrials.gov NCT00334035). At the 10-year follow-up, over 80% of the cohort were successfully reassessed, providing rare insights into long-term outcomes (ClinicalTrials.gov NCT01926340).

Eligible participants will be re-contacted for a one-time assessment including structured clinical interviews, cognitive testing, psychosocial and qualitative measures. Retrospective case-note reviews will extract longitudinal data on relapse episodes, medication use, hospitalizations, and available laboratory results.

Data will be analyzed using latent class analysis to identify subgroups, latent growth models for cognitive trajectories, and regression approaches to test predictors and outcomes.

Ethical safeguards include re-consenting all participants, pre screening/ redacting medical records to preserve rater blinding,and strict de-identification of data. This study will be conducted in accordance with the Declaration of Helsinki and relevant institutional guidelines.

By extending this landmark cohort to 20 years, the study will provide novel evidence to guide personalized treatment decisions and inform policies on long-term antipsychotic use in psychosis.

• Long-term Overall Functioning [Срок оценки: Assessed for 6 months preceding the follow-up assessment]
• Long-term Role Functioning [Срок оценки: Assessed for 6 months preceding the follow-up assessment]
• Overall Clinical Status [Срок оценки: Within 6 months previous to the follow-up assessment]
• Long-term Psychopathology [Срок оценки: Within 6 months previous to the follow-up assessment]
• Long-term Positive Symptoms [Срок оценки: Within 6 months previous to the follow-up assessment]
• Long-term Negative Symptoms [Срок оценки: Within 6 months previous to the follow-up assessment]
• Medication Adherence [Срок оценки: Within 1 month previous to the follow-up assessment]
• Semantic Memory and Executive Function [Срок оценки: Assessed at the follow-up assessment]
• Verbal Working Memory [Срок оценки: Assessed at the follow-up assessment]
• Visual Working Memory and Spatial Processing [Срок оценки: Assessed at the follow-up assessment]
• Stressful Life Events [Срок оценки: Within 6 months previous to the follow-up assessment]
• Health-Related Quality of Life [Срок оценки: Varies according to the individual questionnaire items, ranging from the past 4 weeks to the past 12 months prior to the follow-up assessment]