S122. TEN-YEAR FOLLOW-UP AFTER FIRST EPISODE PSYCHOSIS: FOCUSED ON LOW DOSE ANTIPSYCHOTIC MAINTENANCE AND FUNCTIONING

BACKGROUND: Patients’ long-term phenomenology and outcomes after first episode psychosis are of great interest to patients, their caregivers and care providers. Contradictory messages regarding the necessity of long-term antipsychotic treatment and the factors affecting outcomes warrant careful examination. METHODS: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special focus on patients maintaining very low dose antipsychotics and their functioning. RESULTS: Of the 81 patients with first episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n=46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit and 10 patients (18.2%) received very low dose antipsychotics (chlorpromazine equivalent [CPZE] dose < 50 mg/d) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization and being on clozapine therapy were correlated to poorer functioning. Fifteen of the 20 good-functioning patients received dosage of antipsychotics no more than the reported minimum effective dose (CPZE 200 mg/d). Antipsychotic-free status was achieved only in two non-psychotic patients. DISCUSSION: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first episode psychosis, even if they cannot successfully discontinue antipsychotic treatment in the long run. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.