BACKGROUND In first episode psychosis (FEP) baseline negative symptoms (BNS) and relapse both predict less favorable functional outcome. Relapse-prevention is one of the most important goals of treatment. Apart from discontinuation of antipsychotics, natural causes of relapse are unexplained. We hypothesized that BNS, apart from predicting worse functional outcome, might also increase relapse risk. METHODS We performed a post-hoc analysis of 7-year follow-up data of a FEP cohort (n = 103) involved in a dose-reduction/discontinuation (DR) vs. maintenance treatment (MT) trial. We examined: 1) what predicted relapse, 2) what predicted functional outcome, and 3) if BNS predicted relapse, whether MT reduced relapse rates compared to DR. After remission patients were randomly assigned to DR or MT for 18 months. Thereafter, treatment was uncontrolled. OUTCOMES BNS and duration of untreated psychosis (DUP) predicted relapse. Number of relapses, BNS, and treatment strategy predicted functional outcome. BNS was the strongest predictor of relapse, while number of relapses was the strongest predictor of functional outcome above BNS and treatment strategy. Overall and within MT, but not within DR, more severe BNS predicted significantly higher relapse rates. Treatment strategies did not make a difference in relapse rates, regardless of BNS severity. INTERPRETATION BNS not only predicted worse functional outcome, but also relapses during follow-up. Since current low dose maintenance treatment strategies did not prevent relapse proneness in patients with more severe BNS, resources should be deployed to find optimal treatment strategies for this particular group of patients.

中文翻译：

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阴性症状预示着高复发率，并且两者都预示着首发精神病的不良功能结果，独立于治疗策略

背景 在首次发作的精神病 (FEP) 中，基线阴性症状 (BNS) 和复发都预示着较差的功能结果。预防复发是治疗的最重要目标之一。除了停用抗精神病药外，复发的自然原因无法解释。我们假设 BNS 除了预测更差的功能结果外，还可能增加复发风险。方法 我们对参与剂量减少/停药 (DR) 与维持治疗 (MT) 试验的 FEP 队列 (n = 103) 的 7 年随访数据进行了事后分析。我们检查了：1）什么预测了复发，2）什么预测了功能结果，3）如果 BNS 预测复发，与 DR 相比，MT 是否降低了复发率。缓解后患者被随机分配到 DR 或 MT 组，为期 18 个月。此后，治疗不受控制。结果 BNS 和未经治疗的精神病 (DUP) 持续时间预测复发。复发次数、BNS 和治疗策略可预测功能结果。BNS 是复发的最强预测因子，而复发次数是 BNS 和治疗策略以上功能结果的最强预测因子。总体而言，在 MT 内，但不在 DR 内，更严重的 BNS 预测复发率显着更高。无论 BNS 严重程度如何，治疗策略都不会对复发率产生影响。解释 BNS 不仅可以预测更差的功能结果，还可以预测随访期间的复发。由于目前的低剂量维持治疗策略并不能预防更严重 BNS 患者的复发倾向，因此应部署资源为这一特定患者群体寻找最佳治疗策略。