Psychopathology trajectories and relapse in first episode schizophrenia with assured long-acting injectable adherence over 24 months

Relapse following a first episode of schizophrenia (FES) is common and often results in serious adverse psychosocial consequences. Treatment non-adherence is a key risk factor for relapse, but why relapse occurs despite antipsychotic treatment adherence remains unclear. This study examined the differences in FES psychopathology trajectories over 24-months with assured long-acting injectable antipsychotic (LAIA) treatment, to control for treatment adherence between those who relapsed and those who did not and what moderates these group differences. We collected clinical and socio-demographic data from 107 participants with FES treated with LAIA medication over a 24-month period. Relapse was defined using the modified Csernansky criteria. Substance use was assessed through participant and family interviews and urine toxicology. Linear mixed model repeated measures models were constructed to (1) compare psychopathology trajectories over 24 months between relapse versus non-relapse groups (2) to examine factors moderating differential trajectories between the groups. Positive symptom trajectories were significantly worse in the relapse compared to non-relapse group over 24 months (F(8, 649 = 3.29), p = 0.001). More severe childhood trauma (CT), in particular physical abuse (PA) (F(39, 298 = 1.78), p = 0.004), was associated with worse positive symptom trajectories over 24 months in those who experienced a relapse event. Our findings suggest that the examination of a history of CT and, in particular childhood PA measures for relapse in individuals with FES, is important.