BACKGROUND: This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. METHODS: We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). RESULTS: Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. CONCLUSIONS: Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation.

Biological Psychiatry Division Department of Psychiatry and Psychotherapy Medical University Innsbruck Innsbruck Austria

Department of Psychiatry Academic Medical Center University of Amsterdam Amsterdam The Netherlands

Department of Psychiatry Psychotherapy and Psychosomatics Psychiatric Hospital University of Zurich Switzerland Militärstrasse 8 PO Box 1930 8021 CH Zurich

Department of Psychiatry Psychotherapy and Psychosomatics Psychiatric Hospital University of Zurich Switzerland Militärstrasse 8 PO Box 1930 8021 CH Zurich; Institute of Psychiatry Laboratory of Neuroscience University of Sao Paulo Sao Paulo Brazil

Psychiatric Clinic Faculty Hospital Hradec Králové Charles University Medical School Hradec Králové Czech Republic

Rudolf Magnus Institute of Neuroscience Department of Psychiatry University Medical Center Utrecht The Netherlands

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