Impact of long-acting antipsychotics as initial treatment in first episode psychosis populations with substance use disorder comorbidity

Poster A114, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Amal Abdel-Baki1,3,4, Dominic Thibault2,3,4, Sofia Medrano3,4, Emmanuel Stip1,2,3,4, Stéphane Potvin2,3; 1Centre Hospitalier Université Montréal, 2Institut Universitaire en Santé Mentale de Montréal, 3Département de Psychiatrie de l'Université de Montréal, 4Centre de Recherche du Centre Hospitalier de l'Université de Montréal

Introduction: Substance use disorder (SUD) is highly prevalent in patients with first episode psychosis (FEP) and associated with poor adherence and worst treatment outcomes. Although relapses are frequent in FEP, current literature concerning the usage of long-acting injectable antipsychotics (LAI-AP) is scant. Moreover, available studies often exclude patients with SUD. Objectives: Determine the impact of LAI-AP as first intention treatment on psychotic relapses or rehospitalisations in FEP with comorbid SUD (FEP-SUD). Methods: Naturalistic, longitudinal, 3-year prospective and retrospective study on 237 FEP-SUD patients admitted into two early intervention services in Montreal between October 2005 and April 2012. The patients were divided based on the medication introduced as first intention, either oral antipsychotics (OAP, n=206) or LAI-AP (n=31). Baseline characteristics were compared with ANOVA and a Kaplan-Meier survival analysis was performed on relapse and rehospitalisation. Results: Compared to the OAP group, patients in the LAI-AP group presented worse prognosis factors (eg: history of homelessness). However, the LAI-AP group presented a lower relapse rate (67.7% vs 76.7%) and higher relapse-free survival time (694 vs 447 days, p=0.008) and a trend for reduced rehospitalization rates (48.4% vs 57.3%) and hospitalization-free survival time (813 vs 619 days, p=0.065). Of those receiving OAP as first intention, 41.3% were eventually switched to LAI-AP and displayed the worst outcome in relapse and rehospitalisation. Conclusion: LAI-AP should be strongly considered as first intention treatment of FEP-SUD patients since this pharmacological option reduces the risk of relapse and rehospitalisation even in the individuals with poor prognostic factors.

Topic Area: Psychopharmacology

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