One in five first-episode schizophrenia patients had psychosis return despite consistent antipsychotic injections
In 99 first-episode schizophrenia patients receiving long-acting injectable antipsychotics for 24 months, 21% experienced breakthrough psychosis, with cannabis use identified as an independent predictor.
Quick Facts
What This Study Found
About 21% of patients developed breakthrough psychotic symptoms despite assured medication adherence via long-acting injections. Current cannabis use independently predicted breakthrough episodes, and post-breakthrough treatment response was poorer than the initial response.
Key Numbers
99 patients (mean age 24.1, 73.7% male). 21 of 99 (21.2%) developed breakthrough psychosis after a mean of 17.4 months. Mean follow-up was 20 months.
How They Did This
Prospective cohort of 99 previously minimally treated first-episode schizophrenia-spectrum patients treated with long-acting injectable antipsychotics and followed for up to 24 months with regular assessments.
Why This Research Matters
By using long-acting injectable antipsychotics, this study removes non-adherence as a factor, showing that breakthrough psychosis occurs even with guaranteed medication delivery, and that cannabis use is a modifiable risk factor.
The Bigger Picture
The finding that post-breakthrough treatment response was worse than the initial response suggests a possible link between breakthrough episodes and emerging treatment resistance, making prevention of these episodes all the more important.
What This Study Doesn't Tell Us
Relatively small sample of 99 patients from a single site. The association between cannabis use and breakthrough psychosis is observational and does not prove causation.
Questions This Raises
- ?Would cannabis cessation programs reduce breakthrough psychosis rates?
- ?Is the link between breakthrough psychosis and blood lipid levels a meaningful biological signal or a confound?
Trust & Context
- Key Stat:
- 21% had breakthrough psychosis; cannabis use was an independent predictor
- Evidence Grade:
- Moderate: prospective design with assured medication adherence, though limited by small sample and single site.
- Study Age:
- Published in 2020 in Schizophrenia Research.
- Original Title:
- Predictors of psychosis breakthrough during 24 months of long-acting antipsychotic maintenance treatment in first episode schizophrenia.
- Published In:
- Schizophrenia research, 225, 55-62 (2020)
- Authors:
- Emsley, Robin(3), Asmal, Laila(4), Rubio, Jose M, Correll, Christoph U, Kane, John M
- Database ID:
- RTHC-02535
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked Questions
What is breakthrough psychosis?
Breakthrough psychosis (BAMM) occurs when patients develop psychotic symptoms despite taking antipsychotic medication at therapeutic doses to which they previously responded. In this study, long-acting injections ensured patients were actually receiving their medication.
How strong was the cannabis link?
Current cannabis use was one of the independent predictors of breakthrough episodes, alongside changes in cholesterol levels. The study could not determine whether stopping cannabis would prevent breakthroughs.
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Cite This Study
https://rethinkthc.com/research/RTHC-02535APA
Emsley, Robin; Asmal, Laila; Rubio, Jose M; Correll, Christoph U; Kane, John M. (2020). Predictors of psychosis breakthrough during 24 months of long-acting antipsychotic maintenance treatment in first episode schizophrenia.. Schizophrenia research, 225, 55-62. https://doi.org/10.1016/j.schres.2019.11.025
MLA
Emsley, Robin, et al. "Predictors of psychosis breakthrough during 24 months of long-acting antipsychotic maintenance treatment in first episode schizophrenia.." Schizophrenia research, 2020. https://doi.org/10.1016/j.schres.2019.11.025
RethinkTHC
RethinkTHC Research Database. "Predictors of psychosis breakthrough during 24 months of lon..." RTHC-02535. Retrieved from https://rethinkthc.com/research/emsley-2020-predictors-of-psychosis-breakthrough
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.