Psychosis Treatment Failure More Common in Patients With ASD

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In patients with multiple treatment failure, reasons for the first antipsychotic switch were intolerable adverse effects, insufficient response, or nonadherence.
In patients with multiple treatment failure, reasons for the first antipsychotic switch were intolerable adverse effects, insufficient response, or nonadherence.

According to the results of a recent study published in the Journal of Clinical Psychiatry, multiple treatment failure in children with first-episode psychosis was more common among patients with comorbid autism spectrum disorders.

Researchers enrolled children between the ages of 10 and 17 years with first-episode psychosis, using a clinical records database of patients in South London, United Kingdom. They evaluated the association of multiple treatment failure before the age of 18 years and comorbid autism disorders, using a Cox regression analysis, and categorized multiple treatment failure as the initiation of a third novel antipsychotic because of nonadherence, adverse effects, or insufficient response.

Of the 638 children with first-episode psychosis, 124 cases of multiple treatment failure (19.4%) were reported. After adjustment for confounding variables, comorbid autism spectrum disorders were associated with an increased rate of multiple treatment failure (adjusted hazard ratio [HR], 1.99; P =.008).

Other factors significantly associated with multiple treatment failure included older age at referral (adjusted HR, 1.39; P =.001), black race (1.73; P =.03), and frequency of clinical contact (1.006; P <.001).

In patients with multiple treatment failure, reasons for the first antipsychotic switch were intolerable adverse effects (44.3%), insufficient response (21.0%), or nonadherence (14.5%). The reasons for switching antipsychotics were significantly different between the groups with and without comorbid autism spectrum disorder (P =.05).

The study authors concluded that "[autism spectrum disorder] comorbidity was associated with a 2-fold increased risk of [multiple treatment failure]," and added that the results "may explain why some children with premorbid difficulties and [early-onset psychosis] are at increased risk for adverse social, educational, and occupational functioning."

Reference

Downs JM, Lechler S, Dean H, et al. The association between comorbid autism spectrum disorders and antipsychotic treatment failure in early-onset psychosis: a historical cohort study using electronic health records [published online November 7, 2017]. J Clin Psychiatry. doi:10.4088/JCP.16m11422

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