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Grandiosity Linked to Relapse With Oral Antipsychotics

November 13, 2019

Higher scores in grandiosity and less severe hallucinatory behavior at baseline were significantly associated with relapse in patients with schizophrenia who received oral antipsychotics, according to a study published online in Schizophrenia Research.

The study was a secondary analysis of the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) trial. The study randomized 305 outpatients with schizophrenia to either biweekly long-acting injectable risperidone or daily oral second-generation antipsychotics. Over up to 30 months of follow-up, 73 patients relapsed at least once.

For this analysis, researchers aimed to identify individual symptoms at baseline associated with relapse, as well as individual symptoms that preceded relapse.

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More severe grandiosity and less hallucinatory behavior at baseline were significantly linked with relapse in patients receiving oral antipsychotics, according to the study. Researchers noted that patients with grandiosity may be less motivated to adhere to oral antipsychotic regimens, a Psychiatric News Alert explained.

The study did not identify any individual symptoms associated with relapse in patients receiving the long-acting injectable risperidone.

Meanwhile, researchers found emotional withdrawal was significantly worse in patients 8 and 2 weeks before relapse, compared with emotional withdrawal at baseline. The finding suggests heightened emotional withdrawal may be a useful marker of potential relapse.

“While it is unclear whether this symptom worsening is a predictor of relapse or a part of a relapsing process, this timeline may offer a window for possible interventions in an effort to avert relapses,” Psychiatric News Alert quoted from the study.

—Jolynn Tumolo


Saito Y, Sakurai H, Kane JM, et al. Predicting relapse with residual symptoms in schizophrenia: a secondary analysis of the PROACTIVE trial. Schizophrenia Research. 2019 October 28;[Epub ahead of print].

Symptoms of grandiosity may point to higher risk of relapse on oral antipsychotic. Psychiatric News Alert. November 4, 2019.

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