The association between co-morbid autism spectrum disorders and antipsychotic treatment failure in early-onset psychosis: a historical cohort study using electronic health records
Journal of Clinical Psychiatry
Physicians Postgraduate Press
Reason for embargo
Currently under an indefinite embargo pending publication by Physicians Postgraduate Press. Permanent indefinite embargo to be applied on publication, as per publisher policy
Objective: In a sample of children and adolescents with first-episode psychosis, we investigated whether multiple treatment failure (MTF, defined as the initiation of a third trial of novel antipsychotic due to non-adherence, adverse effects or insufficient response) was associated with co-morbid autism spectrum disorders. Methods: Data were from the electronic health records of 638 children (51% male) with first-episode psychosis, aged between 10 and 17, referred to mental health services in South London, UK, using the Clinical Record Interactive Search (CRIS) system. The effect of autism spectrum disorder comorbidity on the development of MTF over a 5-year period was modelled using Cox regression. Results: There were 124 cases of MTF prior to the age of 18 (19.3% of the sample). Comorbid autism spectrum disorders was significantly associated with MTF (adjusted hazard ratio-aHR 1.99, 95% CI 1.19–3.31; p=0.008) after controlling for a range of potential confounders. Other factors significantly associated with MTF included older age at first presentation, Black ethnicity, and frequency of clinical contact. No significant association between other co-morbid neurodevelopmental disorders (hyperkinetic disorder or intellectual disability) and MTF was found. Conclusions: Children with first-episode psychosis and co-morbid autism spectrum disorders at first presentation are less likely to have a beneficial response to antipsychotics.
This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Other funders include Guy’s and St Thomas’ Charity and the Maudsley Charity (BRC-2011-10035). Dr Downs is supported by a Medical Research Council (MRC) Clinical Research Training Fellowship (MR/L017105/1). Mr Dean and Ms Lechler received salary support from the Foundation of Professional Services to Adolescents, UK. Dr Hayes was funded by an MRC Population Health Scientist Fellowship (MR/J01219X/1). Dr Patel was funded by an MRC CRTF (MR/K002813/1). We appreciated the technical support from informatics personnel in the Biomedical Research Centre. Professors Hotopf and Simonoff are NIHR Senior Investigators. Professor Arrango, Dr Pina-Camacho and Dr Diaz-Caneja Instituto de Salud Carlos III, co-financed by funds from the ERDF, European Commission, CIBERSAM, Madrid Regional Government, EU Structural Funds and Seventh Framework Program, Fundación Alicia Koplowitz and Fundación Mutua Madrileña
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