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RecruitingNCT07616999Updated Jun 26, 2026

A 20-Year Follow-up of First Episode Psychosis: Longitudinal Effects of Early Treatment Strategies and Relapse

An observational study in Schizophrenia, sponsored by The University of Hong Kong. Recruiting at 1 site in China. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-06-26.

Sponsored by The University of Hong Kong · Observational

From the registry’s dates

  • Started May 2026; still recruiting 4 months later.
Study type
Observational
Model
Case-control
Time perspective
Prospective
Enrollment
178
Ages
18 Years to 65 Years
Sex
All
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Study summary

The study aims to address the following questions:

  1. Do subgroups defined by early medication choices, relapse, and medication taken over 20 years differ in clinical, cognitive, and functional outcomes?
  2. What are the long-term cognitive functioning trajectories, what factors predict these trajectories, and how do they relate to outcomes?
  3. What might be the mechanisms behind medication discontinuation and poor long-term outcome, including the roles of multiple relapses and treatment resistance after first-episode psychosis?

Eligible patients will be invited to a one-time face-to-face interview. A trained research assistant will guide the participants through questions about their background, clinical symptoms, daily functioning, cognitive abilities, and psychological well-being.

Read the detailed description

Schizophrenia and related psychotic disorders are highly heterogeneous, with long-term outcomes shaped by early treatment decisions. Antipsychotic medications are effective in preventing relapse, but prolonged use carries substantial side effects, and many patients discontinue in real-world settings. Evidence on the long-term impact of early discontinuation remains scarce. This project is a 20-year follow-up of a uniquely well-characterized cohort of 178 individuals with first episode psychosis (FEP), originally enrolled in a randomized controlled trial (RCT) of antipsychotic maintenance versus discontinuation after achieving sustained remission (ClinicalTrials.gov NCT00334035). At the 10-year follow-up, over 80% of the cohort were successfully reassessed, providing rare insights into long-term outcomes (ClinicalTrials.gov NCT01926340).

Eligible participants will be re-contacted for a one-time assessment including structured clinical interviews, cognitive testing, psychosocial and qualitative measures. Retrospective case-note reviews will extract longitudinal data on relapse episodes, medication use, hospitalizations, and available laboratory results.

Data will be analyzed using latent class analysis to identify subgroups, latent growth models for cognitive trajectories, and regression approaches to test predictors and outcomes.

Ethical safeguards include re-consenting all participants, pre screening/ redacting medical records to preserve rater blinding,and strict de-identification of data. This study will be conducted in accordance with the Declaration of Helsinki and relevant institutional guidelines.

By extending this landmark cohort to 20 years, the study will provide novel evidence to guide personalized treatment decisions and inform policies on long-term antipsychotic use in psychosis.

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Conditions studied

  • Schizophrenia

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Keywords

  • Schizophrenia
  • 20-year follow up
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In context

Schizophrenia

3,471 studies on the registry are indexed under Schizophrenia; 472 are open to participants now.

This study's planned enrollment of 178 is close to the median of 178 across 491 observational studies indexed under Schizophrenia.

Browse Schizophrenia studies →

Lead sponsor

The University of Hong Kong is the lead sponsor of 1,262 studies on the registry; 340 are open to participants now.

Of its 8 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Trained research assistants will approach active patients at their upcoming psychiatric out-patient consultations at the hospitals to introduce the follow-up study and to obtain written informed consent.

Participants were individuals who previously participated in a randomized controlled trial investigating medication continuation/discontinuation on relapse during first episode psychosis (ClinicalTrials.gov NCT00334035). The trial included specific inclusion and exclusion criteria, detailed as follows:

Inclusion criteria

Inclusion Criteria:

  • A diagnosis of schizophrenia or non-affective psychosis (schizophreniform disorder, schizoaffective disorder, brief psychotic disorder, or psychosis not otherwise specified) (DSM-IV)
  • Aged 18 to 65 years at the time of original enrolment
  • Had been treated with antipsychotic drugs for at least 12 months
  • No history of relapse or exacerbation or had to be asymptomatic (free of positive symptoms of psychosis) at study entry.

Exclusion criteria

Exclusion Criteria:

  • A diagnosis of drug-induced psychosis
  • Current treatment with clozapine, with mood stabilizing medications (lithium, valproate or carbamazepine) or with depot medication
  • Had high risk of suicide or violence
  • Inability to provide informed consent at recruitment
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Study design

Observational model
Case-control
Time perspective
Prospective
Enrollment
178 participants (estimated)
Target follow-up
20 Years
Patient registry
Yes

Groups and cohorts

  • Early maintenance treatment group

    Drug (quetiapine, 400mg/d) during the 12-month randomized phase of the study

  • Early discontinuation group

    Drug (placebo) during the 12-month randomized phase of the study

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What researchers measure

Primary outcomes

  1. Long-term Clinical Outcome

    Poor clinical outcome is defined categorically as any of: Persistent positive symptoms of psychosis, requirement for clozapine, or death from suicide. A good clinical outcome is defined as meeting none of the above criteria

    Time frame: From enrollment to 20-year follow-up

Secondary outcomes

  1. Long-term Overall Functioning

    Evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). Lower scores reflect poorer functioning in social and work-related domains, irrespective of psychopathology

    Time frame: Assessed for 6 months preceding the follow-up assessment

  2. Long-term Role Functioning

    Evaluated using the Role Functioning Scale (RFS), which assesses functioning across key domains including work productivity, independent living and self-care, relationships with immediate social networks, and relationships with extended social networks. Higher scores indicate better functioning

    Time frame: Assessed for 6 months preceding the follow-up assessment

  3. Overall Clinical Status

    Evaluated using the Clinical Global Impression (CGI) scale, a measure of global illness severity and change in condition over time. The scale comprises Severity and Improvement ratings, with higher scores indicating more severe current illness and worsened clinical status over the past six months, respectively

    Time frame: Within 6 months previous to the follow-up assessment

  4. Long-term Psychopathology

    Evaluated using the Positive and Negative Syndrome Scale (PANSS), which evaluates self-reported symptom severity across positive symptoms, negative symptoms, and general psychopathology domains. Higher scores indicate greater symptom severity

    Time frame: Within 6 months previous to the follow-up assessment

  5. Long-term Positive Symptoms

    Evaluated using the Scale for the Assessment of Positive Symptoms (SAPS), which evaluates self-reported symptom severity across domains including hallucinations, delusions, bizarre behavior, and formal thought disorder. Higher scores indicate greater symptom severity

    Time frame: Within 6 months previous to the follow-up assessment

  6. Long-term Negative Symptoms

    Evaluated using the Scale for the Assessment of Negative Symptoms (SANS), which evaluates self-reported domains including affective flattening, alogia, avolition-apathy, anhedonia-asociality, and attention-related impairment. Higher scores indicate greater symptom severity

    Time frame: Within 6 months previous to the follow-up assessment

  7. Medication Adherence

    Evaluated using the Medication Compliance Questionnaire (MCQ), which includes subscales assessing self-reported medication-taking behaviors and medication-related attitudes. Higher scores indicate better medication adherence and more positive attitudes toward medication

    Time frame: Within 1 month previous to the follow-up assessment

  8. Semantic Memory and Executive Function

    Participants engage in a Verbal Fluency Task, where they will be asked to name as many animals as possible within one minute. Outcomes include the counts of correct, repeated, and incorrect responses. Higher numbers of correct responses indicate better cognitive functioning

    Time frame: Assessed at the follow-up assessment

  9. Verbal Working Memory

    Participants engage in a Letter-Number Span Test, where they will be asked to repeat sequences of numbers and letters presented verbally by research staff in forward or backward order. The number of items to be recalled gradually increases throughout the task. Higher scores indicate better working memory performance

    Time frame: Assessed at the follow-up assessment

  10. Visual Working Memory and Spatial Processing

    Participants engage in a Visual Patterns Test, where they will be required to remember and reproduce visually presented geometric patterns after brief exposure. Higher scores indicate better visual memory performance

    Time frame: Assessed at the follow-up assessment

  11. Stressful Life Events

    The Stressful Life Events (SLE) questionnaire evaluates the number of significant life events experienced (e.g., loss of a loved one, severe financial problems) and the associated level of distress reported by participants. Higher scores indicate greater exposure to stressful events and/or higher levels of distress

    Time frame: Within 6 months previous to the follow-up assessment

  12. Health-Related Quality of Life

    Evaluated using the 36-Item Short Form Health Survey (SF-36), which includes two subscales assessing physical health and mental health across multiple domains (e.g., physical ability in fulfilling role-related tasks, bodily pain, and emotional well-being). Higher scores indicate better perceived health status and quality of life

    Time frame: Varies according to the individual questionnaire items, ranging from the past 4 weeks to the past 12 months prior to the follow-up assessment

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Study locations

1 of 1 sites recruiting
  • Department of Psychiatry, Queen Mary Hospital
    Hong Kong, China
    Recruiting
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References and documents

Publications

  • Hui CLM, Honer WG, Lee EHM, Chang WC, Chan SKW, Chen ESM, Pang EPF, Lui SSY, Chung DWS, Yeung WS, Ng RMK, Lo WTL, Jones PB, Sham P, Chen EYH. Long-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial. Lancet Psychiatry. 2018 May;5(5):432-442. doi: 10.1016/S2215-0366(18)30090-7. Epub 2018 Mar 15. PubMed 29551618 ↗
  • Chen EY, Hui CL, Lam MM, Chiu CP, Law CW, Chung DW, Tso S, Pang EP, Chan KT, Wong YC, Mo FY, Chan KP, Yao TJ, Hung SF, Honer WG. Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial. BMJ. 2010 Aug 19;341:c4024. doi: 10.1136/bmj.c4024. PubMed 20724402 ↗

Individual participant data

Plan to share: No — The data will be made available upon reasonable request, subject to ethical considerations and data privacy protections.

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 26, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07616999
Lead sponsor
The University of Hong Kong
Collaborators
Research Grants Council, Hong Kong
Responsible party
Dr. Christy Lai-ming Hui (Associate Professor, The University of Hong Kong) — Principal investigator
First posted
Jun 1, 2026
Start date
May 21, 2026
Primary completion
Dec 31, 2028 (estimated)
Completion
Dec 31, 2028 (estimated)
Last update
Jun 26, 2026

Study contacts

Lai Ming Christy Hui, PhD
Contact
christy@lmhui.com
852-22554486

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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