Therapeutic Interventions and Clinical Outcomes Following Breakthrough Psychosis on Antipsychotic Maintenance Medication (BAMM)

BACKGROUND: Despite consistently good adherence to antipsychotic treatment, some patients experience relapse, known as breakthrough psychosis on antipsychotic maintenance medication (BAMM). This study aimed to clarify the therapeutic interventions and outcomes following BAMM. METHODS: This retrospective chart review included patients who experienced BAMM, defined as hospitalization during adherent long-acting injectable antipsychotic (LAI) treatment at Yamanashi Prefectural Kita Hospital. Clinical and demographic data were collected, including therapeutic interventions during the index hospitalization and maintenance treatment failure (psychiatric rehospitalization or treatment discontinuation) following BAMM. Kaplan-Meier survival analysis was conducted to estimate time to maintenance treatment failure within 3 years after the index discharge, and a Cox proportional hazards model was used to identify factors associated with maintenance treatment failure. RESULTS: Fifty-nine patients were included. Therapeutic interventions after BAMM varied substantially. While most patients continued the same LAI treatment during hospitalization, some discontinued or required dose adjustments. Clozapine was initiated in nearly 20% of patients, mostly after maintenance treatment failure following BAMM. Maintenance treatment failure was common: over 50% of patients experienced it within 1 year, and ~70% within 3 years. A longer time from LAI initiation to BAMM was significantly associated with a reduced risk of maintenance treatment failure. CONCLUSIONS: Clinical outcomes following BAMM are often unfavorable. Further research is warranted to identify optimal approaches for preventing and managing BAMM.