Disorders - Psychosis Disorders
Chen, E. Y., Chang, W. C., Chan, S. K., Lam, M. M., Hung, S. F., Chung, D. W., Hui, C. L., Wong, G. H., Au Yang, W. S., Tang, J. Y.
Hong Kong Medical Journal, 21 : 23-26
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
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Treatment and intervention: Service Delivery & Improvement, Case management
Conus, P., Berk, M., Cotton, S. M., Kader, L., Macneil, C., Hasty, M. K., Hallam, K., Lambert, M., Murphy, B. P., McGorry, P. D.
Background: Treatment strategies for mental disorders may vary according to illness stage. However no data currently exist to guide treatment in first episode psychotic mania. The aim of this study was to compare the safety and efficacy profile of chlorpromazine and olanzapine, as add-on to lithium, in patients with a first episode of psychotic mania, expecting better safety profile and adherence to olanzapine but similar efficacy for both treatments.; Methods: Data from 83 patients were collected in an 8-week randomised controlled trial on clinical variables, side effects, vital signs, and weight. Analyses of treatment differences over time were based on intent-to-treat principles. Kaplan-Meier estimated survival curves were used to analyse time-to-event data and mixed effects models repeated measures analysis of variance were used to determine treatment group differences over time on safety and efficacy measures.; Results: Ethics committee approval to delay informed consent procedure until recovery from the acute episode allowed the inclusion of 83 patients highly representative of those treated in the public sector. Contrary to our hypotheses, safety profile of both medications was similar. A signal for higher rate (P=.032) and earlier occurrence (P=.043) of mania remission was observed in the olanzapine group which did not survive correction for multiple comparisons.; Conclusions: Olanzapine and chlorpromazine have a similar safety profile in a uniquely representative cohort of patients with first episode psychotic mania. The possibility for a greater impact of olanzapine on manic symptoms leading to earlier remission of the episode needs exploration in a large sample.; Copyright © 2015 Elsevier Masson SAS. All rights reserved.
European Psychiatry, 30(8) : 975-982
- Year: 2015
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Lithium
Barlati, S., De-Peri, L., Deste, G., Vita, A.
Objectives There is a growing body of evidence suggesting that barriers to functional recovery are associated with a host of neurocognitive impairments in both the early and later course of schizophrenia. Given the significant influence of cognitive functions on daily functioning, several cognitive training approaches have been developed to improve cognitive deficits in schizophrenia. Increasing amounts of data suggest that cognitive remediation leads to improvements not only in cognition, but also in functional outcomes of schizophrenia. Some researchers speculate that deficits in cognition are more amenable to remediation during earlier phases of the illness, rather than when chronicity has developed. Despite the widely cited benefits of cognitive remediation in long-term course patients, fewer studies have examined the extent to which cognitive remediation has practical implications in the early stages of schizophrenia. The aim of this paper is to review the available literature on cognitive remediation in the prodromal phase and the early course of schizophrenia. Methods This review summarizes findings of cognitive changes induced in the early course and the prodromal phases of schizophrenia by different cognitive remediation approaches. Electronic searches were performed in the PubMed database, and all the studies published until January 2013 have been taken in account. Controlled studies of cognitive training are discussed in more detail. Results Few studies on the effects of cognitive training programs have been conducted in first episode or in early schizophrenia, and only three studies have been conducted in the prodromal phase of the disease or in subjects at risk for psychosis. The studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and in subjects at risk for the disease. Conclusions Although preliminary positive results have been achieved, more empirical research is needed to confirm the efficacy of cognitive remediation in the early course of schizophrenia, and future studies should address the issue of the usefulness of cognitive remediation in the prodromal phases of schizophrenia or in subjects at risk for psychosis.
Journal of Psychopathology, 21(1) : 1-12
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Bond, G., Drake, R., Luciano, A.
Aims: Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. Methods: We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. Results: Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. Conclusions: In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Epidemiology & Psychiatric Sciences, 24(5) : 446-457
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
, Other service delivery and improvement interventions
Fernandez-Gonzalo, S., Turon, M., Jodar, M., Pousa, E., Hernandez-Rambla, C., García, R., Palao, Diego.
People with schizophrenia/schizoaffective disorders at early stages of the illness present cognitive and social cognition deficits that have a great impact in functional outcomes. Cognitive Remediation Therapy (CRT) has demonstrated consistent effect in cognitive performance, symptoms and psychosocial functioning. However, any CRT intervention or social cognition training have been specifically designed for patients in the early stages of psychosis. The aim of this pilot study is to assess the efficacy of a new computerized cognitive and social cognition program for patients with schizophrenia/schizoaffective disorder with recent diagnosis. A comprehensive assessment of clinical, social and non-social cognitive and functional measures was carried out in 53 randomized participants before and after the 4-months treatment. Significant results were observed in Spatial Span Forwards, Immediate Logical Memory and Pictures of Facial Affect (POFA) total score. None of these results were explained by medication, premorbid social functioning or psychopathological symptoms. No impact of the intervention was observed in other cognitive and social cognition outcome neither in clinical and functional outcomes. This new computerized intervention may result effective ameliorating visual attention, logical memory and emotional processing in patients in the early stages of schizophrenia/schizoaffective disorder.; Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Psychiatry Research, 228(3) : 501-509
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Czepielewski, L. S., Sodre, L., Souza, A. C. L., Bucker, J., Burke, K. P., Cereser, K. M., Gama, C. S.
Presents a study which aims to examine the changes in verbal learning of patients with schizophrenia (SZ) by presenting the results from a randomized, double-blind, placebo-controlled trial of amantadine adjunctive to antipsychotics. The present study suggests that amantadine may be a potential adjunctive treatment strategy for improving cognition through learning in recent onset patients with schizophrenia. A small sample size and short follow-up period are limitations of this study. report. However, given the compelling evidence of NMDA receptor role in the pathophysiology of SZ and its possible usefulness as adjunctive drug therapy for this disease, amantadine (AMT) might be a tool for cognitive enhancement through improvement of learning potential. Besides remission of psychotic symptoms, treatments for SZ should ultimately focus on ameliorating functioning and quality of life of patients, what might be reached by increasing cognitive performance. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Schizophrenia Research, 168(1-2) : 571-572
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Chen, A., Chibnall, J., Nasrallah, H.
Background: Omega-3 fatty acids have shown promise as an adjunctive treatment for schizophrenia. However, efficacy across studies has been inconsistent. We conducted a meta-analysis of published controlled studies with the goal of detecting different efficacy profiles at various stages of schizophrenia. Methods: An online search was conducted for randomized, double-blind, placebo-controlled clinical trials, and a meta-analysis was conducted. Results: Ten studies met the criteria for inclusion. Among patients in the prodromal phase of schizophrenia, omega-3 supplementation reduced psychotic symptom severity and lowered conversion rates to first-episode psychosis. In patients with first-episode schizophrenia, omega-3 decreased nonpsychotic symptoms, required lower antipsychotic medication dosages, and improved early treatment response rates. Omega-3 had mixed results in patients with stable chronic schizophrenia, with only some patients experiencing significant benefits. Among patients with chronic schizophrenia, use of omega-3 fatty acids both by those experiencing acute exacerbations and those who had discontinued antipsychotic medications resulted in worsening of psychotic symptoms. Conclusions: The data suggest that omega-3 fatty acids may be efficacious in reducing clinical symptoms for patients in the earlier stages of schizophrenia (prodrome and first episode), while producing mixed results for patients in the chronic stages. Based on these results, omega-3 fatty acids would not be recommended for acute exacerbations in patients with chronic schizophrenia nor for relapse prevention after discontinuation of antipsychotics. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Annals of Clinical Psychiatry, 27(4) : 289-296
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Fisher, M., Loewy, R., Carter, C., Lee, A., Ragland, D., Niendam, T., Schlosser, D., Pham, L., Miskovich, T., Vinogradov, S.
Objective: Cognitive deficits that characterize schizophrenia are present in the prodrome, worsen with illness onset, and predict functional outcome. Cognitive dysfunction is thus a critical target for early intervention in young individuals with recent onset schizophrenia. Method: This 2-site double-blind randomized controlled trial investigated cognitive training of auditory processing/verbal learning in 86 subjects with recent onset schizophrenia (mean age of 21 years). Subjects were given laptop computers to take home and were asked to perform 40 hours of training or 40 hours of commercial computer games over 8 weeks. We examined cognitive measures recommended by the Measurement and Treatment Research to Improve Cognition in Schizophrenia initiative (MATRICS), symptoms, and functioning. We also assessed baseline reward anticipation to index motivational system functioning and measured changes in auditory processing speed after 20 hours of training to assess target engagement. Results: Auditory training subjects demonstrated significant improvements in global cognition, verbal memory, and problem solving compared with those of computer games control subjects. Both groups showed a slight but significant decrease in symptoms and no change in functional outcome measures. Training-induced cognitive gains at posttraining showed significant associations with reward anticipation at baseline and with improvement in auditory processing speed at 20 hours. Conclusion: Neuroscience-informed cognitive training via laptop computer represents a promising treatment approach for cognitive dysfunction in early schizophrenia. An individual's baseline motivational system functioning (reward anticipation), and ability to engage in auditory processing speed improvement, may represent important predictors of treatment outcome. Future studies must investigate whether cognitive training improves functioning and how best to integrate it into critical psychosocial interventions. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Schizophrenia Bulletin, 41(1) : 250-258
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
De-Maio, M., Graham, P., Vaughan, D., Haber, L., Madonick, S.
Aim: This article presents a literature review of treatments for first-episode psychosis throughout the world and describes the POTENTIAL (Patient-Oriented Treatment for Early or New onset schizophrenia To Initiate A Long-term recovery) Early Psychosis Programme in detail, explaining the model and the rationale, as well as the uniqueness of the programme.; Methods: An international search was conducted for English articles using PubMed, PsycINFO and PsycARTICLES, as well as the reference lists of published studies and reviews. One article that is currently in press was included, which was not part of the original literature search. Inclusion criteria included any published or in press study focused upon treatment programmes for early psychosis. Out of the 62 articles collected, 27 publications met this criterion and were utilized. In addition to identifying clinical programmes, gaps in treatment for this population were identified.; Results: The primary method in the United States for the treatment of early psychosis is randomized trial for new pharmacological treatments where patients are research subjects. Although there are a multitude of both research and clinical programmes internationally, the few programmes that exist in the United States that focus upon first-episode psychosis are either research based or focus upon prodromal symptoms. Clinical programmes such as the POTENTIAL programme are nearly non-existent.; Conclusions: Although the POTENTIAL programme has been successful both clinically and financially, there are still more strides to be taken to improve upon young adult services. Future development of the programme is continuing with the incorporation of outcome data and outreach into the community.; © 2014 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 9(1) : 1-11
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
Kantrowitz, J. T., Woods, S. W., Petkova, E., Cornblatt, B., Corcoran, C.M., Chen, H., Silipo, G., Javitt, D. C.
Background: Antagonists of N-methyl-D-aspartate-type glutamate receptors (NMDAR) induce symptoms that closely resemble those of schizophrenia, including negative symptoms. D-serine is a naturally occurring NMDAR modulator that reverses the effects of NMDAR antagonists in animal models of schizophrenia. D-serine effects have been assessed previously for treatment of established schizophrenia, but not in the early stages of the disorder. We aimed to assess effects of D-serine on negative symptoms in at risk individuals. Methods: We did a double-blind, placebo-controlled, parallel-group randomised clinical trial at four academic US centres. Individuals were eligible for inclusion in the study if they were at clinical high risk of schizophrenia, aged between 13-35 years, had a total score of more than 20 on the Scale of Prodromal Symptoms (SOPS), and had an interest in participation in the clinical trial. Exclusion criteria included a history of suprathreshold psychosis symptoms (ie, no longer qualifying as prodromal) or clinical judgment that the reported symptoms from the SOPS were accounted for better by another disorder (eg, depression). Randomisation was done using a generated list with block sizes of four. Participants were stratified by site, with participants, investigators, and assessors all masked through use of identical looking placebos and centralised drug dispensation to study assignment. D-serine (60 mg/kg) was given orally in divided daily doses for 16 weeks. The primary endpoint was for negative SOPS, measured weekly for the first 6 weeks, then every 2 weeks. Participants who received at least one post-baseline assessment were included in analysis. Serum cytokine concentrations were collected at baseline, midpoint, and endpoint to assess the mechanism of action. Safety outcomes including laboratory assessments were obtained for all individuals. This trial is registered with ClinicalTrials.gov, number NCT0082620. Findings: We enrolled participants between April 2, 2009, and July 23, 2012. 44 participants were randomly assigned to receive either D-serine (n = 20) or placebo (n = 24); 35 had assessable data (15 D-serine, 20 placebo). D-serine induced a 35.7% (SD 17.8) improvement in negative symptoms, which was significant compared with placebo (mean final SOPS negative score 7.6 [SEM 1.4] for D-serine group vs 11.3 [1.2] for placebo group; d = 0.68, p = 0.03). Five participants who received D-serine and nine participants who received placebo discontinued the study early because of withdrawn consent or loss to follow-up (n = 8), conversion to psychosis (n = 2), laboratory-confirmed adverse events (n = 2), or protocol deviations (n = 2). Interpretation: This study supports use of NMDAR-based interventions, such as D-serine, for treatment of prodromal symptoms of schizophrenia. On the basis of observed effect sizes, future studies with sample sizes of about 40 per treatment group would be needed for confirmation of beneficial effects on symptoms and NMDAR-related inflammatory changes. Long-term studies are needed to assess effects on psychosis conversion in individuals at clinical high risk of schizophrenia. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Lancet Psychiatry, 2(5) : 403-412
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Ising, H., Smit, F., Veling, W., Rietdijk, J., Dragt, S., Klaassen, R., Savelsberg, N., Boonstra, N., Nieman, D., Linszen, D., Wunderink, L., vanderGaag, M.
Background. Although there is evidence for the effectiveness of interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost effectiveness and cost-utility of cognitive-behavioural therapy (CBT) to prevent first-episode psychosis. Method. The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival and quality-adjusted life years (QALYs) gained. Results. In the cost-effectiveness analysis, the proportion of averted psychoses was significantly higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US$844 (551) per prevented psychosis. In the cost-utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than those of RC. Conclusions. Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show little difference between the two conditions. The CBT intervention proved to be cost saving. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychological Medicine, 45(7) : 1435-1446
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Gry Secher, R., Hjorthoj, C. R., Austin, S. F., Thorup, A., Jeppesen, P., Mors, O., Nordentoft, M.
Introduction : Specialized early intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 and 5 years. Few studies have examined long-term outcomes of these interventions. Aim : To examine the effect of 2 years of OPUS vs treatment as usual (TAU) within an FEP cohort, 10 years after inclusion into the OPUS trial. Methods : From 1998 to 2000, participants were randomized to OPUS or TAU. Ten years later, we conducted comprehensive interviews and performed register-based follow-up on all participants in national Danish registers. We analyzed participants according to the intention-to-treat principle. Results : Of the 547 participants included in the study, 347 (63.4%) took part in this follow-up. While there was evidence of a differential 10-year course in the development of negative symptoms, psychiatric bed days, and possibly psychotic symptoms in favor of OPUS treatment, differences were driven by effects at earlier follow-ups and had diminished over time. Statistically significant differences in the course of use of supported housing were present even after 8-10 years. There were no differences between OPUS and TAU regarding income, work-related outcomes, or marital status. Conclusion: Most of the positive short-term effects of the OPUS intervention had diminished or vanished at this long-term follow-up. We observed a clear tendency that OPUS treatment leads to fewer days in supported housing. There is a need for further studies investigating if extending the intervention will improve outcomes more markedly at long-term follow-ups.
Schizophrenia Bulletin, 41(3) : 617-626
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions