Disorders - Psychosis Disorders
Schmidt, S., Schultze-Lutter, F., Schimmelmann, B., Maric, N., Salokangas, R., Riecher-Rossler, A., vanderGaag, M., Meneghelli, A., Nordentoft, M., Marshall, M., Morrison, A., Raballo, A., Klosterkotter, J., Ruhrmann, S.
This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
European Psychiatry, 30(3) : 388-404
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
Smesny, S., Milleit, B., Schaefer, M. R., Hipler, U. C., Milleit, C., Wiegand, C., Hesse, J., Klier, C. M., Holub, M., Holzer, I., Berk, M., McGorry, P. D., Sauer, H., Amminger, G. P.
Background: Oxidative stress and impaired antioxidant defenses are reported in schizophrenia and are associated with disturbed neurodevelopment, brain structural alterations, glutamatergic imbalance, increased negative symptoms, and cognitive impairment. There is evidence that oxidative stress predates the onset of acute psychotic illness. Here, we investigate the effects of omega-3 PUFA on the vitamin E and glutathione antioxidant defense system (AODS). Method: In 64 help-seeking UHR-individuals (13-25 years of age), vitamin E levels and glutathione were investigated before and after 12 weeks of treatment with either 1.2 g/d omega-3 (PUFA-E) or saturated fatty acids (SFA-E), with each condition also containing 30.4 mg/d alpha-tocopherol to ensure absorption without additional oxidative risk. Results: In multivariate tests, the effects on the AODS (alpha-tocopherol, total glutathione) were not significantly different (p=0.13, p=0.11, respectively) between treatment conditions. According to univariate findings, only PUFA-E caused a significant alpha-tocopherol increase, while PUFA-E and SFA-E caused a significant gamma- and delta-tocopherol decrease. Total glutathione (GSHt) was decreased by PUFA-E supplementation. Conclusion: Effects of the PUFA-E condition on the vitamin E and glutathione AODS could be mechanisms underlying its clinical effectiveness. In terms of the vitamin E protection system, PUFA-E seems to directly support the antioxidative defense at membrane level. The effect of PUFA-E on GSHt is not yet fully understood, but could reflect antioxidative effects, resulting in decreased demand for glutathione. It is still necessary to further clarify which type of PUFA/antioxidant combination, and in which dose, is effective at each stage of psychotic illness.
Prostaglandins Leukotrienes & Essential Fatty Acids, 101 : 15-21
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
, Vitamins and supplements
Masi, G., Milone, A., Veltri, S., Iuliano, R., Pfanner, C., Pisano, S.
The atypical antipsychotic quetiapine has been used in different psychotic and non-psychotic disorders in children and adolescents in randomized clinical trials, open-label studies and chart reviews. Most of these studies suggest that quetiapine may be a promising agent with a potential for use in young patients. The aim of this paper is to critically review available literature on quetiapine in the treatment of children and adolescents with a variety of psychiatric disorders, including psychotic disorders, bipolar disorders (manic and depressive episodes), conduct disorder, autism spectrum disorder, Tourette's syndrome and personality disorders. Furthermore, we report on possible neurochemical pathways involved during treatment with quetiapine, and discuss some issues that are clinically relevant in daily practice, such as titration strategies, safety and tolerability, and monitoring possible side effects. Controlled studies support the short-term efficacy for treating psychosis, mania, and aggression within certain diagnostic categories. However, although quetiapine seems well tolerated in various pediatric populations during acute and intermediate treatments, and hyper-prolactinemia and extra-pyramidal side effects are consistently low among studies, weight gain and alterations in lipid profile need to be closely monitored. Furthermore, the distal benefit/risk ratio during long-term treatment remains to be determined.
Pediatric Drugs, 17 : 125-140
- Year: 2015
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Privat, A. T., Baquero, D. B., Santacana, A. M., Sola, V. P.
Introduction: Some studies have shown that more than 40% of patients with first episode psychosis (FEP) are non - adherent and treatment with long - acting antipsychotics (LAIs) may increase their compliance. However, studies on efficacy of LAIs versus oral antipsychotics for preventing relapse among schizophrenia patients have produced conflicting results. Objectives: The aim of the present study is to assess in naturalistic settings if patients with FEP treated with LAIs have a decreased incidence of readmission compared with patients in treatment with oral antipsychotics over 6 months follow - up. Methods: 188 FEP patients had been consecutively admitted to Hospital del Mar since January 2008 to September 2014. Psychometric assessment included: sociodemographic data, duration of untreated psychosis (DUP), diagnosis, substance use and clinical data at baseline. At 6 - months follow - up, antipsychotic treatment and number of admissions and emergencies over 6 months were also recorded. We investigated whether group treatments differ in readmission rates, attendance rates at emergencies services emergencies. Results: We found a significant decreased incidence of readmission (p=0,000) and a lower number of emergencies (p=0,017) in the group of FEP patients treated with LAIs versus the group treated with oral antipsychotics. Conclusion: In this naturalistic study, treatment with LAIs is associated with a reduced readmission rate and a lower number of emergencies in patients with FEP. These findings are in agreement with the results of other studies showing a significant reduced relapse rate and lowest risk of re - hospitalization in FEP patients treated with LAIs.
Current Psychopharmacology, 4(1) : 52-57
- Year: 2015
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Service Delivery & Improvement, Other service delivery and improvement interventions
Nordentoft, M., Melau, M., Iversen, T., Petersen, L., Jeppesen, P., Thorup, A., Bertelsen, M., Hjorthoj, C. R., Hastrup, L. H., Jorgensen, P.
Background: The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process. Methods: Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial. Results: To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction. Discussion: The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out-such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Early Intervention in Psychiatry, 9(2) : 156-162
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Skills training, Other Psychological Interventions, Other service delivery and improvement interventions
Pawelczyk, T., Grancow, M., Kotlicka-Antczak, M., Pawelczyk, A.
Introduction: Omega-3 polyunsaturated fatty acids (n3-PUFA) are major constituents of the neural membranes. N-3 PUFA take part in several neuronal mechanisms, including modulation and control of neurobiological processes, such as ion channel and receptor activity, neurotransmitter release, synaptic plasticity, second messenger pathways and neuronal gene expression. Deficiency in n-3 PUFA has been postulated in the etiology of schizophrenia. Intervention trials supplementing n-3 PUFA were conducted to assess the efficacy of n-3 PUFA in reducing symptom severity in exacerbations of chronic schizophrenia and acute phase of first-episode schizophrenia. The results were n-3 PUFA were found to prevent conversion to psychosis in clinical high risk populations. Objectives: To assess the efficacy n-3 PUFA as add-on treatment in relapse prevention in first-episode schizophrenia patients. Methods: We conducted a randomized, double-blind, placebo-controlled, parallel-group single-center 6 months augmentation trial of either 2,2 g per day of n-3 PUFA or placebo added on to an adjustable dose of antipsychotic medication in first-episode schizophrenia patients. Intervention was composed of either 1320 mg/day of eicosapentaenoic acid plus 880 mg/day of docosahexaenoic acid or placebo olive oil. The relapse rate was observed during a follow up period of 12 months. Results: 71 patients completed the study (41% female). Relapse was observed in 4 patients (11.4%) enrolled in n-3 PUFA group and 12 patients (33.3%) in placebo group over a period of 12 months. The difference was statistically significant (log rank test, p=0.0225). Conclusions: The results indicate, that n-3 PUFA add-on therapy can effectively prevent relapses in firstepisode schizophrenia patients.
European Psychiatry, 30 : 1751
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, Relapse prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Pijnenborg, G., Timmerman, M., Derks, E., Fleischhacker, W., Kahn, R., Aleman, A.
Although antipsychotics are widely prescribed, their effect of on improving poor illness insight in schizophrenia has seldom been investigated and therefore remains uncertain. This paper examines the effects of low dose haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on insight in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. The effects of five antipsychotic drugs in first episode psychosis on insight were compared in a large scale open randomized controlled trial conducted in 14 European countries: the European First-Episode Schizophrenia Trial (EUFEST). Patients with at least minimal impairments in insight were included in the present study (n = 455). Insight was assessed with item G12 of the Positive and Negative Syndrome Scale (PANSS), administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. The use of antipsychotics was associated with clear improvements in insight over and above improvements in other symptoms. This effect was most pronounced in the first three months of treatment, with quetiapine being significantly less effective than other drugs. Effects of spontaneous improvement cannot be ruled out due to the lack of a placebo control group, although such a large spontaneous improvement of insight would seem unlikely. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
European Neuropsychopharmacology, 25(6) : 808-816
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Ray, P., Sinha, V. K., Tikka, S. K.
Background: Repetitive transcranial magnetic stimulation (rTMS) has been found to be effective in reducing frequency and duration of auditory verbal hallucinations (AVH). Priming stimulation, which involves high-frequency rTMS stimulation followed by low-frequency rTMS, has been shown to markedly enhance the neural response to the low-frequency stimulation train. However, this technique has not been investigated in recent onset schizophrenia patients. The aim of this randomized controlled study was to investigate whether the effects of rTMS on AVH can be enhanced with priming rTMS in recent onset schizophrenia patients.Methods: Forty recent onset schizophrenia patients completed the study. Patients were randomized over two groups: one receiving low-frequency rTMS preceded by priming and another receiving low-frequency rTMS without priming. Both treatments were directed at the left temporo-parietal region. The severity of AVH and other psychotic symptoms were assessed with the auditory hallucination subscale (AHRS) of the Psychotic Symptom Rating Scales (PSYRATS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression (CGI).Results: We found that all the scores of these ratings significantly reduced over time (i.e. baseline through 1, 2, 4 and 6 weeks) in both the treatment groups. We found no difference between the two groups on all measures, except for significantly greater improvement on loudness of AVH in the group with priming stimulation during the follow-ups (F = 2.72; p < .05).Conclusions: We conclude that low-frequency rTMS alone and high-frequency priming of low-frequency rTMS do not elicit significant differences in treatment of overall psychopathology, particularly AVH when given in recent onset schizophrenia patients. Add on priming however, seems to be particularly better in faster reduction in loudness of AVH. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Annals of General Psychiatry, 14 : ArtID 8
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Transcranial magnetic stimulation (TMS)
Piskulic, D., Barbato, M., Liu, L., Addington, J.
Individuals at clinical high risk (CHR) of psychosis evidence cognitive deficits. Given suggestions that deficits in cognition are related to poor functional outcome, cognition is a good treatment target. The aim of this study was to test the efficacy of cognitive remediation therapy (CRT) in improving cognition of CHR individuals. Participants were tested at baseline, immediately following CRT and 9 months post-baseline. The mixed effects modelling demonstrated no differences in cognition between the experimental group and the control group at any time point. For the experimental group, however, there was a trend towards improvement in speed of processing between baseline and 9-month follow-up (t(29)=-2.91, P=0.06) and at post-CRT compared to 9-month follow-up (t(29)=-2.99, P<0.05). In the control group, significant improvements in working memory were observed between post-CRT and 9-month follow-up (t(29)=-3.06, P<0.05). Despite significant improvements in social functioning in the intervention group between baseline and 9-month follow-up (t(28)=-3.26, P<0.05), these improvements were not correlated with cognition. There were trends towards improvement and no trends of decline in the two groups. While CRT may be valuable for individuals at CHR, the type of intervention employed needs to be carefully considered.; Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Psychiatry Research, 225(1-2) : 93-98
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Nieman, D. H., McGorry, P D.
The at-risk mental state (ARMS) has been substantially researched and used as the basis for new clinical settings and strategies over the past two decades. However, it has also caused controversy and intense debate. In this Review, we assess available evidence and propose future directions. Accumulating research suggests that a blend of clinical staging and profiling, which naturally incorporates ARMS, might be a better guide for treatment of patients in different stages of psychiatric illness than the categorical DSM and ICD systems. Furthermore, clinical staging, with its emphasis on balancing risks and benefits, could help to prevent premature treatment or overtreatment with psychotropic drugs. Meta-analyses and reviews show that treatment of ARMS leads to a significant reduction in transition rate to a first psychosis. The debate about stigma associated with ARMS is based on scarce published work. The few studies that have been done suggest that stigma (including self-stigma) arises largely from negative societal views on psychiatric disorders and, depending on the setting and approach, not from engagement in treatment for ARMS per se. The evidence base suggests that definition of ARMS is an important step in implementation of clinical staging and profiling in psychiatry. However, more research across traditional diagnostic boundaries is needed to refine these clinical phenotypes and link them to biomarkers with the goal of personalised stepwise care. Health-system reform is overdue and a parallel process to support this approach is needed, which is similar to how physical forms of non-communicable disease are treated. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Lancet Psychiatry, 2(9) : 825-834
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement
Piskulic, D., Nelson, B., Alvarez-Jimenez, M., McGorry, P.
Background and Objectives: Schizophrenia is a progressive disorder that moves through multiple stages starting from non-specific risk factors to at-risk mental state (ARMS) (also known as ultra-high risk of psychosis or UHR) to first episode of psychosis (FEP) to chronic course marred by frequent relapses and varying degrees of disability. In order to prevent a deteriorating course, treatments designed to address and possibly even correct the abnormal neuronal system functioning and psychosocial deficits need to be implemented early before potentially irreversible and maladaptive changes take place.Methods: A literature search was conducted in the electronic databases Pub-Med and MEDLINE for relevant empirical and review articles published in peer reviewed journals.Results: The review of literature suggests that a range of pharmacological and psychosocial interventions are being used and trialled in treatment of early stages of schizophrenia with varying degrees of success. Conclusions: There is a variety of therapies for schizophrenia ranging in scope from improving symptom profiles to functional recovery and a good rationale for their use early in the course of illness. Treatments that focus on integrating pharmacological, psychological and psychosocial interventions with a strong evidence base for effectiveness need to be integrated for the best chance to avert or hinder schizophrenia. Schizophrenia research is moving towards a notion that early intervention can interact with existing and intact neuroplasticity mechanisms that can be harnessed in an adaptive manner to promote healthier neural system functioning and increased stress resiliency, which will in turn lead to symptom reduction and functional recovery.
European Journal of Psychiatry, 29(2) : 135-143
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Randall, J. R., Vokey, S., Loewen, H., Martens, P. J., Brownell, M., Katz, A., Nickel, N. C., Burland, E., Chateau, D.
Objectives: To review and synthesize the currently available research on whether early intervention for psychosis programs reduce the use of inpatient services.; Methods: A systematic review was conducted using keywords searches on PubMed, Embase (Ovid), PsycINFO (ProQuest), Scopus, CINAHL (EBSCO), Social Work Abstracts (EBSCO), Social Science Citations Index (Web of Science), Sociological Abstracts (ProQuest), and Child Development & Adolescent Studies (EBSCO). To be included, studies had to be peer-reviewed publications in English, examining early intervention programs using a variant of assertive community treatment, with a control/comparison group, and reporting inpatient service use outcomes. The primary outcome extracted number hospitalized and total N. Secondary outcome extracted means and standard deviations. Data were pooled using random effects models. Primary outcome was the occurrence of any hospitalization during treatment. A secondary outcome was the average bed-days used during treatment period.; Results: Fifteen projects were identified and included in the study. Results of meta-analysis supported the occurrence of a positive effect for intervention for both outcome measures (any hospitalization OR: 0.33; 95% CI 0.18-0.63, bed-days usage SMD: -0.38, 95% CI -0.53 to -0.24). There was significant heterogeneity of effect across the studies. This heterogeneity is due to a handful of studies with unusually positive responses.; Conclusion: These results suggest that early intervention programs are superior to standard of care, with respect to reducing inpatient service usage. Wider use of these programs may prevent the occurrence of admission for patients experiencing the onset of psychotic symptoms.; © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
Schizophrenia Bulletin, 41(6) : 1379-1386
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions