Disorders - Psychosis Disorders
Kuzmanovic, A., Zivkovic, N., Pavicevic, D., Djokic, G., Zoric, K.
Introduction: Good response on treatment and stable remission are of great importance for patients in first episode of psychosis. According to literature 5-15% schizophrenic patients experience an overall improvement greater than 50-60%, especially when receiving stable treatment with atypical antipsychotics for more than one year. Such patients are considered as super-responders to a specific pharmacological treatment, since they may be well enough to be employed, live independently, sustain long-term relationships, and form a family [1-3]. According to our knowledge there is no study in available literature focusing on identification special characteristics of super-responders on antipsychotic treatment in non affective psychosis. Objective: To explore and assess socio-demographic characteristics of super-responders on treatment with atypical antipsychotics (AAP). Methods: This prospective clinical study included 146 drug naïve patients, between 18-55 years of age, with acute psychotic episode, that met the ICD-10 criteria for first psychotic episode (F23). Patients were divided into five groups according to specific antipsychotic treatment: Haloperidol group (H) - 31 patients, Risperidone group (R) - 32 patients, Olanzapine group (O) - 33 patients, Clozapine group (C) - 32 patients and Quetiapine XR group (Q) - 18 patients. Inpatients and outpatients were observed for 12 months period, and antipsychotic treatment was assessed, according to specially designed protocol which included: Positive and Negative Symptom Schedule Scale (PANSS) and Sheehan Disability Scale (SDS). Patients with PANSS score higher than 95, and with SDS score higher than 15 were included in this study. After one year period percent of super-responders and demographic characteristics of super-responders were determined. As super-responders we considered patients with more than 50% improvement in PANSS and SDS score. Statistical analyses were made with SPSS 15.0 for Windows. Results: There were no significant statistical differences in pretrial scores between groups for PANSS score and SDS score. There were significant statistical difference in PANSS score and SDS score reduction after 12 months in all five groups (p<0.001). After one year period percent of super-responders was: 3.22% in H group, 12.5% in R group, 15.15% in O group, 27.5% in C group and 22.2% in Q group. Overall percent of super-responders in all five groups was 15.75%. Overall percent of super-responders in four AAP groups was 19.13%. There is statistically significant difference in the percentage of super-responders between atypical and typical antipsychotics, atypical in favor. After one year of period super-responders were on maintenance doses of antipsychotics equivalent to 100 to 200 mg/day dose of chlorpromazine. Demographic characteristics of super-responders were: mean age 25.21±7.22; 13% were male, 87% female; 4.35% were smokers, 95.65% non-smokers; 8.7% had high school education, 91.3% were students or had faculty, 77.5% had stable relationship or was married. Conclusion: Demographic characteristics of super-responders on treatment with atypical antipsychotics are: young patients, predominately female, non-smokers, students or with bachelor/master degree, in stable relationship or married. Future studies should consider possible clinical predictors of super-responders, such as rapid response to therapy, adverse events, compliance and insight.
European Neuropsychopharmacology, 24 : S358
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Lin, J. J., Lee, H. M., Chan, K. W., Chang, W. C., Su, W., Honer, W. G., Khong, P. L., Tze, M., Chan, C. L. W., So, K. F., Chen, E. Y. H.
Background: Impairments of attention and memory are detectable in early psychosis, and often result in severe, longstanding functional impairments. Pharmacological interventions for cognitive impairments have been largely unsuccessful. The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive functioning and clinical symptoms in female patients with early psychosis. The potential neuromechanism underlying the clinical consequences was also investigated. Methods: Female patients (n=120) diagnosed with schizophrenia spectrum disorders, brief psychosis, psychosis NOS, or delusional disorder (according to SCID) were recruited from three hospital/clinic sites. They were randomized into integrated yoga therapy group, aerobic exercise programme group and waiting list as the control group. Both interventions were held three times weekly. At baseline and at 12 weeks, clinical symptoms, cognitive functions, quality of life and fitness levels were assessed in all participants and completed structural MRI data were collected in 58 patients. Repeated measures ANOVA and ANCOVA analyses of the clinical, cognitive, quality of life and fitness data were compared between baseline and at 12 weeks among the three groups. Post-hoc Bonferroni test was used for comparing between two groups. Structural MRI data was analyzed by FreeSurfer V5.1 and Qdec V1.4 to calculate the brain volume and cortical thickness. Results: Completed clinical and cognitive data were collected in 85 patients and completed MRI imaging data of good quality were collected in 39 patients. No significant differences in age, education years, and duration of the illness at baseline were observed among the three groups. Both yoga and aerobic exercise groups demonstrated significant improvements in verbal encoding (p<0.01), short-term memory (p<0.05), long-term memory (p<0.01), and working memory (p<0.01) with moderate to large effect sizes compared to control groups. The yoga group showed significantly enhanced attention and concentration (p<0.05). Both yoga and aerobic exercise significantly improved overall clinical symptoms (p<0.05) and depressive symptoms (p<0.05) after 12 weeks. Significant increases were observed in the thickness of the left superior frontal gyrus and the right inferior frontal gyrus (pars triangularis) in the aerobic exercise group. Significant increases were observed in the volume of the postcentral gyrus and the posterior corpus callosum in the yoga group. There was a statistically significant correlation between improvements in working memory and changes in the postcentral gyrus (r=0.54, p<0.01) after controlling for the multiple comparisons with a Bonferroni adjusted alpha level. Discussion: Both types of exercise improved memory in early psychosis patients, with yoga having a superior effect on attention than aerobic exercise. Observed increments in the cortical thicknesses and volume may indicate improved neurogenesis.
Schizophrenia Research, 153 : S260
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Liu, F., Guo, X., Wu, R., Ou, J., Zheng, Y., Zhang, B., Xie, L., Zhang, L., Yang, L., Yang, S., Yang, J., Ruan, Y., Zeng, Y., Xu, X., Zhao, J.
Background: It is difficult to improve negative symptoms and cognitive impairments in schizophrenia. A previous pilot study has shown that minocycline, a semi-synthetic second-generation tetracycline, is effective in treating for negative and/or cognitive symptoms in schizophrenia. Objectives: The present study was designed to examine the efficacy and safety of minocycline for the treatment of negative symptoms and cognitive impairments in patients with schizophrenia. Methods: Ninety-two patients with early stage schizophrenia treated with risperidone entered this 16-week, double blind, randomized, placebo-controlled clinical trial. Subjects were randomly assigned to receive minocycline (200 mg per day) or the placebo. The primary outcome was evaluated using the Scale for the Assessment of Negative Symptoms (SANS). Secondary outcomes included the response rate of SANS, the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), and cognitive tests. Results: Subjects receiving minocycline had greater improvements on SANS total scores and PANSS negative subscale scores (P < 0.001) when compared with those receiving the placebo. Rates of treatment response (43.6%) in the minocycline group were significantly higher than those in the placebo group (10.0%) after 16 weeks of treatment. There was no significant difference between the seven cognitive domains (P > 0.05), except for the attention domain (P = 0.044). Conclusions: The addition of minocycline to atypical antipsychotic drugs in early schizophrenia had significant efficacy on negative symptoms but had a slight effect on the attention domains of patients with schizophrenia. It may be considered as a new adjunct treatment for negative symptoms of schizophrenia. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Schizophrenia Research, 153(1-3) : 169-176
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Other biological interventions
Liu, J., Sun, J., Shen, X., Guo, W., Zhi, S., Song, G., Xu, Q., Song, J.
Background: Increased serum prolactin and weight gain are common side effects of atypical antipsychotics but few studies have assessed the long-term pattern of these adverse effects. Aim: Compare the effects of risperidone and quetiapine on serum prolactin and weight over 12 months of treatment among female patients with first-episode schizophrenia. Methods: Eighty female inpatients with first-episode schizophrenia were randomly assigned to receive risperidone (n = 40) or quetiapine (n = 40) for 12 months. Prolactin concentration, weight and height were measured one day before starting treatment and 1,3, 6, 9 and 12 months after initiating treatment. Severity of symptoms was assessed at the same time periods using the Positive and Negative Syndrome Scale (PANSS). Results: Thirty-one patients in the risperidone group and 33 patients in the quetiapine group completed the 12 months of treatment. PANSS scores decreased at each follow-up assessment for both groups; the improvement was significantly greater in the risperidone group after 3 months and 6 months of treatment but by the 9th month of treatment the level of improvement in the two groups was similar. In the quetiapine group serum prolactin remained stable throughout the 12 months but in the risperidone group the serum prolactin level increased 3.5- to 5.2- fold over the one-year follow-up. Weight gain was seen in both groups, particularly during the first 3 months of treatment: 62% of the increase in BMI in both groups had occurred by the end of the 3rd month of treatment. No between-group differences in weight changes were observed. The correlation between changes in weight and changes in prolactin levels were weakly positive: rs = 0.17 (p = 0.104) in the risperidone group and r = 0.07 (p = 0.862) in the quetiapine group. Conclusions: Risperidone and quetiapine had similar efficacy in the first year of treatment of first-episode schizophrenia though risperidone was more rapidly effective. Use of risperidone was associated with chronic hyperprolactinemia but this did not occur with quetiapine. Long-term use of both drugs was associated with sustained weight gain; the timing and magnitude of the weight gain is similar for the two drugs. Weight gain was not strongly related to changes in prolactin levels. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Shanghai Archives of Psychiatry, 26(2) : 88-94
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
McFarlane, W. R., Susser, E., McCleary, R., Verdi, M., Lynch, S., Williams, D., McKeague, I. W.
Objective: This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis. Methods: The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12-35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect. Results: On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=-64% to -11%) in the Greater Portland area. The rate increased by 8% (CI=-5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (26% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis. Conclusions: PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.
Psychiatric Services, 65(10) : 1194-1200
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Hjorthoj, C. R., Baker, A., Fohlmann, A., Nordentoft, M
Introduction: Cannabis use disorders are highly prevalent in patients with schizophrenia and other psychoses, and are probably associated with a range of poor outcomes. Several trials have been conducted on this population, the results of which have been summarized in several systematic reviews but never in meta-analyses specifically regarding cannabis use.; Methods: PubMed, PsycINFO, EMBASE, and The Cochrane Central Register of Controlled Trials were searched using predefined search terms. We included randomized trials of all types of interventions targeting cannabis use disorders in patients with schizophrenia spectrum disorders. We extracted information on intervention types, efficacy, trial characteristics, and risk of bias.; Results: There was no evidence of an effect on frequency of cannabis use, but intervention effects of motivational intervention with or without cognitive behavior therapy were observed on quantity of use and on positive symptoms of schizophrenia. Psychosocial intervention did not have an appreciable effect on negative symptoms. Longer interventions appear to be more efficacious, and efficacy may be better in trials with comparatively few women. Larger trials may be better at establishing effects on positive symptoms.; Conclusion: Psychosocial interventions appear moderately efficacious in reducing quantity of cannabis-use and positive symptoms.;
Current Pharmaceutical Design, 20(13) : 2205-2211
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Hutton, P., Taylor, P.
Background: Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT). Method: A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed treatment for preventing psychosis in people who are not taking antipsychotic medication, when compared to usual or non-specific control treatment. Included studies had to meet basic quality criteria, such as concealed and random allocation to treatment groups. Results: Our search produced 1940 titles, out of which we found seven completed trials (six published). The relative risk (RR) of developing psychosis was reduced by more than 50% for those receiving CBT at every time point [RR at 6 months 0.47, 95% confidence interval (CI) 0.27-0.82, p = 0.008 (fixed-effects only: six randomized controlled trials (RCTs), n = 800); RR at 12 months 0.45, 95% CI 0.28-0.73, p = 0.001 (six RCTs, n = 800); RR at 18-24 months 0.41, 95% CI 0.23-0.72, p = 0.002 (four RCTs, n = 452)]. Heterogeneity was low in every analysis and the results were largely robust to the risk of an unpublished 12-month study having unfavourable results. CBT was also associated with reduced subthreshold symptoms at 12 months, but not at 6 or 18-24 months. No effects on functioning, symptom-related distress or quality of life were observed. CBT was not associated with increased rates of clinical depression or social anxiety (two studies). Conclusions: CBT-informed treatment is associated with a reduced risk of transition to psychosis at 6, 12 and 18-24 months, and reduced symptoms at 12 months. Methodological limitations and recommendations for trial reporting are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Psychological Medicine, 44(3) : 449-468
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Karacetin, G.
Early onset schizophrenia is defined as the onset of psychosis before the age of 18 years and very early-onset schizophrenia is a term used for cases developing before the age of 13 years. The aim of this presentation is to review the recent studies related to treatment of childhood-onset schizophrenia. A computerized-aided literature search was performed in PubMed database for recent studies that assessed the effectiveness, safety and tolerability of first-generation and second- and third-generation antipsychotics in children and adolescents with schizophrenia. The main treatment modality in schizophrenia is pharmacological in both children and adults. Antipsychotic drugs are the first-line of treatment and atypical antipsychotics should be preferred to typical antipsychotics as they show at least the same efficacy and a better tolerability in childhood-onset schizophrenia. Recent randomized controlled trials have shown the efficacy of some atypical antipsychotics in childhood-onset schizophrenia. As a result, aripiprazole, olanzapine, quetiapine, paliperidone and risperidone have received formal indications for the treatment of schizophrenia between the ages of 13-17 years. The pediatric use of atypical antipsychotic drugs has increased considerably over the past decade. Risperidone was the most often prescribed atypical antipsychotic in a naturalistic longitudinal study of early-onset first psychotic episodes in children and adolescents, followed by quetiapine and olanzapine. Clozapine, which is the prototype of the atypical antipsychotic class, is reserved for cases unresponsive or intolerant of other antipsychotics because of the risk of serious side effects. Risperidone is associated with a higher frequency of extrapyramidal symptoms than other antipsychotics, while olanzapine is associated with marked weight gain. Hyperprolactinemia and QTc interval prolongation are the other side effects that raise concern for the clinical use of antipsychotics in children and adolescents. Early detection and treatment of childhood-onset schizophrenia may improve outcomes of the disorder. Current data provides evidence for the effectiveness and safety of atypical antipsychotic use in children and adolescents with schizophrenia. Although atypical antipsychotics are associated with a lower risk of extrapyramidal symptoms, metabolic abnormalities such as weight gain, hyperglycemia and dyslipidemia require careful monitoring in children and adolescents. Antipsychotic drugs may also differ with regard to their pharmacokinetics, which should be kept in mind for improving utilization of these drugs in children and adolescents.
Klinik Psikofarmakoloji Bulteni, 24 : S43
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Desamericq, G., Schurhoff, F., Meary, A., Szoke, A., Macquin-Mavier, I., Bachoud-Levi, A. C., Maison, P.
Purpose: Most schizophrenic patients have mild to moderate cognitive impairment in the early stages of schizophrenia. The aim was to compare the long-term effects of various antipsychotic drugs on overall cognition and on specific cognitive domains in patients with schizophrenia or related disorders. Methods: We searched MEDLINE and EMBASE for randomized controlled trials in which oral formulations of second-generation antipsychotic drugs were compared head-to-head or against placebo or against haloperidol. Trials had to be of at least 6 months duration to be included. We used a network meta-analysis to combine direct and indirect comparisons of the cognitive effects between antipsychotics. Results: Nine studies were eligible. The median trial duration was 52 weeks. Quetiapine, olanzapine and risperidone had better effects on global cognitive score than amisulpride (p < 0.05) and haloperidol (p < 0.05). When memory tasks were considered, ziprasidone had better effect than amisulpride (0.28 [0.02-0.54]) and haloperidol (0.32 [0.09-0.55]). Quetiapine was better than other drugs (p < 0.001) on attention and processing speed tasks, followed by ziprasidone (p < 0.05) and olanzapine (p < 0.05). The effects of quetiapine, risperidone and olanzapine were better than those of amisulpride (p < 0.05) on executive functions. Conclusions: Our results suggest differences between antipsychotics in their effect on the overall cognitive score in schizophrenia. Quetiapine and olanzapine had the most positive effects, followed by risperidone, ziprasidone, amisulpride and haloperidol in that order. Significant differences were also observed according to specific cognitive tasks. © 2013 Springer-Verlag Berlin Heidelberg.
European Journal of Clinical Pharmacology, 70(2) : 127-134
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Harder, S., Koester, A., Valbak, K., Rosenbaum, B.
Objectives: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia spectrum disorder. Method: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence. Results: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up. Conclusion: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research into the curative elements of SPP is needed.
Psychiatry, 77(2) : 155-168
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Javitt, D. C.
Objective: Disturbances in N-methyl-D-aspartate receptor (NMDAR) function contribute to schizophrenia (Sz) and are indexed by objective neurophysiological disturbances. Agents such as glycine and D-serine bind to an allosteric regulatory site of the NMDA receptor complex and may be therapeutically beneficial in Sz. Methods: Two recent studies were conducted with 60 mg/kg/d (∼4 g/d) D-serine. Study 1 investigated D-serine effects (4-6 wks) on neurophysiological biomarkers including MMN and visual P1 in 35 stabilized, chronic Sz subjects, along with PANSS symptoms and MCCB neurocognitive function. Study 2 investigated D-serine effects (16-wk) on prodromal symptoms in 44 individuals at clinical high risk (CHR) for Sz based on SIPS/SOPS criteria. Results: Study#1: D-serine patients showed a significant (8.5±13.2%) decline in PANSS symtpoms vs. placebo, along with a small but significant improvement in MCCB composite score. Significant improvements were also observed for MMN (p=0.044) and visual P1 (p= 0.043, d=0.67). Study#2: a highly significant (p= 0.03; d=0.68) 35.7 ±17.8% reduction was observed in effect was observed on SOPS negative symptoms. Furthermore, >20% improvement was observed in 9/10 subjects who completed all 16 weeks of treatment vs. only 5/11 placebo patients (p=0.023). A 30.9 ±14.9% reduction was observed on total symptoms that approached significance (p= 0.07, d= 0.67). Conclusion: These are the first double-blind studies of D-serine at a dose of 60 mg/kg. Although magnitude of symptoms improvement was small in chronic patients, objective effects were observed on brain function including improvements in both auditory and visual neurophysiological measures. Moreover, in prodromal patients, robust improvements in symptoms were observed, suggesting that NMDAR-based interventions may be most effective when applied early in the course of Sz.
International Journal of Neuropsychopharmacology, 17 : 19
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Denia, D. T., Sanz-Fuentenebro, F. J., Alvarez, T. P., Rodriguez, V. M.
Background: The mechanism of action of clozapine, the unique treatment with a demonstrated advantage in resistant schizophrenia is markedly different as compared to other typical and atypical antipsychotics. Restrictions on clozapine use leave open the question of its potential utility in the earliest stages of the disease, as a first option, when the deterioration rate may be more pronounced. In the context of a clinical trial, our group has developed a 2-year longitudinal study to test the hypothesis that the use of clozapine in Treatment-Naïve FES may limit the degree of prefrontal gray matter loss and, consequently, it can attenuate the cognitive and functional early impairment better than risperidone. Methods: Up to date, 34 Treatment-Naïve FES patients were included in the trial. They were randomly assigned to clozapine or risperidone as drug treatment. 52.9% of the sample have completed the trial, 12 patients in the clozapine group and 6 patients in the risperidone group. 23 healthy controls matched for age, sex and educational level were recruited. Patients were evaluated twice by a neuropsychological battery related to prefrontal functions: in the first week after attending mental health services and 2 years later. For statistical analysis of related samples Wilcoxon non-parametric test was used. Results: At baseline, FES patients (n:18) yield significantly below controls on all neuropsychological variables assessed, except in immediate verbal recall. The analysis of the treatment groups did not describe differences between them at baseline. At 2 years follow-up evaluation, the healthy controls still show better performance compared to patients. Patiens group (n=18) showed significance improvement on their performance at 2 year follow-up on sustained attention-CPT-Hits (M=-11.05 (9.04); Z=-3.59; p<0.001), shifting attention-TMTB-A (M=28.0 (40.87); Z=-2.35; p=0.018) working memory-WAIS III inverse-digits (M=-1.87 (2.98); Z=-2.20; p=0.022), processing speed-TMTA (M=9.61 (18.52); Z=-2.14; p=0.032), semantic fluency (M=-5.33 (7.92); Z=-2.46; p=0.014), Visuospatial hability-ROCF Copy (M=-1.36 (3.53); Z=-1.97; p=0.048) and Verbal Memory RAVL (M=-1.94 (3.38) Z=-2.23; p=0.025). Health-control group improved on fonologic fluency (M=-4.00 (4.47); Z=-2.39; p=0.016) and semantic fluency (-3.83 (5.73); Z=-1.97; p=0.049). Risperidone group (n:6) significantly improved their performance on visuospatial hability-ROCF Copy-(M=-3.08 (3.04); Z=-2.21; p=0.027). Clozapine group (n:12) significantly improved their performance on Sustained attention-CPT-Hits (M=-13.91 (8.80); Z=-3.61; p=0.002), processing speed-TMTA (M=13.08 (21.44); Z=-2.00; p=0.045), working memory-WAIS-III Inverse digits (M=-0.75 (0.86); Z=-2.31; p=0.021), cognitive flexibility-WSCT Perseverative Errors % (M=7.16 (12.54); Z=-2.08; p=0.037) and resistance to retroactive interference RAVLT (M=1.42 (1.97); Z=-2.04; p=0.041) Discussion: These preliminary results suggest a better cognitive response in patients treated with clozapine on several neuropsicological variables related to prefrontal cortex processes. They describe significance improvement on processing speed, sustained and shifting attention, and working memory processes (manipulation and effective retrieval of information). However, at this time, the hypothesis that clozapine can attenuate cognitive decline associated with the early stages of schizophrenia cannot be firmly supported due to the small sample size.
Schizophrenia Research, 153 : S371
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)