Disorders - Psychosis Disorders
Bartholomeusz, C. F., Allott, K., Killackey, E., Liu, P., Wood, S. J., Thompson, A.
Background: Social cognitive deficits have a detrimental effect on social and role functioning at both early and late stages of psychotic illness. Aim: To assess the feasibility of social cognition and interaction training (SCIT) in first-episode psychosis (FEP). Methods: A total of 12 FEP participants were sequentially allocated to one of two SCIT groups, each of which met once per week for 10 consecutive weeks. Social cognition and functioning was assessed at baseline and post-intervention. Results: SCIT was well-tolerated and retention was good. FEP participants improved significantly on measures of emotion recognition and social and occupational functioning. Conclusions: This study extends previous research by applying SCIT early in the course of illness, with the rationale that there is greater brain plasticity in this developmental phase of life, and greater scope to reduce or prevent disability. Results suggest SCIT is acceptable to and potentially helpful for this young population, thus a large randomized controlled trial is warranted. (copyright) 2013 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 7(4) : 421-426
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Bartzokis, G., Lu, P. H., Couvrette, A. J., Raven, E. P., DeTore, N. R., Kirkpatrick, C. J., Finn, J. P., Villablanca, P., L-Altshuler, L., Mintz, J., Ventura, J., Casaus, L. R., Luo, J. S., Subotnik, K. L., Nuechterlein, K. H.
Background: Post-mortem and imaging studies suggest that early in the treatment of schizophrenia (SZ), antipsychotics increase myelination and specifically intracortical myelin (ICM). We used MRI to examine whether in SZ, the ICM trajectory is dysregulated, altered by oral antipsychotics, associated with cognitive performance, and whether antipsychotic formulation can modify the ICM trajectory. Methods: Frontal lobe ICM volume was estimated using a novel dual contrast MRI method. Study 1: Seventy-one male SZ subjects taking oral antipsychotics whose medication exposures ranged from 0-333 months were examined in conjunction with 57 healthy male controls (HCs). Study 2: Six-month randomized trial of risperidone long acting injectable (RLAI, N = 9) versus oral risperidone (RisO, N = 13) in first-episode SZ subjects. Results: Study 1: When plotted against medication exposure, the ICM trajectory of SZ subjects was highly quadratic, significantly increasing during the first treatment year and significantly decreased thereafter such that by middle age, the ICM levels of SZ subjects were similar to HCs in their 80s. Cognitive scores were associated with ICM volume. Study 2: Compared to healthy controls, ICM volume increased significantly (p = .005) in the RLAI and non-significantly (p = .39) in the RisO groups. SZ subjects receiving RLAI had better medication adherence and more ICM increases (chi-square p <.05). Conclusion: Oral antipsychotic treatment increased ICM during the first year of treatment followed by declining ICM despite continued treatment. This ICM trajectory resembles antipsychotic response trajectory with high rates of remission in the first year followed by progressively lower response rates. Better adherence and/or pharmacokinetics provided by RLAI may modify this ICM trajectory, possibly through delivering continuous inhibition of the constitutively active enzyme glycogen synthase kinase 3 (GSK3). Dopamine and serotonin receptor blockade provided by antipsychotics inhibit GSK3 and promote myelination. The results support post-mortem evidence that SZ pathophysiology involves ICM deficits and suggest that correction of these deficits through GSK3 inhibition may be a shared mechanism of action of antipsychotics.
Schizophrenia Bulletin, 39 : S322
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Amr, M., Lakhan, S. E., Sanhan, S., Al-Rhaddad, D., Hassan, M., Thiabh, M., Shams, T.
Background: Schizophrenia is a chronic disease of global importance. The second-generation antipsychotic quetiapine has a favorable side-effect profile, however, its clinical effectiveness has been called into question when compared with first-generation antipsychotics such as haloperidol. This study evaluates the efficacy and tolerability of quetiapine versus haloperidol for first-episode schizophrenia in the outpatient setting. Methods. 156 adult patients with first-episode schizophrenia participated in an outpatient clinical trial and were randomized to quetiapine (200 mg/d; n = 78) or haloperidol (5 mg/d; n = 78). The study medications were titrated to a mean daily dose of 705 mg for quetiapeine and 14 mg for haloperidol. The patients were assessed at baseline, six weeks, and twelve weeks. The primary outcome measures were positive and negative scores of the Positive and Negative Syndrome Scale (PANSS). Secondary measures were Global Assessment of Functioning (GAF) scale for overall psychosocial functioning, and Simpson-Angus Scale (SAS) for extra-pyramidal symptoms. Results: At twelve weeks, the quetiapine group had a greater decrease in PANSS positive (18.9 vs. 15.3, p = 0.013) and negative scores (15.5 vs. 11.6, p = 0.012), however, haloperidol showed a greater decrease in general psychopathology score (23.8 vs. 27.7, p = 0.012). No significant difference between groups were found for total PANSS (58.3 vs. 54.8, p = 0.24) and GAF (45.7 vs. 46.2, p = 0.79).ANOVA identified significant group interactions on PANSS positive (F = 18.72, df = 1.6,52.4, p < 0.0001), negative (F = 5.20, df = 1.1,35.7, p < 0.0001), depression/anxiety (F = 106.49, df = 1.14,37.8, p < 0.0001), and total scores (F = 7.51, df = 1.4,45.6, p = 0.001).SAS (8.62 vs. 0.26, p < 0.0001) and adverse events of akathisia (78% vs. 0%, p = 0.000), parkinsonism (66.6% vs. 0%, p < 0.0001), and fatigue (84.6% vs. 66.6%, p = 0.009) were greater in haloperidol compared to quetiapine, whereas headache was more common in quetiapine treated patients (11.5% vs. 35.9%, p < 0.0001). Conclusions: Quetiapine has greater efficacy for positive and negative symptoms with less extra-pyramidal symptoms than haloperidol when used for first-episode schizophrenia in the outpatient setting. (copyright) 2013 Amr et al.; licensee BioMed Central Ltd.
International Archives of Medicine, 6(1) :
- Year: 2013
- 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)
Amminger, G. P., Chanen, A. M., Ohmann, S., Klier, C. M., Mossaheb, N., Bechdolf, A., Nelson, B., Thompson, A., McGorry, P. D., Yung, A. R., Schafer, M. R.
Objective: To investigate whether long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFAs) improve functioning and psychiatric symptoms in young people with borderline personality disorder (BPD) who also meet ultra-high risk criteria for psychosis. Methods: We conducted a post hoc subgroup analysis of a double-blind, randomized controlled trial. Fifteen adolescents with BPD (mean age 16.2 years, [SD 2.1]) were randomized to either 1.2 g/day n-3 PUFAs or placebo. The intervention period was 12 weeks. Study measures included the Positive and Negative Syndrome Scale, the Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning. Side effects were documented with the Udvalg for Kliniske Undersogelser. Fatty acids in erythrocytes were analyzed using capillary gas chromatography. Results: At baseline, erythrocyte n-3 PUFA levels correlated positively with psychosocial functioning and negatively with psychopathology. By the end of the intervention, n-3 PUFAs significantly improved functioning and reduced psychiatric symptoms, compared with placebo. Side effects did not differ between the treatment groups. Conclusions: Long-chain n-3 PUFAs should be further explored as a viable treatment strategy with minimal associated risk in young people with BPD.
Canadian Journal of Psychiatry, 58(7) : 402-408
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Allott, K. A., Cotton, S. M., Chinnery, G. L., Baksheev, G. N., Massey, J., Sun, P., Collins, Z., Barlow, E., Broussard, C., Wahid, T., Proffitt, T. M., Jackson, H. J., Killackey, E.
Aims: To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6. months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). Methods: 135 FEP participants (IPS n= 69; TAU n= 66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6. months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. Results: Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6. months was predicted by enrolment in education at baseline (p= .002) and poorer visual organisation and memory (p= .024). Employment over 6. months was predicted by employment at baseline (p= .041) and receiving IPS (p= .020). Better visual organisation and memory predicted total hours of paid work over 6. months (p< .001). Conclusions: Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP. (copyright) 2013 Elsevier B.V.
Schizophrenia Research, 150(1) : 136-143
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
Armijo, J., Mendez, E., Morales, R., Schilling, S., Castro, A., Alvarado, R., Rojas, G.
Background: In Chile, the clinical guidelines "for the treatment of people from first episode of schizophrenia" aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. Objectives: This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. Methodology: An electronic search was carried out using PUBMED, LILACS, and Science Direct as databases. Criteria of inclusion: (i) randomized clinical trials, (ii) Community-based interventions, (iii) diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). Exclusion Criteria: (i) treatments exclusively pharmacological, (ii) interventions carried out in inpatient settings, (iii) bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). Results: Sixty-six articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. Conclusion: Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia. (copyright) 2013 Armijo, Mendez, Morales, Schilling, Castro, Alvarado and Rojas.
Frontiers in Psychiatry, 4(OCT) :
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement
Chien, W. T., Chan, S. W. C.
Background: Positive effects on the relapse from illness and compliance with medication by patients have been observed from family intervention for schizophrenia. However, little attention has been paid to the effects on family members, particularly those in non-Western countries. Inconsistent and inconclusive findings were found on the family-related outcomes and longer-term effects of family intervention.; Objective: This study tested the effects of a nine-month family-led mutual support group for Chinese people with schizophrenia, compared with a psycho-education group and standard psychiatric care over a 24-month follow-up.; Design: A randomised controlled trial [registered with ClinicalTrials.gov (NCT00940394)] with repeated-measures, three-group design.; Settings: Two regional psychiatric outpatient clinics in Hong Kong.; Participants: One hundred and thirty-five Chinese family caregivers and their patients with schizophrenia were randomly recruited, of whom 45 family dyads received family-led mutual support group, a psycho-education group, or standard care.; Methods: After completing the pre-test questionnaire, the participants were randomly assigned into one of the three study groups. The mutual support and psycho-education groups comprised 14 two-hour group sessions, with patients participating in at least 5 sessions. Those in standard care (and two treatment groups) received routine psychiatric care. Multiple patient and family-related psychosocial outcomes were compared at recruitment and at one week, 12 months, and 24 months following interventions.; Results: One hundred and twenty-six of 135 family dyads completed the three post-tests and 43 (95.6%) attended at least nine group sessions (60%) of the mutual support group programme. Mean ages of the family caregivers in the study ranged from 41.2 (SD=7.0) to 42.7 (SD=7.6) years. About two-thirds of the caregivers were male and patients' parent or spouse. The results of multivariate analysis of variance followed by Helmert contrasts tests indicated that the participants in the mutual support group indicated significantly greater improvement in family and patient functioning [F(2, 132)=5.40, p=0.005 and F(2, 132)=6.88, p=0.001, respectively] and social support for families [F(2, 131)=5.01, p=0.005], and in reducing patients' symptom severity [F(2, 132)=4.65, p=0.01] and length of re-hospitalisations [F(2, 132)=4.78, p=0.01] at 12- and 24-month follow-ups.; Conclusions: Family-led mutual support group for schizophrenia produces longer-term benefits to both the patients' and families' functioning and relapse prevention for patients, compared with psycho-education and standard care. This group programme can be an effective family intervention for Chinese people with schizophrenia.; Copyright © 2013 Elsevier Ltd. All rights reserved.
International Journal of Nursing Studies, 50(10) : 1326-1340
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Supportive therapy
Chien, W. T., Yip, A. L. K.
During the last three decades, an increasing understanding of the etiology, psychopathology, and clinical manifestations of schizophrenia spectrum disorders, in addition to the introduction of second-generation antipsychotics, has optimized the potential for recovery from the illness. Continued development of various models of psychosocial intervention promotes the goal of schizophrenia treatment from one of symptom control and social adaptation to an optimal restoration of functioning and/or recovery. However, it is still questionable whether these new treatment approaches can address the patients' needs for treatment and services and contribute to better patient outcomes. This article provides an overview of different treatment approaches currently used in schizophrenia spectrum disorders to address complex health problems and a wide range of abnormalities and impairments resulting from the illness. There are different treatment strategies and targets for patients at different stages of the illness, ranging from prophylactic antipsychotics and cognitive-behavioral therapy in the premorbid stage to various psychosocial interventions in addition to antipsychotics for relapse prevention and rehabilitation in the later stages of the illness. The use of antipsychotics alone as the main treatment modality may be limited not only in being unable to tackle the frequently occurring negative symptoms and cognitive impairments but also in producing a wide variety of adverse effects to the body or organ functioning. Because of varied pharmacokinetics and treatment responsiveness across agents, the medication regimen should be determined on an individual basis to ensure an optimal effect in its long-term use. This review also highlights that the recent practice guidelines and standards have recommended that a combination of treatment modalities be adopted to meet the complex health needs of people with schizophrenia spectrum disorders. In view of the heterogeneity of the risk factors and the illness progression of individual patients, the use of multifaceted illness management programs consisting of different combinations of physical, psychological, and social interventions might be efficient and effective in improving recovery. (copyright) 2013 Chien and Yip. This work is published by Dove Medical Press Ltd.
Neuropsychiatric Disease & Treatment, 9 : 1311-1332
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Barlati, S., Deste, G., DePeri, L., Ariu, C., Vita, A.
Objectives. This study is aimed to review the current scientific literature on cognitive remediation in schizophrenia. In particular, the main structured protocols of cognitive remediation developed for schizophrenia are presented and the main results reported in recent meta-analyses are summarized. Possible benefits of cognitive remediation in the early course of schizophrenia and in subjects at risk for psychosis are also discussed. Methods. Electronic search of the relevant studies which appeared in the PubMed database until April 2013 has been performed and all the meta-analyses and review articles on cognitive remediation in schizophrenia have been also taken into account. Results. Numerous intervention programs have been designed, applied, and evaluated, with the objective of improving cognition and social functioning in schizophrenia. Several quantitative reviews have established that cognitive remediation is effective in reducing cognitive deficits and in improving functional outcome of the disorder. Furthermore, the studies available support the usefulness of cognitive remediation when applied in the early course of schizophrenia and even in subjects at risk of the disease. Conclusions. Cognitive remediation is a promising approach to improve real-world functioning in schizophrenia and should be considered a key strategy for early intervention in the psychoses. (copyright) 2013 Stefano Barlati et al.
Schizophrenia Research & Treatment, :
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Eack, S. M., Mesholam-Gately, R. I., Greenwald, D. P., Hogarty, S. S., Keshavan, M. S.
Cognitive rehabilitation has shown beneficial effects on cognition in patients with schizophrenia, which may also help to improve negative symptoms due to overlapping pathophysiology between these two domains. To better understand the possible relationship between these areas, we conducted an exploratory analysis of the effects of Cognitive Enhancement Therapy (CET) on negative symptoms. Early course schizophrenia outpatients (n = 58) were randomized to 2 years of CET or an Enriched Supportive Therapy (EST) control condition. Results revealed significant and medium-sized (d = 0.61) differential improvements favoring CET in overall negative symptoms, particularly social withdrawal, affective flattening, and motor retardation. Neurocognitive improvement was associated with reduced negative symptoms in CET, but not EST patients. No relationships were observed between improvements in emotion processing aspects of social cognition, as measured by the Mayer-Salovey-Caruso Emotional Intelligence Test, and negative symptoms. CET represents an effective cognitive rehabilitation intervention for schizophrenia that may also have benefits to negative symptoms. Future studies specifically designed to examine negative symptoms during the course of cognitive rehabilitation are needed. (copyright) 2013 Elsevier Ireland Ltd.
Psychiatry Research, 209(1) : 21-26
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy, Supportive therapy
Diaz, I., Pelayo-Teran, J. M., Perez-Iglesias, R., Mata, I., Tabares-Seisdedos, R., Suarez-Pinilla, P., Vazquez-Barquero, J. L., Crespo-Facorro, B.
The aim of the study was to identify predictors associated with a lower likelihood of achieving a clinical remission 1 year after the first break of the illness. Participants were 174 consecutive subjects included in a first episode programme with no prior treatment with antipsychotic medication. Patients were assigned to haloperidol, olanzapine or risperidone in a randomized, open-label, prospective clinical trial. The main outcome variable was the remission criteria developed by the Remission in Schizophrenia Working Group. Clinical variables were included in a logistic regression analysis in order to predict the remission state at 1 year. At 1 year, 31% of patients met criteria for remission. The logistic regression analysis revealed that the strongest predictors of achieving clinical remission 1 year away from a first episode of non-affective psychosis were the length of duration of untreated psychosis (DUP), the severity of negative symptomatology and the educational level attained at baseline. The results suggest that: (1) patients with a lengthy DUP, a greater severity of negative symptomatology at baseline and with a lower education level are in a higher risk of not achieving a clinical remission during the first year of treatment; and (2) early intervention clinical programs should aim to reduce the length of DUP in order to provide a better outcome for patients. Copyright (copyright) 2012 Elsevier Ireland Ltd. All rights reserved.
Psychiatry Research, 206(2-3) : 181-187
- Year: 2013
- 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)
Emsley, R., Chiliza, B., Asmal, L., Mashile, M., Fusar-Poli, P.
Aim: There are sound reasons for considering the use of long-acting injectable antipsychotics early in the course of schizophrenia. We reviewed available literature on the subject. Method: We conducted an electronic database search and critically reviewed all studies in which a long-acting injectable antipsychotic was evaluated in early psychosis patients. Results: There is a need for well-designed studies as most of those reported were open-label and non-comparative, and samples were frequently small. Conclusions: The available evidence does suggest that long-acting injectable antipsychotics can be used safely and effectively in early stages of the illness, and that they may be associated with better outcomes than with oral medications. However, this is largely supported by evidence from naturalistic cohort studies and a small number of controlled trials of risperidone long-acting injection. Evidence for olanzapine and paliperidone long-acting injectables in particular is limited. (copyright) 2013 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 7(3) : 247-254
- Year: 2013
- 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)
, Service Delivery & Improvement, Other service delivery and improvement interventions