Disorders - Psychosis Disorders
Penn, D. L., Uzenoff, S. R., Perkins, D., Mueser, K. T., Hamer, R., Waldheter, E., Saade, S., Cook, L.
The Graduated Recovery Intervention Program (GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first episode psychosis were randomized to GRIP. +. TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life. Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation. (copyright) 2010 Elsevier B.V.
Schizophrenia Research, 125(2-3) : 247-256
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Volavka, Jan, Czobor, Pal, Derks, Eske M., Bitter, Istvan, Libiger, Jan, Fleischhacker, W. Wolfgang
Objective: To compare the effects of haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on hostility in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. Method: We used the data acquired in the European First-Episode Schizophrenia Trial, an open, randomized trial (conducted in 14 countries) comparing 5 antipsychotic drugs in 498 patients aged 18–40 years with first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. DSM-IV diagnostic criteria were used. Patients were assessed between December 23, 2002 and January 14, 2006. Most subjects joined the study as inpatients and then continued with follow-ups in outpatient clinic visits. The Positive and Negative Syndrome Scale (PANSS) was administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. We analyzed the scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility (a score > 1) at baseline. We hypothesized (1) that the treatments would differ in their efficacy for hostility and (2) that olanzapine would be superior to haloperidol. Our primary statistical analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time. Secondary analysis addressed the question of whether the effects on hostility found in the primary analysis were specific to this item. All our analyses were post hoc. Results: The primary analysis of hostility indicated an effect of differences between treatments (F[sub]4,889[/sub] = 4.02, P = .0031). Post hoc treatment-group contrasts for hostility change showed that, at months 1 and 3, olanzapine was significantly superior (P < .05) to haloperidol, quetiapine, and amisulpride in reducing hostility. Secondary analyses demonstrated that these results were at least partly specific to hostility. Conclusions: Both hypotheses were supported. Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia, schizoaffective disorder, and schizophreniform disorder. This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects and propensity to cause weight gain. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Clinical Psychiatry, 72(7) : 955-961
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Vinogradov, S., Fisher, M., Loewy, R. L., Lee, A., Moua, K., Pham, L., Niendam, T. A., Daniel Ragland, J., Carter, C. S.
Background: The cognitive deficits that characterize patients with established schizophrenia are present even before illness onset and typically worsen as the individual progresses into the first episode of psychosis. Moreover, the severity of the initial deficits predicts functional outcome several years later. Cognitive dysfunction thus should be a primary target for aggressive early intervention in young recent-onset populations. Methods: We applied neuroplasticity-based cognitive training to 50 young individuals within 5 years of onset of their first psychotic episode (mean age of 21 years). We performed a 2-site randomized controlled trial of 40 hours of cognitive training vs. 40 hours of commercial computer games, delivered over 8 weeks. We examined MATRICS-recommended neurocognitive outcome measures, symptoms, and role functioning. Results: Subjects in the auditory training group demonstrated significant improvements in global cognition (P = .03), verbal learning and memory (P = .02), and problemsolving (P = .05), as compared with computer games control subjects, and gains in speed of processing approaching trend level (P = .13). There were no significant differences in symptoms or functional outcome measures in this short time period. Conclusion: Neuroplasticity-based cognitive training represents a highly promising treatment approach to target the cogni- tive dysfunction in early psychosis. Future studies must investigate whether it improves long-term outcome and community functioning, and how best to integrate it into critical psychosocial interventions such as supported education and supported employment.
Schizophrenia Bulletin, 37 : 325-326
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Morse, Megan, Procter, Nicholas
Aims and objectives: The aim of this paper is to examine high-level evidence in early intervention in psychosis and scope the potential role of the mental health nurse-practitioner in the treatment of management of early psychosis. Background: Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long-term disability. As specialised early intervention in psychosis is emerging, the nurse-practitioner role in mental health is also gaining momentum. The background literature highlights several critical synergies between nurse-practitioners’ scope of practice and needs of patients with early psychosis. Design: Literature review. Method: Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was limited to articles published between 1988–2009. Eligible studies were limited to systematic reviews and randomised controlled trials. Results: Two systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse-practitioner role in early psychosis. Conclusions: Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental health nurse-practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social inclusion and social connectedness. Relevance to clinical practice: Mental health nurse-practitioners have the potential to provide specialist support to meet the needs of this complex group. Central to this is an ability to build an evidence-base around the treatment and management of people with early psychosis and deliver effective education and leadership across clinical, inter-professional and organisational domains. The paper concludes by positing a set of recommendations for nurse-practitioners in the field of early psychosis in the Australian mental health setting. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Clinical Nursing, 20(19-20) : 2702-2711
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
, First episode (psychosis only)
, Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement
Stauffer, Virginia L., Case, Michael, Kinon, Bruce J., Conley, Robert, Ascher-Svanum, Haya, Kollack-Walker, Sara, Kane, John, McEvoy, Joseph, Lieberman, Jeffrey
Early response to antipsychotic medication has been shown to accurately predict later response to continued use of the same treatment in patients with chronic schizophrenia. This study examines whether this predictive pattern exists for patients with first-episode psychosis. We used a data-driven threshold for early response of ≥ 26.2% improvement from baseline on the Positive and Negative Syndrome Scale (PANSS[sub]0–6[/sub]) Total score to determine whether response at Week 2 of treatment may predict response at Week 12 in a randomized, double-blind trial of olanzapine versus haloperidol for treatment of patients with first-episode psychosis (N = 225). Later response was defined as a ≥ 40% and ≥ 50% improvement in PANSS Total[sub]0–6[/sub] score and as remission. At Week 2, 43% (97/225) of patients were identified as early responders. At a threshold for later response of ≥ 50% improvement in PANSS0–6 Total score, early non-response most strongly predicted later non-response, demonstrating high specificity (74%) and high negative predictive value (80%). As had been seen in the treatment of patients with chronic schizophrenia, early non-response was a robust predictor of subsequent non-response in the treatment of patients with first-episode psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Psychiatry Research, 187(1-2) : 42-48
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Subotnik, K. L., Ventura, J., Gretchen-Doorly, D., Luo, J. S., Casaus, L. R., Hellemann, G. S., Victoria, A., Nuechterlein, K. H.
Background: Short acting oral antipsychotic medication is more commonly used than long-acting injectable forms, but the effectiveness of oral medications is hampered by poor adherence. Methods: We are comparing the clinical efficacy of the long-acting injectable formulation of risperidone (RLAI) to the oral form in a 12-month randomized controlled trial in recent- onset schizophrenia patients. This is a preliminary report from a sample of first-episode schizophrenia patients (Sample 4) of the Developmental Processes in Schizophrenic Disorders Project (PI: Keith Nuechterlein, Ph.D.), conducted at the UCLA Aftercare Research Program. The enrollment target is 110. Interim analyses were conducted with 61 recent-onset schizophrenia patients who were randomized to injectable vs. oral risperidone. Results: To date, only 1 patient has refused to continue treatment at the time of randomization to RLAI, and 1 other discontinued after only 2 injections. There were notable clinical advantages of risperidone long-acting injectable (RLAI). The rate of psychotic relapse was lower (7% vs. 31%), time without relapse was longer (means of 350 vs. 300 days, P = .013), and the rate of early discontinuation of treatment for any reason was significantly lower (17% vs. 41%, P = .04) for the RLAI group compared with the oral risperidone group. Over the initial 6 months of treatment for 49 patients who completed 6 months or longer of the protocol, the RLAI group had reductions in Brief Psychiatric Rating Scale (BPRS) symptoms of Unusual Thought Content (P = .03), Conceptual Disorganization (P=.05), Hostility (P =. 02), and Emotional Withdrawal (P = .04), and increased Motor Retardation (P = .03), relative to the oral risperidone patient group. Each patient's adherence was rated on a 1-5 scale based on timeliness of injections for RLAI, and pill counts, patient reports, plasma levels, and psychiatrist judgments for oral medication. Adherence with oral risperidone did not differ prior to randomization, but adherence was much better for injectable compared with oral medication during the randomized treatment (P < .001). Medication adherence significantly predicted psychotic relapse (P = .017). Medication adherence was significantly associated with improvement on a number of symptoms on the BPRS over the initial 6 months. Conclusion: If these findings are confirmed in the full sample, they will support the use of RLAI in the early course of schizophrenia.
Schizophrenia Bulletin, 37 : 323
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Robles, Olalla, Zabala, Arantzazu, Bombin, Igor, Parellada, Mara, Moreno, Dolores, Ruiz-Sancho, Ana, Arango, Celso
The primary purpose of this study was to compare changes in cognition in early-onset psychosis after 6-months treatment with quetiapine or olanzapine. This is a randomized, single-blind, 6-month study in 50 adolescents with a diagnosis of early-onset psychosis. Patients were randomized to quetiapine (n = 24) or olanzapine (n = 26). A thorough neuropsychological battery was administered at baseline and after 6-month treatment. Out of the total sample included in the study, 32 patients completed at least 6-months treatment with the assigned medication (quetiapine, n = 16; olanzapine, n = 16). No changes were observed in cognitive performance after 6-month treatment with quetiapine or olanzapine. Although some trends toward cognitive improvement were observed for the olanzapine group after 6-month treatment, neither group showed statistically significant gains. Furthermore, there was no evidence of any differential efficacy of olanzapine or quetiapine on cognitive improvement in this sample of adolescents with psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Schizophrenia Bulletin, 37(Suppl 2) : 405-415
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Schennach-Wolff, R., Jager, M., Mayr, A., Meyer, S., Kuhn, K. U., Klingberg, S., Heuser, I., et-al
Background: To evaluate the predictive validity of early response compared to other well-known predictor variables in acutely ill first-episode patients. Methods: 112 patients were treated with a mean dosage of 4.14. mg ((plus or minus) 1.70) haloperidol and 112 patients with a mean dosage of 4.17. mg ((plus or minus) 1.55) risperidone for a mean inpatient treatment duration of 42.92. days ((plus or minus) 16.85) within a double-blind, randomized controlled trial. Early response was defined as a (greater-than or equal to) 30% improvement in the PANSS total score by week 2, response as a (greater-than or equal to) 50% reduction in the PANSS total score from admission to discharge and remission according to the consensus criteria. Univariate tests and logistic regression models were applied to identify significant predictors of response and remission. Results: 52% of the patients were responders and 59% remitters at discharge. Non-remitters at discharge were hindered from becoming remitters mainly by the presence of negative symptoms. Univariate tests revealed several significant differences between responders/non-responders and remitters/non-remitters such as age, severity of baseline psychopathology as well as the frequency of early response. Both early response (p < 0.0001) and a higher PANSS positive subscore at admission (p = 0.0002) were identified as significant predictors of response at discharge, whereas a shorter duration of untreated psychosis (p = 0.0167), a lower PANSS general psychopathology subscore (p < 0.0001), and early treatment response (p = 0.0002) were identified as significant predictors of remission. Conclusion: Together with the finding that early response is a significant predictor of response and remission, the relevance and predictive validity of negative and depressive symptoms for outcome is also highlighted. (copyright) 2010 Elsevier B.V.
European Neuropsychopharmacology, 21(5) : 370-378
- Year: 2011
- 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)
Sevy, S., Robinson, D. G., Sunday, S., Napolitano, B., Miller, R., McCormack, J., Kane, J.
The purpose of this study is to compare the efficacy of olanzapine and risperidone for the acute treatment of first-episode schizophrenia patients with cannabis use disorders. This secondary analysis of a previously published study included 49 first-episode patients with a diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a co-occurring lifetime diagnosis of cannabis use disorders randomly assigned to treatment with either olanzapine (n = 28) or risperidone (n = 21) for 16. weeks. The olanzapine group did not differ significantly from the risperidone group for initial response rates of positive symptoms, and rates of cannabis use or alcohol use during the study. Positive symptoms and the Scale for Assessment of Negative Symptoms (SANS) global asociality-anhedonia scores improved over time but did not differ between study medications. In both groups, cannabis use during the study was higher in patients who used cannabis within three months of the admission. Thus, our results suggest that olanzapine and risperidone had a similar initial efficacy on psychotic symptoms and substance use in first-episode patients with co-occurring cannabis use disorders. If clinicians are choosing between olanzapine versus risperidone treatment for this population, their decision should be based upon factors other than symptom response and short-term substance misuse. (copyright) 2011 Elsevier Ltd.
Psychiatry Research, 188(3) : 310-314
- Year: 2011
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Scoriels, Linda, Barnett, Jennifer H., Murray, Graham K., Cherukuru, Srinivasarao, Fielding, Mark, Cheng, Frances, Lennox, Belinda R., Sahakian, Barbara J., Jones, Peter B.
Background: Emotional impairments are important determinants of functional outcome in psychosis, and current treatments are not particularly effective. Modafinil is a wake-promoting drug that has been shown to improve emotion discrimination in healthy individuals and attention and executive function in schizophrenia. We aimed to establish whether modafinil might have a role in the adjuvant treatment of emotional impairments in the first episode of psychosis, when therapeutic endeavor is arguably most vital. Methods: Forty patients with a first episode of psychosis participated in a randomized, double-blind, placebo-controlled crossover design study testing the effects of a single dose of 200 mg modafinil on neuropsychological performance. Emotional functions were evaluated with the emotional face recognition test, the affective go-no go task, and the reward and punishment learning test. Visual analogue scales were used throughout the study to assess subjective mood changes. Results: Modafinil significantly improved the recognition of sad facial expressions (z = 2.98, p = .003). In contrast, there was no effect of modafinil on subjective mood ratings, on tasks measuring emotional sensitivity to reward or punishment, or on interference of emotional valence on cognitive function, as measured by the affective go-no go task. Conclusions: Modafinil improves the analysis of emotional face expressions. This might enhance social function in people with a first episode of psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Biological Psychiatry, 69(5) : 457-464
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Zhang, J., Gallego, J., Robinson, D., Malhotra, A., Kane, J., Correll, C.
Background: Although early treatment choice in first episode schizophrenia is considered important, no meta-analysis has compared individual first-generation antipsychotics (FGAs) with second-generation antipsychotics (SGAs). Methods: Meta-analysis of randomized, head-to-head trials comparing SGAs with FGAs in first episode schizophrenia. Primary outcomes were total psychopathology change, response rate and all-cause discontinuation. Secondary outcomes included specificcause discontinuation, psychopathology ratings and adverse effects. Results: Pooling data by antipsychotic class across 13 trials (n=2509), SGAs were not different from FGAs regarding total psychopathology change, response rates, positive symptoms, Clinical Global Impressions, patient's choice discontinuation, long-term remission, and metabolic changes. Conversely, SGAs significantly outperformed FGAs regarding negative symptoms, depression, global cognition, lower discontinuation due to any cause, inefficacy and intolerability, and less EPS, akathisia, use of anticholinergics and benzodiazepines, being associated with significantly greater weight gain (p values: <0.05-0.01). Concerning individual SGA comparisons with an FGA, amisulpride and olanzapine outperformed FGAs in 8 and 9 out of 13 efficacy outcomes, respectively, risperidone in 4, quetiapine in 3, and clozapine and ziprasidone in 1, each. Weight gain occurred significantly more with olanzapine, clozapine and risperidone. Olanzapine caused significantly greater cholesterol increase, whereas amisulpride and ziprasidone were associated with lower triglycerides and glucose changes, respectively (p values: <0.05-0.01). Discussion: Amisulpride and olanzapine and, to a lesser degree, risperidone and quetiapine were superior to FGAs in first episode schizophrenia, but weight and metabolic problems were also greater with olanzapine. Clinicians need to individualize treatment decisions, weighing different aspects of efficacy, tolerability, availability and cost.
* ABSTRACT ONLY*
Neuropsychopharmacology, 36 : S175
- Year: 2011
- 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)
Thorup, Anne, Petersen, Lone, Jeppesen, Pia, Nordentoft, Merete
Background: Aim: Method: Results: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was investigated in the 'OPUS' study by analysing data concerning quality of life.We aimed to investigate the 'quality of life from patients' perspective' among a cohort of young adults with a first-episode psychosis at the time of treatment initiation and after two years. Especially, we were interested in analysing if there were any significant effects on the subjective quality of life of receiving an intensive psychosocial assertive community treatment called 'OPUS' compared to standard treatment (ST).This study is part of the Danish 'OPUS' trial, a randomised controlled trial (RCT) comparing 'treatment as usual' (standard treatment, ST) with 'OPUS' treatment. The Lancashire Quality of Life Profile (LQoLP), which is a combined objective and subjective instrument, was administered at baseline and after two years of treatment, N=280.The intensive 'OPUS' treatment did not affect the quality of life measured by Lancashire QoLP in a significantly different way from the standard treatment (ST). There were no significant differences in quality of life between the ST group and the OPUS group concerning the 9 life domains. Quality of life correlated with psychopathology (both psychotic and negative symptoms) to a minor extent and more strongly with the affective balance and level of self-esteem.
Schizophrenia Research, 116(1) : 27-34
- Year: 2010
- 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, Other service delivery and improvement interventions