Disorders - Psychosis Disorders
Zhornitsky, S., Stip, E.
Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients. Copyright (copyright) 2012 Simon Zhornitsky and Emmanuel Stip.
Schizophrenia Research & Treatment, :
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Marvin, S. E., Miklowitz, D. J., O'Brien, M. P., Cannon, T. D.
Objective: This study tested treatment fidelity in a randomized controlled trial of family-focused therapy for adolescents and young adults at clinical high risk for psychosis (CHR youth). Methods: The treatment sample included 110 youth ages 12-30 with prodromal psychosis and their families. The Therapist Adherence and Competence Scale (TCAS; Weisman et al., 1998; Miklowitz & O'Brien, 2009) was used to rate 24 therapists across 8 sites on demonstrated skill in providing the FFT-PY or a 3-session psychoeducation control, enhanced care (EC). The TCAS includes items measuring techniques specific to FFT-PY as well as nonspecific factors that were not expected to differ across treatment conditions. Results: Raters classified 90% of FFT and EC cases as 'good' (5) or better (6-7) on a 1-7 scale of overall fidelity. TCAS ratings indicated that FFT-PY included a greater emphasis on communication ((chi)2(2, n = 82) = 70.11, P = .001) and problem solving skills ((chi)2(2, n = 83) = 44.73, P = .001) training, but that the quality of nonspecific factors, such as rapport, did not differ between FFT-PY and EC, F(1,170) = .28, P > .05. Levels of family conflict and levels of prodromal symptomatology were not associated with fidelity ratings. Conclusion: High levels of fidelity were obtained in a multi-site study of family intervention for CHR youth, despite variability in level of prodromal symptom severity and family conflict. Future studies should examine which specific therapeutic components of FFT are associated with positive outcomes of clinical high-risk conditions.
Early Intervention in Psychiatry, 6 : 95
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Malla, A., Norman, R., Iyer, S., Joober, R., Brown, T., Schmitz, N., Nordentoft, M., Latimer, E., Jarvis, E., Abdel-Baki, A.
The benefits of specialized early intervention services (SEIS) for psychotic disorders in the first two years have been reasonably well established. Recent evidence suggests that returning to regular care after 2 years of SEIS results in failure to sustain the benefits over the subsequent 3 years, achieved during SEIS tenure. Recently we have reported that a reduced intensity SEI services for an additional three years results in significantly better outcome (Norman et al., 2011). In order to influence mental health policy in publicly funded mental health systems, further evidence is required through a randomized controlled evaluation of an extension of SEIS from 2 to 5 years in comparison to regular care after the initial 2 years of SEIS. In this presentation we will report such an approach and interim results from a RCT using rates of sustained engagement, length of remission and health economic indices as outcome measures. We will present methodological issues and data based on interim analyses (N = 162, SEIS = 82, RC = 80; mean length in the study = 24 months) to show that sustained disengagement rates are significantly higher in the regular care condition (27%) compared to SEIS (13%) and higher proportion of patients in SEIS are in complete remission compared to RC (34% vs. 23% at 12 months, and 50% vs. 33% at 24 months). These preliminary results, based on 80% of the total sample (N = 212) thus far recruited and at a mean of 24 months in the study, are encouraging. Difficulties associated with conducting a servicebased trial are also discussed.
Early Intervention in Psychiatry, 6 : 36
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Lawlor, E., Madigan, K., Russell, V., O'Connor, J. J., Turner, N., Clarke, M., Waddington, J., O'Callaghan, E.
Background: A Cochrane review of 25 randomized controlled trials of psychosis and comorbid substance use found little evidence of effective strategies to improve outcome amongst this cohort. Few studies have evaluated a group based intervention and none have utilized a group based cognitive behavioural therapy approach combined with motivational interviewing. Aim: We adapted the Cannabis and Psychosis (CAP) individual programme to a group-based format for those with early phase psychosis and cannabis abuse. The final intervention consisted of 12 weekly sessions and was based upon motivational interviewing, cognitive behavioural therapy and psychoeducation. The six phases included: (i) entry: gaining commitment to treatment; (ii) commitment: building commitment to a goal of nonproblematic substance misuse; (iii) goal setting: reinforcing commitment to change and development of goal achievement strategies; (iv) challenges: withdrawal counseling; (v) relapse prevention and lifestyle: early warning signs, healthy living; (vi) maintenance: coping skills. Results: In total 230 individuals were referred to the trial. Of those referred, 72 (31%) did not meet inclusion criteria and 70 (30.4%) refused. Of the remainder, 88 were randomized on a 2 : 1 ratio, 59 (26%) to intervention and 29 (13%) to treatment as usual. However 32 (14%) individuals allocated to the intervention declined to participate in the group based programme. Conclusion: It is difficult to engage participants with early phase psychosis and comorbid cannabis use with a group psychological intervention aimed at improving outcome in psychosis. Innovative engagement strategies are needed with this cohort.
Early Intervention in Psychiatry, 6 : 28
- Year: 2012
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation
Killackey, E.
Background: While first episode psychosis (FEP) services have developed in Australia since the mid 1980s, there has been less consideration of interventions around employment until recently. This presentation will summarize the system context in Australia and the results of an Australian randomized controlled trial of individual placement and support (IPS). Methods: A group of 41 people with FEP wanting to find work were randomized to IPS (n=20) or treatment-asusual (TAU, n=21). The IPS group worked with an employment consultant for a six month period. Those in TAU could access clinical services and external vocational agencies. Assessments were at baseline and six months. Findings: More of the IPS group were employed or education than those in TAU (17 vs 6, p=0.000) at follow up. For employment only there was a significant difference (13 vs 2, p=0.000). Those in IPS had a higher median income ($2432 vs $0, p=0.012) and worked more hours per week (median 38 vs 22.5, p=0.006) and more weeks (median 5.0 vs 0, p=0.021). The IPS group also showed significantly reduced use of welfare benefits. Conclusions: The IPS approach has great potential for those with FEP. This study shows that the results achieved at outcome are significantly better than high quality TAU. These results also indicate that this approach is well suited to the Australian labour market and mental health system.
Australian & New Zealand Journal of Psychiatry, 46 : 47
- Year: 2012
- 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, Individual placement and support (IPS), vocational interventions
Kopelowicz, A., Zarate, R., Wallace, C. J., Liberman, R. P., Lopez, S. R., Mintz, J.
Context: Evidence-based interventions to improve medication adherence among patients with schizophrenia are lacking. Although family psychoeducation has demonstrated efficacy in improving outcomes in schizophrenia, empirical support for its ability to enhance medication adherence is scarce. Objective: To determine whether a culturally adapted, multifamily group (MFG) therapy would increase medication adherence and decrease psychiatric hospitalizations for Spanish-speaking Mexican Americans with schizophrenia. Design: A total of 174 Mexican American adults with schizophrenia-spectrum disorder and their key relatives were studied in a 3-armed, randomized controlled trial of MFG therapy focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18, and 24 months. Setting: Two community mental health centers in Los Angeles, California. Participants: Patients had a diagnosis of schizophrenia or schizoaffective disorder with a recent exacerbation of psychotic symptoms and nonadherence to medication before enrollment. Intervention: Patients participated in 1 of 2 MFGs (MFG-adherence or MFG-standard) or treatment as usual. Groups convened twice monthly in 90-minute sessions for 1 year. Main Outcome Measures: The Treatment Compliance Interview uses multiple sources of information to quantify medication adherence. Computerized records were used to collect information on the use of inpatient resources. Results: At the end of the 1-year treatment, MFG-adherence was associated with higher medication adherence than MFG-standard or treatment as usual only (F=6.41; P=.003). The MFG-adherence participants had a longer time to first hospitalization ((chi)2=13.3; P=.001) and were less likely to be hospitalized than those in MFG-standard ((chi)2=8.2; P=.04) and treatment as usual alone ((chi)2=11.3; P<.001). Increased adherence accounted for one-third of the overall effect of treatment on the reduced risk for psychiatric hospitalization. Conclusion: Multifamily group therapy specifically tailored to improve medication adherence through a focus on the beliefs and attitudes of the target population is associated with improved outcome for Mexican American adults with schizophrenia-spectrum disorders. Trial Registration: clinicaltrials.gov Identifier: NCT01125267. (copyright)2012 American Medical Association. All rights reserved.
Archives of General Psychiatry, 69(3) : 265-273
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Family therapy
Killackey, E. J., Allott, K. A., Cotton, S. M., Chinnery, G. L., Sun, P., Collins, Z., Massey, J., Baksheev, G., Jackson, H. J.
Vocational recovery has been consistently shown to be a number one priority of people with mental illness generally, and schizophrenia and first-episode psychosis (FEP) specifically. Two previous randomized controlled trials (RCT) demonstrated the benefit of an employment intervention called Individual Placement and Support (IPS) for young people with FEP. The current study was conducted in order to examine not only the vocational benefits of such an approach, but to study a wide range of predictors and consequences of vocational recovery in FEP. The aims of this presentation will be to present the data pertaining to vocational recovery within the first 6 months of this study. The study was a RCT of IPS plus treatment as usual (TAU) compared with TAU alone, conducted at EPPIC in Australia. Participants were 146 young people with FEP. Assessments were conducted at baseline, 6, 12 and 18 months. The IPS intervention was conducted between baseline and the 6-month assessment. There was no difference between groups in number currently in paid work at the 6-month time-point (IPS 44.8% and TAU 29.0%; (chi)2(1) = 3.42, p = 0.065). Over the 6-month period, there was no difference between groups in enrolment in formal education (IPS 53.7% and TAU 41.0%; (chi)2(1) = 2.08, p = 0.149). However, there was a significant difference favouring IPS in competitive employment rate over 6 months (IPS 70.3% and TAU 49.2%; (chi)2(1) = 5.74, p = 0.017). The preliminary results of this study indicate that IPS is effective at getting people into employment. Development of further interventions arising from these results will be discussed.
Early Intervention in Psychiatry, 6 : 13
- Year: 2012
- 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, Individual placement and support (IPS), vocational interventions
Malla, A., Chue, P., Jordan, G., Stip, E., Koczerginski, D., Milliken, H., Joseph, A., Williams, R., Adams, B., Manchanda, R., Oyewumi, K., Roy, M. A.
Few studies have examined effectiveness and tolerability of Risperdal Long Acting Injections (RLAI) in the early phase of psychosis using a randomized controlled design. Eighty four patients in early phase of a schizophrenia spectrum psychosis were randomized to receive either oral medications (n = 42) or RLAI (n = 42) over 2 years. Intent to treat analyses were conducted on all eligible participants (N = 77) for the stabilization (maximum 18 weeks) and maintenance phases (up to week 104) on outcome measures of symptoms, functioning, cognitive evaluations and side effects. Change over time within groups and differences between groups were evaluated. Time to stabilization and relapse were compared across groups using survival analyses. Participants in both groups showed improvement on Positive and Negative Symptoms Scale (PANSS) scores and Clinical Global Impression (CGI) scores as well as scores on Social Occupational Functioning Assessment Scale (SOFAS) but there were no significant differences between groups on time to stabilization or relapse. RLAI participants showed greater change on CGI and PANSS total and negative symptom scores during the stabilization phase while the oral medication group reached the same level of improvement during the maintenance phase. No significant differences were observed between the two groups on any other measure. The current study suggests RLAI is as safe, tolerable and efficacious as oral medications for those in the early phases of psychotic- illness. Thus, RLAI may be as appropriate as oral medications early in illness but may offer no particular advantage to patients willing to take medication.
Early Intervention in Psychiatry, 6 : 100
- Year: 2012
- 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)
, Atypical Antipsychotics (second generation)
Li, Y. M., Zhao, J. P., Ou, J. J., Wu, R. R.
Introduction: Although some previous studies have compared the 2 medicines, ziprasidone and olanzapine most selected chronic patients as subjects. Therefore, the present study was designed to compare the efficacy and safety of ziprasidone vs. olanzapine in naive first-episode schizophrenia.; Methods: 80 patients were randomly assigned to a 6-week treatment either with 80-160 mg/day of ziprasidone or 10-20 mg/day of olanzapine. The primary efficacy measurements were the Positive and Negative Syndrome Scale and Clinical Global Impression-severity scale scores. The second efficacy measurement was the response rate of treatment. Tolerability assessments were also performed.; Results: 79 patients completed the trial. The average dose was 127.5 mg/day with ziprasidone and 19.1 mg/day with olanzapine. No significant differences were found between the 2 groups in primary or secondary efficacy measurements at each visit point (all p>0.05). Body weight significantly increased with olanzapine, and more extrapyramidal symptoms were observed with ziprasidone (all p<0.05). Both medicines were well tolerated, and no serious adverse events were observed.; Conclusion: Ziprasidone was as effective as olanzapine in short-term treatment for first-episode schizophrenia, and both medicines were well tolerated.; © Georg Thieme Verlag KG Stuttgart · New York.
Pharmacopsychiatry, 45(5) : 177-181
- Year: 2012
- 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)
Lecomte, T., Leclerc, C., Wykes, T.
Our team recently conducted a randomized controlled trial comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group, for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12 months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels. Challenges regarding attrition with this clientele are discussed.
International Journal of Group Psychotherapy, 62(2) : 309-321
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Skills training
Leweke, F. M., Piomelli, D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer, C., Klosterkotter, J., Hellmich, M., Koethe, D.
Cannabidiol is a component of marijuana that does not activate cannabinoid receptors, but moderately inhibits the degradation of the endocannabinoid anandamide. We previously reported that an elevation of anandamide levels in cerebrospinal fluid inversely correlated to psychotic symptoms. Furthermore, enhanced anandamide signaling let to a lower transition rate from initial prodromal states into frank psychosis as well as postponed transition. In our translational approach, we performed a double-blind, randomized clinical trial of cannabidiol vs amisulpride, a potent antipsychotic, in acute schizophrenia to evaluate the clinical relevance of our initial findings. Either treatment was safe and led to significant clinical improvement, but cannabidiol displayed a markedly superior side-effect profile. Moreover, cannabidiol treatment was accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement. The results suggest that inhibition of anandamide deactivation may contribute to the antipsychotic effects of cannabidiol potentially representing a completely new mechanism in the treatment of schizophrenia.;
Translational Psychiatry, 2 : e94-e94
- Year: 2012
- 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)
, Other biological interventions
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jiminez, M., Wade, D., Crisp, K., Newman, B., Spiliotacopoulos, D., Lederman, R., McGorry, P. D.
The EPISODE II study was designed to evaluate the effectiveness of a combined individual and family-based psychosocial intervention for the purpose of preventing relapse in young first-episode patients who have reached remission on positive psychotic symptoms. Patient participants were recruited from the Early Psychosis Prevention and Intervention Centre and Barwon Health, Victoria Australia and randomized either to the relapse prevention therapy plus specialist first-episode treatment or to specialist treatment alone. Of the 81 patients who consented to be randomized, 63 of their carers participated in the study. Carers were followed up at 6-monthly interval for 30 months on measures of psychological morbidity and stress related to caregiving. The primary hypothesis was that, compared to family members receiving treatment as usual, family participants who received relapse prevention therapy would have signifi- cantly improved appraisals of stressors related to caregiving. Secondary hypotheses were that RPT would be associated with reduced expressed emotion and improved psychological distress. Outcome data showed that carers who received the relapse prevention therapy sustained significant improvements in stress related to caregiving over the 30 months follow-up. Time effects were evident for emotional over-involvement and for aspects of the appraisal of care giving. There were no significant effects for psychological morbidity. Despite the promising findings from this RCT, problems with sustaining specialist family interventions within mental health services are wide spread. In order to avoid this problem, the potential benefits of adapting the EPISODE II family intervention utilizing the 'moderated online social therapy (MOST)' model will be discussed.
Early Intervention in Psychiatry, 6 : 19
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
, Relapse prevention
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions