Disorders - Psychosis Disorders
Gleeson, J. F. M., Chanen, A., Cotton, S. M., Pearce, T., Newman, B., McCutcheon, L.
Aim: First-episode psychosis and borderline personality disorder are severe mental disorders that have their onset in youth. Their co-occurrence is clinically well recognized, is associated with significant risks and is complex to treat. Yet, there is no published specific intervention for this problem. This study reports a pilot randomized controlled trial comparing combined specialist first-episode treatment plus specialist early intervention for borderline personality, entitled Helping Young People Early, with specialist first-episode treatment alone. We aimed to evaluate the safety and feasibility of adding early intervention for borderline personality. Methods: The study investigated the safety of specialist first-episode treatment plus specialist early intervention for borderline personality in relation to deterioration in psychosis, aggression, self-harm and suicidality, and feasibility in relation to the completion of therapy phases. Sixteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) criteria for first-episode psychosis and borderline personality (four or more DSM-IV criteria) were randomized either to specialist first-episode treatment alone or specialist first-episode treatment plus specialist early intervention for borderline personality and were followed up at the end of treatment and 6months later. Results: The results showed that it was feasible to recruit and assess a high risk and complex group of patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality was an acceptable and safe treatment. Conclusion: A larger-scale randomized controlled trial of early intervention for borderline personality for young first-episode psychosis patients with co-occurring full or subsyndromal borderline personality is warranted. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(1) : 21-29
- Year: 2012
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
, Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive analytic therapy (CAT)
, Case management
Gallego, J. A., Robinson, D. G., John, M., Guveneck-Cokol, P. E., Greenberg, J. L., Kane, J.
Background: Antipsychotic maintenance treatment is critical to prevent the re-emergence of psychotic symptoms after the successful treatment of a first episode of schizophrenia. What level of adherence (and therefore actual dose ingested) is required to prevent the return of symptoms? We tested the hypothesis that patients who are partially adherent compared to those who were fully adherent to maintenance antipsychotic treatment would have greater levels of positive symptoms and also shorter time to first recurrence of positive symptoms. Methods: The sample consisted of 47 first-episode schizophreniaspectrum disorder patients who fulfilled stringent response criteria (a rating of mild or less on the positive symptom items on the Schedule for Affective Disorders and Schizophrenia Change version with psychosis and disorganization items [SADS C + PD] for two consecutive visits) within 16 weeks of starting randomized, controlled treatment with flexible-dosed olanzapine or risperidone. Subjects were assessed weekly, then biweekly and finally monthly for 3 years. For this analysis, follow-up data were censored at the time that subjects left their randomly assigned treatment for any reason. Adherence was determined based on data obtained from patients, family members and clinicians treating subjects. We defined the adherence reference dose as the antipsychotic dose at the time subjects first achieved response criteria. A mean adherence level was determined for each subject based on all weekly adherence ratings; this was converted to a percentage of the adherence reference dose. Based on mean adherence levels, subjects were classified as being fully adherent (>80% adherence reference dose), partially adherent (20-80%) or non-adherent ((less-than or equal to)20%). Survival analysis compared time to reemergence of positive symptoms (i.e. a rating of moderate or greater on one or more SADS C + PD psychosis items) between groups. Mixed model analyses were conducted to determine the longitudinal effect of partial adherence on repeated measures of positive symptoms, using a composite score of seven positive symptoms items (severity of hallucinations, severity of delusions, impaired understandability, derailment, illogical thinking, bizarre behavior and grandiosity) from the SADS C + PD scale. Results: The subjects were young (mean age of 22.7 years (SD=4.4)) and mostly male (n=32, 68%). Twenty (42.6%) patients had responded to olanzapine and 27 (57.4%) to risperidone. Mean dose at the time of response was 7.9 mg (SD: 3.7) with olanzapine and) and 2.9 mg (SD: 1.2) with risperidone. Analysis by adherence groups showed that 15 patients were in the 20-80% category and 32 patients were in the >80% category. No subjects were in the (less-than or equal to)20% category. Overall, 25 (53.2%) patients experienced a re-emergence of positive symptoms while on their original assigned antipsychotic. Fifteen of 31 (48.4%) fully adherent subjects and 10 of 16 (62.5%) partially adherent subjects experienced a recurrence of positive symptoms. Time to recurrence of positive symptoms did not differ between fully adherent and partially adherent groups (log rank test, x2=0.44, p=0.5). However, the mixed model analysis revealed a significant (P=0.0046) increase in positive symptom scores over time in those subjects who were partially adherent to treatment, contrary to the effect observed in fully adherent subjects, in whom positive symptom scores decreased or did not change over time. Conclusions: We found that first-episode schizophrenia spectrum disorder patients who were partially adherent to their maintenance antipsychotic medication had greater levels of positive symptoms over time compared to patients who are fully adherent to their maintenance medication. This is consistent with a prior study (Subotnik et al., 2011) that also examined the effect of partial adherence in a first episode schizophrenia sample. Our study design employed a low dose strategy for initial treatment. Our data suggest that further dose reduction during maintenance treatmen is not advisable.
Neuropsychopharmacology, 38 : S324-S325
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Guo, Xiaofeng, Zhang, Zhanchou, , Zhai, Jinguo, Fang, Maosheng, Hu, Maorong, Wu, Renrong, Liu, Zhening, Zhao, Jingping
Background: The relative effects of the atypical antipsychotic drugs and conventional agent on quality of life and psychosocial functioning in patients with early-stage schizophrenia is still uncertain because of an insufficient number of studies examining this issue.; Methods: In a 12 months open-label, prospective observational, multicenter study, 1029 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine or aripiprazole. The health-related quality of life and psychosocial functioning were assessed using Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the Global Assessment Scale (GAS) and the Activities of Daily Living Scale (ADL), respectively.; Results: At 12 months, treatment resulted in significant improvements in all 8 domain scores of SF-36, GAS and ADL score (all P-values< .001). However, only olanzapine and quetiapine groups demonstrated greater improvement in the role-psychical score of SF-36 and GAS score than did the chlorpromazine group (all P-values ≤ .002).; Conclusions: All antipsychotics may improve quality of life and social function in patients with early-stage schizophrenia, but further studies are needed to determine whether atypical antipsychotics are superior to conventional agents.; Copyright © 2012 Elsevier Inc. All rights reserved.
Comprehensive Psychiatry, 53(7) : 1006-1012
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Hegde, S., Rao, S. L., Raguram, A., Gangadhar, B. N.
Objective: We examined the effectiveness of a 2-month-long home-based cognitive retraining program together with treatment as usual (TAU; psychoeducation and drug therapy) on neuropsychological functions, psychopathology, and global functioning in patients with first episode schizophrenia (FES) as well as on psychological health and perception of level of family distress in their caregivers. Materials and Methods: Forty-five FES patients were randomly assigned to either treatment group receiving home-based cognitive retraining along with TAU (n=22) or to control group receiving TAU alone (n=23). Patients and caregivers received psychoeducation. Patients and one of their caregivers were assessed for the above parameters at baseline, post-assessment (2 months) and at 6-months follow-up assessment. Results: Of the 45 patients recruited, 12 in the treatment group and 11 in the control group completed post-intervention and follow-up assessments. Addition of home-based cognitive retraining along with TAU led to significant improvement in neuropsychological functions of divided attention, concept formation and set-shifting ability, and planning. Effect sizes were large, although the sample size was small. Conclusions: Home-based cognitive retraining program has shown promise. However, further studies examining this program on a larger cohort with rigorous design involving independent raters are suggested.
Indian Journal of Psychiatry, 54(1) : 15-22
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Jaugey, L., Urben, S., Pihet, S., Halfon, O., Holzer, L.
Background: The purpose of the present study was to investigate the short- and long-term effectiveness of a computer-assisted cognitive remediation (CACR) program in adolescents with psychosis or at high risk. Methods: 32 adolescents participated in a blinded 8-week randomized controlled trial of CACR treatment compared to computer games (CG). Clinical and neuropsychological evaluations were undertaken at baseline, at the end of the program and 4 months after finishing the study. Results: At short-term (N=28), results indicated that visuospatial abilities (Repeatable Battery for the Assessment of Neuropsychological Status, RBANS; p = .005) improved significantly more in the CACR group compared to the CG group. Other cognitive functions, psychotic symptoms and psychosocial functioning improved significantly, but at similar rates, in the two groups. At long-term (N=22), cognitive abilities did not demonstrated any amelioration in the control group while, in the CACR group, significant improvements in inhibition (Stroop; p = .040) and reasoning (Block Design Test; p = .005) were observed. In addition, symptom's severity decreased significantly in the control group (p = .046) and marginally in the CACR group (p = .088). Conclusions: CACR can be successfully administered in this population. CACR proved to be effective over and above CG for the most intensively trained cognitive ability. Finally, on the long-term, enhanced cognitive abilities (reasoning and inhibition abilities), which are necessary to execute higher-order goals or to adapt behavior to the ever-changing environment, were observed in adolescents benefiting from a CACR.
Biological Psychiatry, 71(8) : 84S
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Crespo-Facorro, Benedicto, Perez-Iglesias, Rocío, Mata, Ignacio, Martínez-Garcia, Obdulia, Ortiz, Victor, Pelayo-Teran, Jose Maria, Valdizan, Elsa, Vazquez-Barquero, José Luis
Rationale: To enhance the effectiveness of antipsychotics in first-episode psychosis is crucial in order to achieve the most favourable prognosis. Difference in effectiveness between antipsychotics is still under debate.; Objective: The purpose of this study is to determine the long-term (3-year) effectiveness and efficacy of haloperidol, risperidone and olanzapine in first-episode schizophrenia-spectrum disorders.; Method: This is a prospective, randomized, open-label study. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention programme of first-episode psychosis. One hundred seventy-four patients were randomly assigned to haloperidol (N = 56), olanzapine (N = 55), or risperidone (N = 63) and followed up for 3 years. The primary effectiveness measure was all-cause of treatment discontinuation. In addition, an analysis based on per-protocol populations was conducted in the analysis for clinical efficacy.; Results: The treatment discontinuation rate for any cause differed significantly between treatment groups (χ (2) = 10.752; p = 0.005), with a higher rate in haloperidol than in risperidone and olanzapine. The difference in the discontinuation rate between risperidone and olanzapine showed a tendency towards significance (χ (2) = 3.022; p = 0.082). There was a significant difference in the mean time to all-cause discontinuation between groups (log-rank χ ( 2 ) = 12.657;df = 2; p = 0.002). There were no significant advantages to any of the three treatments in reducing the psychopathology severity.; Conclusions: After 3 years of treatment, a lower effectiveness was observed in haloperidol compared to second-generation antipsychotics (SGAs). The use of SGAs for the treatment of early phases of nonaffective psychosis may enhance the effectiveness of antipsychotics.;
Psychopharmacology, 219(1) : 225-233
- Year: 2012
- 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)
Faber, G., Smid, H. G. O. M., VanGool, A. R., Wiersma, D., VanDenBosch, R. J.
Objective: To assess the effects of second generation antipsychotics on neurocognitive function in patients with stable remission of first episode psychosis.; Methods: Fifty-three patients with first onset psychosis in the schizophrenia spectrum entered a randomised controlled trial of guided discontinuation (GD) versus maintenance treatment (MT) with second generation antipsychotics. A comprehensive neurocognitive test battery was administered at the time of remission and shortly after dose reduction or discontinuation (GD-group) or at the same time in the MT-group.; Results: With the exception of negative symptoms, PANSS scores decreased over time and neurocognition improved significantly on most tests in both groups. The GD-group, however, improved significantly more than the MT-group on three neurocognitive measures in the domain of speed of processing.; Conclusion: These data suggest that, in first episode patients, dose reduction or discontinuation of second generation antipsychotics after stable remission is achieved, might improve neurocognitive function more than continuing second generation antipsychotics, suggesting a negative role for second generation antipsychotics, specifically in the domain of speed of processing.; Copyright © 2011 Elsevier Masson SAS. All rights reserved.
European Psychiatry, 27(4) : 275-280
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Medication dose reduction/discontinuation
, Service Delivery & Improvement, Other service delivery and improvement interventions
Bucur, M., Whale, R.
Evidence for efficacy of interventions in patients identified as 'at risk of psychosis' is developing. This review explores overall effect of such interventions. Search strategy: Electronic databases and reference lists. Study selection: Randomised controlled trials of interventions for patients with Yung (1996) defined 'at risk mental state' and recording switch to operationally defined psychosis. Data extraction: Dichotomous rates of transition to psychosis at 6 and 12 months following treatment onset. Results: Six published studies met inclusion criteria: McGorry 2002 (low dose risperidone + CBT + needs based intervention for 6 months vs needs based intervention alone), Morrison 2004 (CBT+monitoring for 6 months vs monitoring alone), McGlashan 2006 (olanzapine for 1 year vs placebo), Amminger 2010 (omega 3 fatty acids for 12 weeks vs placebo), Yung 2010 (cognitive therapy + risperidone vs. cognitive therapy + placebo vs supportive therapy + placebo; all over 12 months), Addington 2011 (cognitive behavioural therapy vs supportive therapy for 6 months). The pooled Peto fixed effect odds ratios for dichotomous switch to psychosis at 6 and 12 months were 0.24 (95% CI 0.13-0.43) and 0.33 (0.19-0.56) respectively. Corresponding NNTs were 5 and 6. Study heterogeneity was remarkably low (I2 = 0% on both occasions). Interventions for 'at risk mental state' appear more effective than control in reducing switch to psychosis at both 6 and 12 months later. Diversely different interventions have remarkably similar beneficial effects vs control which warrants further exploration. Further trial results are awaited to clarify this finding and examine between treatment differences.
Early Intervention in Psychiatry, 6 : 123
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Barlati, S., dePeri, L., Deste, G., Fusar-Poli, P., Vita, A.
Background: The aim of cognitive remediation is to target the cognitive impairments of patients with psychosis, including attentional deficits, memory problems, and limitations in planning and problem solving. It is hoped that by addressing these deficits, patients will be more able to take advantage of other interventions and will be more able to function in social and other domains. Many results in controlled trials of cognitive remediation in adult patients affected by schizophrenia have demonstrated its effectiveness on different cognitive domains and on patient's functioning. Some researchers speculate that deficits in cognition are more amenable to remediation during earlier phases of illness than when chronicity has developed. For these reasons cognitive rehabilitation should be a key component of early intervention programs, seeking to produce durable functional changes in the early course of schizophrenia. Although there is strong evidence that cognitive remediation is effective in adult schizophrenia, there is little evidence about its efficacy and long-term generalized effectiveness in the early course of the disease, and its possible application in the prodromal phase of the disease. Purpose Of Review: The aim of this paper is to review the available literature on cognitive remediation in the prodromal phase and in the early course of schizophrenia. This review summarizes especially findings of cognitive changes induced in the early course or in the prodromal phases of schizophrenia by different remediation methods. Controlled studies of cognitive training are discussed in more detail. Conclusion: Few studies on the effects of cognitive training programs have been conducted in first episode or in early schizophrenia and only one study has been conducted in the prodromal phase of the disease. Although preliminary positive results have been achieved, more empirical research is needed to confirm the efficacy of cognitive remediation in the early course of schizophrenia, and future studies should address the issue of the usefulness of cognitive remediation in the prodromes of psychosis. (copyright) 2012 Bentham Science Publishers.
Current Pharmaceutical Design, 18(4) : 534-541
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Argyriou, E., Petroggona, M., Charitaki, S., Belivanaki, M., Giannakopoulos, G., Kolaitis, G.
Background: Aripiprazole is an atypical antipsychotic that was approved, relatively recently, for use in adolescents with schizophrenia. Objective: The aim was to discuss efficacy and tolerability issues of aripiprazole in adolescents suffering from schizophrenia. Method: A Medline search identified only three studies and one post hoc analysis for one of them, concerning the use of aripiprazole in adolescents with schizophrenia. Finally, one of the studies was excluded because of the small number of cases treated with aripiprazole. Results: Based on the clinical evidence, including data from two short-terms clinical trials and one post-hoc analysis of one of the abovementioned studies, aripiprazole seemed generally safe and well tolerated in children and adolescents. Aripiprazole at doses of 10 to 30 mg/day was more efficacious in ameliorating the symptoms (including hostility) of schizophrenia than was placebo. It was associated with low number and mild-to-moderate intensity of adverse events, and with no clinically relevant findings in ECGs, vital signs, and clinical laboratory tests. The most common adverse events were extrapyramidal disorder, somnolence, and tremor. Also aripiprazole is unlikely to be associated with hyperprolactinemia and clinically significant weight gain. Conclusion: Scant information exists to evaluate the use of aripiprazole in early-onset schizophrenia, due to the lack of published studies. The initial encouraging results provide further support and point out the necessity for systematic research on the efficacy and tolerability of aripiprazole in pediatric patients suffering from schizophrenia. (copyright) 2012 Bentham Science Publishers.
Current Psychopharmacology, 1(2) : 117-121
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Bechdolf, A., Wagner, M., Ruhrmann, S., Harrigan, S., Putzfeld, V., Pukrop, R., Brockhaus-Dumke, A., Berning, J., Janssen, B., Decker, P., Bottlender, R., Maurer, K., Moller, H. J., Gaebel, W., Hafner, H., Maier, W., Klosterkotter, J.
Background: Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which most of the disability and neurobiological deficits of schizophrenia have not yet occurred. Aims: To investigate the effects of an integrated psychological intervention (IPI), combining individual cognitive-behavioural therapy, group skills training, cognitive remediation and multifamily psychoeducation, on the prevention of psychosis in the EIPS. Method: A randomised controlled, multicentre, parallel group trial of 12 months of IPI v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up. Results: A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P = 0.019). Conclusions: Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS. Declaration of interest: None.
British Journal of Psychiatry, 200(1) : 22-29
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy, Psychoeducation, Skills training, Supportive therapy
Chaudhry, Imran B., Hallak, Jaime, Husain, Nusrat, Minhas, Fareed, Stirling, John, Richardson, Paul, Dursun, Serdar, Dunn, Graham, Deakin, Bill
The onset and early course of schizophrenia is associated with subtle loss of grey matter which may be responsible for the evolution and persistence of symptoms such as apathy, emotional blunting, and social withdrawal. Such 'negative' symptoms are unaffected by current antipsychotic therapies. There is evidence that the antibiotic minocycline has neuroprotective properties. We investigated whether the addition of minocycline to treatment as usual (TAU) for 1 year in early psychosis would reduce negative symptoms compared with placebo. In total, 144 participants within 5 years of first onset in Brazil and Pakistan were randomised to receive TAU plus placebo or minocycline. The primary outcome measures were the negative and positive syndrome ratings using the Positive and Negative Syndrome Scale. Some 94 patients completed the trial. The mean improvement in negative symptoms for the minocycline group was 9.2 and in the placebo group 4.7, an adjusted difference of 3.53 (s.e. 1.01) 95% CI: 1.55, 5.51; p < 0.001 in the intention-to-treat population. The effect was present in both countries. The addition of minocycline to TAU early in the course of schizophrenia predominantly improves negative symptoms. Whether this is mediated by neuroprotective, anti-inflammatory or others actions is under investigation.;
Journal of Psychopharmacology, 26(9) : 1185-1193
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions