Disorders - Psychosis Disorders
Nordentoft, M., Vesterager, L., Melau, M., Christenseen, T. O.
Background:ARandomised Clinical Trial of Computer-Assisted Cognitive Training plus a Psychosocial Treatment Programme vs. a Psychosocial Treatment Programme for First-Episode Schizophrenia Patients Methods: One-hundred and seventeen patients with first episode schizophrenia spectrum disorders were assessed on cognitive and daily functioning and randomly assigned to either 38 sessions of CT plus psychosocial treatments vs. 38 psychosocial treatments alone. The CT program was based on scaffolding and errorless learning and divided into modules of attention, memory, and executive functioning. Computerized exercises as well as daily tasks were conducted, and competence dialogues built a bridge to everyday life of patients. Examinations were carried to at baseline, post training (after 4 months) and at 10-month follow-up. Intention- to- treat analyses were carried out, and repeated measurements in mixed model with unstructured variance was applied. Outcomes were everyday skills capacity (UPSA-B), neuropsychological tests, self-esteem (Rosenberg SES), association with the labor market, and PANSS symptom severity. Results: CT significantly improved Rosenbergs Self Esteem 1.96 (0.6-3.3) and Panss general score -2.2 (-4.7 to -0.3)post training. At 10-month follow-up the-CT-group significantly differed from control group with regard to Panss positive scale -1.3 (-2.6 to 0.8), Compt 2.3 (0.0-4.6), WMT 3.6 (0.9-6.3) LNS 1.3 (0.3-2.4), HVLTR 2.1 (0.48-3.65) and Trail making B (-5.89 (-12 to 7-0)). Panss negative symptoms were not influenced Conclusion: CT did improve cognition in several areas and psychotic and general symptoms and self esteem in first episode schizophrenia.
Schizophrenia Bulletin, 37 : 223
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Nordentoft, M., Secher, G., Bertelsen, M., Thorup, A., Austin, S., Albert, N., Jeppesen, P., Krarup, G., Jorgensen, P., Petersen, L.
Objective: Intensive early treatment for first episode psychosis have shown to be effective. It is unknown if the positive effects are sustainable over time. The aim was to determine long term effects of specialised assertive early intervention programme (OPUS) for first episode psychotic patients. Methods: 547 first-episode psychotic patients were enrolled in a single-blinded randomised clinical trial of 2 years of a specialised assertive early-intervention programme versus standard treatment. OPUS treatment consisted of ACT with family involvement and social skills training. Follow-up was 2, 5 and 10 years. 369 patients were interviewed after 2 years, 301 after 5 years and most likely approximately 310 after 10 years. All patients were followed for at least 5 years in the registers. Results: At five-year follow-up, the effect of the treatment seen after 2 years (psychotic dimension: -0.32 95% CI -0.58 to -0.06, P = 0.02, negative dimension: -0.45 95% CI -0.67 to -0.22, P = 0.001) had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1-4.8, P = 0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15-88.12, P = 0.05) during the fiveyear period. Results of the 10-year follow-up will be presented. Conclusion: The OPUS treatment improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years after. A difference on supported housing and use of bed days were found after 5 years in favor of the OPUS treatment.
European Archives of Psychiatry & Clinical Neuroscience, 261 : S37-S38
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Palma-Sevillano, Carol, Canete-Crespillo, Jose, Farriols-Hernando, Naria, Cebria-Andreu, Jordi, Michael, Maria, Alonso-Fernandez, Isabel, Fernandez-Vargas, Maria, Segarra-Gutierrez, Gerard
Background and Objectives: The aim of this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to routine care alone. Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial. Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy (PIPE; n = 21). PIPE comprised individual and family Cognitive-Motivational therapy plus routine care for 12 months. In this paper we present preliminary results at 6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment, and in this manuscript the results at 3 and 6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for variance effects were used for the statistical analysis Results: Significant greater clinical effects were observed in those patients treated in RC + PIPE at three months from baseline assessment and at six months in PANSS scale (Mann-Whitney test; p < 0 000). Other benefits of the program included increase in global activity, reduced relapse rates, and reduction of the pharmacological treatment Conclusions: These findings show the effectiveness of a program of routine care integrated with cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone for patients who are in the initial phase of schizophrenia. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
European Journal of Psychiatry, 25(2) : 68-80
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
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
-
Stage: First episode (psychosis only)
-
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
-
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
-
Stage: First episode (psychosis only)
-
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)
-
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
-
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)