Disorders - Psychosis Disorders
Eack, Shaun M., Greenwald, Deborah P., Hogarty, Susan S., Cooley, Susan J., DiBarry, Ann Louise, Montrose, Debra M., Keshavan, Matcheri S.
Objective: Methods: Results: Conclusions: The early application of cognitive rehabilitation may afford long-term functional benefits to patients with schizophrenia. This study examined the two-year effects of an integrated neurocognitive and social-cognitive rehabilitation program, cognitive enhancement therapy (CET), on cognitive and functional outcomes in early-course schizophrenia.Early-course outpatients (mean+/-SD illness duration=3.19+/-2.24 years) with schizophrenia or schizoaffective disorder were randomly assigned to CET (N=31) or enriched supportive therapy (EST) (N=27), an illness management intervention utilizing psychoeducation and applied coping strategies, and treated for two years. Multivariate composite indexes of cognitive, social adjustment, and symptom domains were derived from assessment batteries administered annually by computer-based tests and raters not blind to treatment assignment.Of the 58 participants who were randomly assigned and treated, 49 and 46 completed one year and two years of treatment, respectively. Intent-to-treat analyses showed significant differential effects favoring CET on social cognition, cognitive style, social adjustment, and symptomatology composites during the first year of treatment. After two years, moderate effects (d=.46) were observed favoring CET for enhancing neurocognitive function. Strong differential effects (d>1.00) on social cognition, cognitive style, and social adjustment composites remained at year 2 and also extended to measures of symptomatology, particularly negative symptoms.CET appears to be an effective approach to the remediation of cognitive deficits in early schizophrenia that may help reduce disability in this population. The remediation of such deficits should be an integral component of early intervention programs treating psychiatrically stable schizophrenia outpatients.
Psychiatric Services, 60(11) : 1468-1476
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Dewa, Carolyn S., Zipursky, Robert B., Chau, Nancy, Furimsky, Ivana, Collins, April, Agid, Ofer, Goering, Paula
Objective: This pilot study compared the effectiveness of specialized care that was home based versus hospital based for individuals experiencing their first psychotic episode. Method: A randomized controlled trial design was used. A total of 29 subjects were interviewed at baseline, 3 and 9 months. Repeated measures analysis of variance was employed to test for statistically significant changes over time within and between groups with regard to community psychosocial functioning and symptom severity. Results: Our findings indicate that subjects in both the home-based and hospital-based programmes significantly improved with regard to symptoms and community functioning over time. However, the rates of change over time were not significantly different between the two programmes. There was a statistically significant difference between programmes with regard to the proportion of subjects with less than two visits (i.e. either did not attend their first assessment or attended followup visits after their assessment). Conclusions: This was a modest pilot study and the sample was too small to allow definitive conclusions to be drawn. However, the results raise questions about differences in initial treatment engagement. They suggest the need for additional research focusing on interventions that promote initial treatment seeking. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Early Intervention in Psychiatry, 3(4) : 304-311
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Davidson, Michael, Galderisi, Silvana, Weiser, Mark, Werbeloff, Nomi, Fleischhacker, Wolfgang W., Keefe, Richard S., Boter, Han, Keet, Ireneus P. M., Prelipceanu, Dan, Rybakowski, Janusz K., Libiger, Jan, Hummer, Martina, Dollfus, Sonia, Lopez-Ibor, Juan J., Hranov, Luchezar G., Gaebel, Wolfgang, Peuskens, Joseph, Lindefors, Nils, Kahn, Rene S.
Objective: Methods: Results: Conclusion: Cognitive impairment, manifested as mild to moderate deviations from psychometric norms, is present in many but not all schizophrenia patients. The purpose of the present study was to compare the effect of haloperidol with that of second-generation antipsychotic drugs on the cognitive performance of patients with schizophreniform disorder or first-episode schizophrenia.Subjects were 498 patients with schizophreniform disorder or first-episode schizophrenia who were randomly assigned to open-label haloperidol (1 to 4 mg/day [N=103]), amisulpride (200 to 800 mg/day [N=104]), olanzapine (5 to 20 mg/day [N=105]), quetiapine (200 to 750 mg/day [N=104]), or ziprasidone (40 to 160 mg/day [N=82]). The Rey Auditory Verbal Learning Test, Trail Making Test Part A and Part B, WAIS Digit Symbol Test, and Purdue Pegboard Test were administered at baseline and the 6-month follow-up evaluation.Compared with scores at baseline, composite cognitive test scores improved for all five treatment groups at the 6-month follow-up evaluation. However, there were no overall differences among the treatment groups. In addition, there was a weak correlation between the degree of cognitive improvement and changes in Positive and Negative Syndrome Scale scores.Treatment with antipsychotic medication is associated with moderate improvement in the cognitive test performance of patients who have schizophreniform disorder or who are in their first episode of schizophrenia. The magnitude of improvement does not differ between treatment with haloperidol and treatment with second-generation antipsychotics. Moreover, cognitive improvement is weakly related to symptom change.
American Journal of Psychiatry, 166(6) : 675-682
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Crespo-Facorro, Benedicto, Mata, Ignacio, Ayesa, Rosa, Ramirez-Bonilla, MariLuz, Martinez-Garcia, Obdulia, Vazquez-Barquero, Jose L.
Objective: To investigate the neurocognitive effectiveness of haloperidol, risperidone, and olanzapine in first-episode schizophrenia-spectrum disorders. Method: This prospective, randomized, open-label study was conducted from February 2001 to February 2005. Data for the present investigation were obtained from a large epidemiologic and 3-year longitudinal intervention program of first-episode psychosis (DSM-IV criteria) conducted at the outpatient clinic and the inpatient unit at the University Hospital Marques de Valdecilla, Santander, Spain. One hundred four patients randomly assigned to haloperidol (N = 35), olanzapine (N = 30), or risperidone (N = 39) who completed clinical and cognitive evaluations at baseline, 6 months, and 1 year were included in the final analysis. Thirty-seven healthy individuals were also longitudinally assessed. A neuropsychological battery that comprised 9 cognitive domains was used. The contribution of clinical changes, concomitant medications, and the severity of motor side effects to cognitive changes was controlled. The main outcome measure was cognitive changes at 1-year follow-up. Results: The 3 treatment groups showed a significant improvement in cognitive scores after 1 year. The differential cognitive effectiveness between antipsychotics was insignificant. The magnitude of cognitive changes was similar in the 3 treatment groups and controls, although a greater improvement on the Finger Tapping Test, Trail Making Test B, and Rey Complex Figure Test was found in the treatment groups. Clinical changes, use of concomitant medications, and the emergence of motor side effects did not significantly account for cognitive changes over time. Conclusions: Haloperidol, olanzapine, and risperidone were equally effective in treating cognitive deficits of psychosis. The effect of practice clearly contributes to cognitive score improvements after treatment with antipsychotics. Our results provide important information regarding the practical utility of antipsychotic treatments to improve cognition and could have implications for developing novel approaches for cognitive pharmacotherapy in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Journal of Clinical Psychiatry, 70(5) : 717-729
- Year: 2009
- 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)
Cuesta, Manuel J., deJalon, Elena Garcia, Campos, M. Soledad, Peralta, Victor
Background: Cognitive impairment in schizophrenia-spectrum disorders is highly prevalent and notably influences functional outcomes. Aims: To characterise the cognitive effectiveness of second-generation antipsychotic drugs. Method: One hundred consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders were admitted. Seventy-seven completed baseline, 1-month and 6-month psychopathological and neuropsychological assessments. Patients were randomised to risperidone or olanzapine treatment. Four final treatment allocation groups were defined since patients continued treatment in their normal setting: risperidone, olanzapine, mixed and no-antipsychotic groups. Results: There were no differences in cognitive effectiveness between the four treatment groups. Reliable change index methods demonstrated that nearly a half of patients showed an improvement in Global Cognitive Score at the 6-month assessment. Improvement on the neuropsychological tests ranged from 17 to 54%. A strong predictor of cognitive response was poor performance on baseline neuropsychological tests; response was moderately influenced by a low premorbid scholastic performance and IQ. Conclusions: Cognitive improvement related to second-generation antipsychotic drugs appeared within the first 4 weeks of treatment and persisted at 6 months irrespective of treatment group. Greater cognitive dysfunction at baseline and lower premorbid cognitive background predicted cognitive improvement in our sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
British Journal of Psychiatry, 194(5) : 439-445
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
deKoning, M. B., Bloemen, O. J. N., vanAmelsvoort, T. A. M. J., Becker, H. E., Nieman, D. H., VanDerGaag, M., Linszen, D. H.
Objective: Method: Results: Conclusion: Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio.A literature search in PubMed, EMBASE and PsycINFO was performed.Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems.At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice.
Acta Psychiatrica Scandinavica, 119(6) : 426-442
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Essali, Adib, Al Haj Haasan, Nahla, Li, Chunbo, Rathbone, John
BACKGROUND: Long-term drug treatment of schizophrenia with typical antipsychotics has limitations: 25 to 33% of patients have illnesses that are treatment-resistant. Clozapine is an antipsychotic drug, which is claimed to have superior efficacy and to cause fewer motor adverse effects than typical drugs for people with treatment-resistant illnesses. Clozapine carries a significant risk of serious blood disorders, which necessitates mandatory weekly blood monitoring at least during the first months of treatment. OBJECTIVES: To evaluate the effects of clozapine compared with typical antipsychotic drugs in people with schizophrenia. SEARCH STRATEGY: For the current update of this review (March 2006) we searched the Cochrane Schizophrenia Group Trials Register. SELECTION CRITERIA: All relevant randomised clinical trials (RCTs). DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a fixed-effect model. We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. For continuous data, we calculated weighted mean differences (WMD) again based on a fixed-effect model. MAIN RESULTS: We have included 42 trials (3950 participants) in this review. Twenty-eight of the included studies are less than 13 weeks in duration, and, overall, trials were at significant risk of bias. We found no significant difference in the effects of clozapine and typical neuroleptic drugs for broad outcomes such as mortality, ability to work or suitability for discharge at the end of the study. Clinical improvements were seen more frequently in those taking clozapine (n=1119, 14 RCTs, RR 0.72 CI 0.7 to 0.8, NNT 6 CI 5 to 8). Also, participants given clozapine had fewer relapses than those on typical antipsychotic drugs (n=1303, RR 0.62 CI 0.5 to 0.8, NNT 21 CI 15 to 49). BPRS scores showed a greater reduction of symptoms in clozapine-treated patients, (n=1145, 16 RCTs, WMD -4.22 CI -5.4 to -3.1), although the data were heterogeneous (Chi2 0.0001, I2 66%). Short-term data from the SANS negative symptom scores favoured clozapine (n=196, 5 RCTs, WMD -5.92 CI -7.8 to -4.1). We found clozapine to be more acceptable in long-term treatment than conventional antipsychotic drugs (n=982, 16 RCTs, RR 0.60 CI 0.5 to 0.7, NNT 15 CI 12 to 20). Blood problems occurred more frequently in participants receiving clozapine (3.2%) compared with those given typical antipsychotics (0%) (n=1031, 13 RCTs, RR 7.09 CI 2.0 to 25.6). Clozapine participants experienced more drowsiness, hypersalivation, or temperature increase, than those given conventional neuroleptics. However, clozapine patients experienced fewer motor adverse effects (n=1433, 18 RCTs, RR 0.58 CI 0.5 to 0.7, NNT 5 CI 4 to 6).The clinical effects of clozapine were more pronounced in participants resistant to typical neuroleptics in terms of clinical improvement (n=370, 4 RCTs, RR 0.71 CI 0.6 to 0.8, NNT 4 CI 3 to 6) and symptom reduction. Thirty-four per cent of treatment-resistant participants had a clinical improvement with clozapine treatment. AUTHORS' CONCLUSIONS: Clozapine may be more effective in reducing symptoms of schizophrenia, producing clinically meaningful improvements and postponing relapse, than typical antipsychotic drugs - but data are weak and prone to bias. Participants were more satisfied with clozapine treatment than with typical neuroleptic treatment. The clinical effect of clozapine, however, is, at least in the short term, not reflected in measures of global functioning such as ability to leave the hospital and maintain an occupation. The short-term benefits of clozapine have to be weighed against the risk of adverse effects. Within the context of trials, the potentially dangerous white blood cell decline seems to be more frequent in children and adolescents and in the elderly than in young adults or people of middle-age.The existing trials have largely neglected to assess the views of participants and their families on clozapine. More c mmunity-based long-term randomised trials are needed to evaluate the efficacy of clozapine on global and social functioning as trials in special groups such as people with learning disabilities. CLOZAPINE VERSUS TYPICAL NEUROLEPTIC MEDICATION FOR SCHIZOPHRENIA: Schizophrenia is a serious, chronic and relapsing mental illness with a worldwide lifetime prevalence of about one per cent. Schizophrenia is characterised by positive symptoms such as hallucinations and delusions and negative symptoms such as emotional numbness and withdrawal. One quarter of those who have experienced an episode of schizophrenia recover and the illness does not recur. Another 25% experience an unremitting illness. Half do have a recurrent illness but with long episodes of considerable recovery from the positive symptoms. The overall cost of the illness to the individual, their carers and the community is considerable.Antipsychotic medications are classified into typical and atypical drugs. First generation or 'typical' antipsychotics such as chlorpromazine and haloperidol have been the mainstay of treatment, and are effective in reducing the positive symptoms of schizophrenia, but negative symptoms are fairly resistant to treatment. In addition, drug treatments are associated with adverse effects which can often compromise compliance with medication and therefore increase the incidences of relapse.People who do not respond adequately to antipsychotic medication are sometimes given the 'atypical' antipsychotic drug clozapine, which has been found to be effective for some people with treatment-resistant schizophrenia. Clozapine is also associated with having fewer movement disorders than chlorpromazine, but may induce life-threatening decreases in white blood cells (agranulocytosis).We reviewed the affects of clozapine in people with schizophrenia compared to typical antipsychotics drugs.This review supports the notion that clozapine is more effective than typical antipsychotics for people with schizophrenia in general, and for those who do not improve on typical antipsychotics in particular. Clozapine is associated with less movement adverse effects than typical antipsychotic drugs, but it may cause serious blood related adverse effects. White blood cell count monitoring is mandatory for all people taking clozapine. There is a worry, however, that studies are - at the very least - moderately prone to bias favouring clozapine. Better conduct and reporting of trials could greatly have increased our confidence in the results.
Cochrane Database of Systematic Reviews, (1) :
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jimenez, M., Wade, D., Gee, D., Crisp, K., Pearce, T., Newman, B., Spiliotacopoulos, D., Castle, D., McGorry, P. D.
Objective: Patients with first-episode psychosis are responsive to acute-phase treatments, but relapse rates are high. This study aimed to evaluate the effectiveness of a psychosocial treatment designed to prevent the second episode of psychosis compared with standardized early psychosis care. Method: In a randomized controlled trial, conducted at the Early Psychosis Prevention and Intervention Centre and Barwon Health, Australia, a multimodal individual and family cognitive-behavioral therapy for relapse prevention was compared with standardized case management within a specialist early psychosis service. Patients aged 15 to 25 years with a first episode of a DSM-IV psychotic disorder were recruited between November 2003 and May 2005. The main outcome measures were the number of relapses and time to first relapse. Results: Forty-one first-episode psychosis patients were randomly assigned to the relapse prevention therapy (RPT) and 40 to standardized case management. At the 7-month follow up, the relapse rate was significantly lower in the therapy condition compared to treatment as usual (p = .042) and time to relapse was significantly longer for the RPT condition (p = .03). The number needed to treat was 6 over 7 months. Conclusions: Interim findings suggest that RPT provided within a specialist early psychosis program was effective in reducing relapse in early psychosis when compared with standardized early psychosis case management. Trial Registration: www.anzctr.org.au Identifier: ACTRN12605000514606. (copyright) Copyright 2009 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 70(4) : 477-486
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
, Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Case management
Kryzhanovskaya, L., Schulz, S. C., McDougle, C., Frazier, J., Dittmann, R., Robertson-Plouch, C., Bauer, T., Xu, W., Wang, W., Carlson, J., Tohen, M.
Objective To assess olanzapine's efficacy and tolerability in adolescents with schizophrenia.
Method One hundred seven inpatient and outpatient adolescents (olanzapine, n = 72, mean age 16.1 years; placebo, n = 35, mean age 16.3 years) with schizophrenia participated in this randomized (2:1), international, multisite, industry-sponsored trial. All patients met DSM-IV-TR criteria for schizophrenia, and they were treated for up to 6 weeks with flexible doses of olanzapine (2.5 - 20.0 mg/day) or placebo. Last-observation-carried-forward mean changes from baseline to endpoint on the anchored version of the Brief Psychiatric Rating Scale for Children, Clinical Global Impression Scale-Severity of Illness, and Positive and Negative Syndrome Scale (PANSS) were assessed.
Results More olanzapine-treated versus placebo-treated patients completed the trial (68.1% versus 42.9%, p = .020). Compared with placebo-treated patients, olanzapine-treated adolescents had significantly greater improvement in Brief Psychiatric Rating Scale for Children total (p = .003), Clinical Global Impressions Scale-Severity of Illness (p = .004), PANSS total (p = .005), and PANSS positive scores (p = .002). Olanzapine-treated patients gained significantly more baseline-to-endpoint weight (4.3 kg versus 0.1 kg, p < .001). Significantly more olanzapine-treated versus placebo-treated patients gained 7% or greater of their body weight at any time during treatment (45.8% versus 14.7%, p = .002). Prolactin and triglyceride mean baseline-to-endpoint changes were significantly higher in olanzapine-treated versus placebo-treated adolescents. The incidence of treatment-emergent significant changes in fasting glucose, cholesterol, or triglycerides did not differ between the groups at endpoint, but significantly more olanzapine-treated patients had high triglycerides at any time during treatment.
Conclusions Olanzapine-treated adolescents with schizophrenia experienced significant symptom improvement. Significant increases in weight, triglycerides, uric acid, most liver function tests, and prolactin were observed during olanzapine treatment.
Journal of the American Academy of Child & Adolescent Psychiatry, 48 : 60-70
- Year: 2009
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Li, C., Xia, J., Wang, J.
Background: Risperidone is a widely used antipsychotic drug for people with schizophrenia. It is important to get a balance between gaining the most positive effects for the least negative outcomes. The optimal dose of risperidone is the focus of this review.Objectives: To determine risperidone dose response relationships for schizophrenia and schizophrenia-like psychoses.Search methods: We searched the Cochrane Schizophrenia Groups Trials Register (July 2008) for all relevant references.Selection criteria: All relevant randomised controlled clinical trials (RCTs).Data collection and analysis: Two review authors independently extracted data and resolved disagreement by discussion with a third member of the team. When insufficient data were provided, we contacted the study authors. For homogenous dichotomous data we calculated fixed-effect relative risk (RR) and 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (MD).Main results: A consistent finding when risperidone ultra low doses (<2 mg/day) were compared with other doses (short-term data) was that more people left early because of insufficient response (n=456, 1 RCT, RR when compared with standard-low (≧4-<6 mg/day) 12.48 CI 1.43 to 4.30). The insufficient response for this low dose is reflected in measures of mental state. When low doses (≧2-<4 mg/day) are used and compared with standard-higher doses (≧6-<10 mg/day) and the high dose range (≧10 mg/day), more people left early because of insufficient response (≧4-<6 mg/day: n=173, 2 RCTs, RR 4.05 CI 1.09 to 15.07; ≧10 mg/day: n=173, 2 RCTs, RR 1.92 CI 1.36 to 2.70). For the outcome of 'no clinically important improvement' results favour standard-higher doses (n=272, 2 RCTs, RR 2.26 CI 0.81 to 6.34). When low doses are compared with other higher doses, we found no differences in terms of cardiovascular, CNS, endocrine or gastrointestinal adverse effects. Unspecified EPS were more frequent with the higher doses (≧10 mg: n=262, 2 RCTs, RR 0.45 CI 0.24 to 0.84). One trial did find that endpoint scores on PANSS significantly favoured a low dose when compared with ≧4-6 mg/day (n=124, 1 RCT, MD -12.40 CI -17.01 to -7.79). When ≧4-<6 mg/day is compared with high doses, less people left early (n=677, 1 RCT, RR leaving any reason 0.74 CI 0.54 to 1.00; n=677, 1 RCT, RR due to adverse effects 0.56 CI 0.32 to 0.97). ≧4-<6 mg/day was no worse than ≧6-<10 mg/day for 'no clinically important improvement' (n=39, 1 RCT, RR on CGI-I 0.79 CI 0.29 to 2.17). People allocated ≧4-<6 mg/day had more movement disorders than those on a low dose (n=124 1 RCT, RR 2.28 CI 1.67 to 3.11). When ≧6-<10 mg/day is compared with standard-lower doses and a high dose range, there is no significant difference in terms of proportions leaving early. ≧6-<10 mg/day is better than a low dose for 'no clinical important improvement' (n=172, 2 RCTs, RR 0.76 CI 0.61 to 0.94). Overall ≧6-<10 mg/day caused less problems especially in EPS when compared with ≧10mg/day (n=261, 2 RCTs, RR unspecified EPS 0.56 CI 0.31 to 0.99). When a high dose was compared with a low dose less people left early (n=70, 1 RCT, RR 0.43 CI 0.26 to 0.71) but not when compared with a standard-lower dose (n=677, 1 RCT, RR leaving due to adverse event 1.78 CI 1.03 to 3.09). ≧10 mg/day was better than a low dose in terms of 'no clinical important improvement' (n=257, 2 RCTs, RR 0.64 CI 0.50 to 0.82), but worse than a standard-higher dose (≧6-<10 mg/day: n=255, 2 RCTs, RR 1.22 CI 1.00 to 1.51). ≧10 mg/day caused more unspecified EPS adverse effects and any drug for adverse events when compared with a standard-higher dose and with a low dose.Authors' conclusions: There is still lack of strong evidence for an optimal dose for clinical practice. The quality of trials suggests that an over estimate of effect is likely and we think this is most probably for the mid-range doses. One such dose (standard-lower dose range, 4-<6 mg/day) does seem optimal for clinical response and adverse effects Weak evidence suggests that low doses (≧2-<4 mg/day) may be of value for people in their first episode of illness. High doses (≧10 mg/day) did not confer any advantage over any other dose ranges and caused more adverse effects, especially for movement disorders. Ultra low dose (<2 mg/day) seemed useless. We advise the use of dosages from low dose to standard-lower dose for different kinds of individual patients. Future trials should focus on specific populations, e.g. those in their first episode, with acute exacerbation, in relapse or refractory to treatment, and should also test the optimal dose of risperidone over a longer period of time and in the community.
Cochrane Database of Systematic Reviews, (4) : CD007474
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
McGorry, Patrick D., Nelson, Barnaby, Amminger, G. Paul, Bechdolf, Andreas, Francey, Shona M., Berger, Gregor, Riecher-Rossler, Anita, Klosterkotter, Joachim, Ruhrmann, Stephan, Schultze-Lutter, Frauke, Nordentoft, Merete, Hickie, Ian, McGuire, Philip, Berk, Michael, Chen, Eric Y. H., Keshavan, Matcheri S., Yung, Alison R.
Objective: Data Sources: Study Selection: Data Synthesis: Conclusions: Over the last 15 years, a focus on early intervention in psychotic disorders has emerged. Initially, the early psychosis movement focused on timely recognition and phase-specific treatment of first-episode psychosis. However, early psychosis researchers suspected that pushing the point of intervention even further back to the prodromal phase of psychotic disorders may result in even better outcomes. This article reviews intervention research in the ultra-high-risk phase of psychotic disorders.A literature search of intervention trials with ultra-high-risk cohorts published after 1980 was conducted on PubMed with the search terms prodrome and intervention.All published intervention trials with ultra-high-risk cohorts.The first generation of intervention trials indicated that both pharmacologic and psychological intervention strategies may be of value in terms of symptom reduction and delay or prevention of onset of threshold psychotic disorder.Further controlled intervention trials with larger sample sizes are required in order to confirm and extend these findings. We argue that the clinical staging model provides a framework for the rationale and design of such studies, with simpler, safer, and more benign interventions being better candidates for first-line treatment, while more complex and potentially harmful treatments should be reserved for those cases in which response has failed to occur. Recent evidence indicates that neuroprotective agents, such as essential fatty acids, may be a suitable form of intervention for the ultra-high-risk phase of psychotic disorders, with a positive risk-benefit balance. Ethical aspects have become more salient given the recently observed declining transition rate in ultra-high-risk samples. We outline the key questions for the next generation of ultra-high-risk intervention trials.
Copyright 2009 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 70(9) : 1206-1212
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Morrison, Anthony P.
The main objective of this paper is to review the literature regarding studies of cognitive behaviour therapy (CBT) for people with first episode psychosis or early psychosis. A comprehensive search of the PsycINFO and MEDLINE databases identified twelve studies, including several randomised controlled trials and quasi-experimental studies. There were few significant differences between groups at end of treatment or at follow-up, and no differences in rates of relapse or readmission. The findings suggest, however, that CBT does have important benefits in terms of rate of recovery, improvements in certain symptoms (e.g. auditory hallucinations and hopelessness) and quality of life. Thus, there is modest support for the application of CBT for people experiencing early psychosis; however, the studies to date have difficulties with study design, theoretical underpinnings and how well the treatment targets fit with the CBT model. Future research addressing these issues is required to determine whether CBT for early psychosis may prove to be more effective than current data would suggest. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Psychosis: Psychological, Social & Integrative Approaches, 1(2) : 103-112
- Year: 2009
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)