Disorders - Psychosis Disorders
Wijnen, B. F. M., Pos, K., Velthorst, E., Schirmbeck, F., Chan, H. Y., de-Haan, L., van-der-Gaag, M., Evers, S. M. A. A., Smit, F.
Background In schizophrenia spectrum disorders, negative symptoms (e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve QOL in an economically sustainable way. Methods A health-economic evaluation was conducted alongside a single-blind randomised controlled trial in two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal and the health sector perspective. Results Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. >= 5-point decrease on the PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings. Conclusions In the Dutch context where TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still be evaluated if adjunct CBTsa therapy is a cost-effective alternative. Copyright © 2018 Wijnen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PLoS ONE, 13 (11) (no pagination)(e0206236) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Heinssen, R.
The Recovery After an Initial Schizophrenia Episode initiative evaluated the feasibility, effectiveness, and scalability of a multi-element, team-based approach to first episode psychosis care in the United States. The Early Treatment Program comparative effectiveness trial (RAISE-ETP) enrolled 404 participants from 34 community centers in 21 states; clinics were randomly assigned to provide specialized early intervention services (NAVIGATE; N = 17) or usual community care (N = 17). The median duration of untreated psychosis (DUP) among participants was 74 weeks. After 24 months, NAVIGATE recipients experienced greater improvements in quality of life, psychopathology, and involvement in work or school compared with patients in community care. In addition, NAVIGATE was more cost-effective than typical treatment. Median DUP was a significant moderator of treatment effects on quality of life and overall symptoms, but not on employment or school attendance. Patients with shorter DUP derived substantially more benefit from NAVIGATE compared to those with longer DUP, and participants in community care. For NAVIGATE patients with DUP <74 weeks, average annual treatment costs were 15 percent lower compared to the annual cost of typical care. Together these findings underscore the importance of complementary approaches for improving FEP outcomes. In 2013, the National Institute of Mental Health launched research initiatives to test feasible strategies for reducing DUP and achieving rapid referral of persons with FEP to specialized treatment programs. The focus, methods, and preliminary findings from 10 funded projects will be presented, along with implications for reducing DUP in ~200 specialized early intervention clinics now established in the United States.
Early Intervention in Psychiatry, 12 (Supplement 1) : 22
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Murru, A., Carpiniello, B.
The first psychotic episode is classically viewed as a critical period which management is important in determining the long-term outcome of the schizophrenia (SCZ). For this reason, the duration of untreated illness (DUI), defined as the interval between the onset of the psychiatric disorder and the administration of the first pharmacological treatment, is a clinical variable that has been increasingly investigated due to its potentially modifiable nature and its value as a predictor of outcome. DUI is poorly applicable and highly unreliable in psychosis. The present critical review examines the impact of DUI and its more operative definition of "duration of untreated psychosis" (DUP) in the course and outcome of SCZ, focusing on its epidemiologic, clinical, prognostic factors. Length of DUP has been identified as positively related to a worst treatment response, symptom control and overall functional outcome in SCZ. Negative symptoms appear to be prominently related to longer DUP. Neuroimaging correlates of DUP have not been clearly outlined: few of the studies considering first-episode patients and DUP showed structural abnormalities. A low proportion of significant associations were found mostly in cerebellum and occipital lobe of patients with longer DUP. Also, evidence of an inverse correlation between cognitive alterations and DUP is not conclusive. DUI and DUP are multidimensional constructs that imply both intrinsic, illness related (e.g. subtle symptoms at onset) and extrinsic factors (e.g. access to mental health services), so that from its study sprouted in the last decades First-Episode Units, aimed at providing secondary prevention in SCZ such as providing a timely diagnosis and treatment to patients experiencing their first psychotic episode. Early intervention seems to ensure a shortened DUP, especially for people presenting with brief limited intermittent psychotic symptoms, and, ultimately, ensure a more favorable prognosis for patients affected by SCZ. Copyright © 2016 Elsevier Ireland Ltd
Neuroscience Letters, 669 : 59-67
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Schlosser, D. A., Campellone, T. R., Truong, B., Etter, K., Vergani, S., Komaiko, K., Vinogradov, S.
The onset of schizophrenia occurs during a period critical for development of social relationships and functional independence. As such, interventions that target the early course of illness have the potential to stave off functional decline and restore functioning to pre-illness levels. In this entirely remote study, people with recent-onset schizophrenia spectrum disorders (SSDs) participated in a 12-week randomized controlled trial to determine the efficacy of PRIME (personalized real-time intervention for motivational enhancement), a mobile-based digital health intervention designed to improve motivation and quality of life.
Schizophrenia Bulletin, 44(5) : 1010-1020
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Wu, R. Q., Lin, C. G., Zhang, W., Lin, X. D., Chen, X. S., Chen, C., Zhang, L. J., Huang, Z. Y., Chen, G. D., Xu, D. L., Lin, Z. G., Zhang, M. D.
Background: Risperidone and paliperidone have been the mainstay treatment for schizophrenia and their potential role in neuroprotection could be associated with brain-derived neurotrophic factor (BDNF) and N400 (an event-related brain potential component). So far, different effects on both BDNF and N400 were reported in relation to various antipsychotic treatments. However, few studies have been conducted on the mechanism of risperidone and paliperidone on BDNF and N400. This study aimed to compare the effects of risperidone and paliperidone on BDNF and the N400 component of the event-related brain potential in patients with first-episode schizophrenia.
Methods: Ninety-eight patients with first-episode schizophrenia were randomly divided into the risperidone and paliperidone groups and treated with risperidone and paliperidone, respectively, for 12 weeks. Serum BDNF level, the latency, and amplitude of the N400 event-related potential before and after the treatment and Positive and Negative Syndrome Scale (PANSS) scores were compared between the two groups.
Results: A total of 94 patients were included in the final analysis (47 patients in each group). After the treatment, the serum BDNF levels in both groups increased (all P < 0.01), while no significant difference in serum BDNF level was found between the groups before and after the treatment (all P > 0.05). After the treatment, N400 amplitudes were increased (from 4.73 +/- 2.86 muv and 4.51 +/- 4.63 muv to 5.35 +/- 4.18 muv and 5.52 +/- 3.08 muv, respectively) under congruent condition in both risperidone and paliperidone groups (all P < 0.01). Under incongruent conditions, the N400 latencies were shortened in the paliperidone group (from 424.13 +/- 110.42 ms to 4.7.41 +/- 154.59 ms, P < 0.05), and the N400 amplitudes were increased in the risperidone group (from 5.80 +/- 3.50 muv to 7.17 +/- 5.51 muv, P < 0.01). After treatment, the total PANSS score in both groups decreased significantly (all P < 0.01), but the difference between the groups was not significant (P > 0.05). A negative correlation between the reduction rate of the PANSS score and the increase in serum BDNF level after the treatment was found in the paliperidone group but not in the risperidone group.
Conclusions: Both risperidone and paliperidone could increase the serum BDNF levels in patients with first-episode schizophrenia and improve their cognitive function (N400 latency and amplitude), but their antipsychotic mechanisms might differ.
Chinese Medical Journal, 131(19) : 2297-2301
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Kuzman, M. R., Kuharic, D. B., Kekin, I., Makaric, P., Madzarac, Z., Makar, A. K., et al.
Background: Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. Different approaches were used to counteract these side effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first episode psychosis on antipsychotic-induced metabolic changes. Method(s): We enrolled 71 patients with first episode psychosis treated at the Zagreb University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual (TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months follow-up. Result(s): Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional level significantly increased at month 18th in both groups. Conclusion(s): While both types of treatment were effective in reducing psychopathology and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities and antipsychotic-induced weight gain. Copyright © 2018 Rojnic Kuzman, Bosnjak Kuharic, Kekin, Makaric, Madzarac, Koricancic Makar, Kudlek Mikulic, Bajic, Bistrovic, Bonacin and Vogrinc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Frontiers in Psychiatry, 9 (OCT) (no pagination)(00488) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Ahuir, M., Cabezas, A., Minano, M. J., Algora, M. J., Estrada, F., Sole, M. et al.
Metacognitive training (MCT) improves cognitive biases in psychosis. We aimed to explore whether the effectiveness of the combination of psychoeducation and MCT group treatments on cognitive biases differed if the combination was started by psychoeducation or by MCT. Fourty-nine stable patients with a recent-onset psychosis were randomized to two different sequences: MCT+psychoeducation vs psychoeducation+MCT. Cognitive biases, psychopathology symptoms, insight and functioning were assessed. Cognitive biases and depressive symptoms improved with both group interventions, without differential effects between both sequences. Our study suggests that MCT and psychoeducation are useful in improving cognitive biases and depressive symptoms in recent-onset psychosis.
Psychiatry Research, 270 : 720-723
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy, Psychoeducation
Landa, Y., Mueser, K., Jacobs, M., Jespersen, R., Wyka, K., Swiderski, C., Cahalan, C., Gossrau, J. J., Doss, A., Reyna, V., Silbersweig, D.
To decrease the severity of symptoms and functional impairment in youth at high risk of developing psychosis we have established a comprehensive Group and Family-based Cognitive Behavioral Therapy Program (GF-CBT). GF-CBT, which is grounded in theory and research on information processing in delusions, decision making, memory and behavioral change, teaches youth at-risk strategies for reducing biased information processing in order to prevent the formation of delusional beliefs. Families learn CBT techniques to support, encourage and maintain use of these skills at home. Two mixed methods studies were completed: a pilot open trial to evaluate the program's feasibility and a pilot randomized controlled trial to evaluate its efficacy, as compared to symptom monitoring, over a 2-year follow-up. Nineteen youth ages 12-25 and 20 family members participated. Results support the feasibility and preliminary efficacy of GF-CBT, as evidenced by high levels of program satisfaction and significant remission rates among GF-CBT participants, with the majority no longer meeting ARMS criteria post-CBT, and maintaining recovery at the follow-up. At post-treatment GF-CBT group showed greater decreases in positive and negative symptoms (CAARMS) as well as improvements in functioning (SOFAS). The difference between groups increased over time. As part of the SAMHSA funded project to improve outcomes for as many as 2,000 youth and their families affected by, or at risk of, early onset psychosis in the State of Missouri, GF-CBT has been implemented in 3 DMH clinics. GF-CBT state-wide implantation, including clinician training and "Train-the-Trainer" procedures to allow sustainability of the intervention will be discussed.
Early Intervention in Psychiatry, 12 (Supplement 1) : 183
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Erickson, D., Whitehurst, D., Roes, M., Digiacomo, A.
Purpose: Although the Individual Placement and Support (IPS) strategy has achieved 'gold standard' status for enhancing employment among older clients in the later stages of mental illness, the nature and timing of its contributions to younger clients in the early stages of illness is less understood. This randomized controlled trial assesses the effectiveness of the IPS model of employment support in a population-based sample of early-psychosis clients. Method(s): We have recruited 109 clients from the Fraser Health Early Psychosis program; 55 clients received one year of IPS support and 54 received 'treatment as usual' (TAU). A variety of employment, clinical, and service-use outcomes were assessed at 6- and 12-months; this presentation describes employment outcomes. Result(s): Over 12 months, clients who received IPS in addition to TAU more often worked (80%) than did those receiving TAU alone (60%; chi-square = 4.50, p = .03). However, there was no significant difference in the number of days worked (58.7 days in IPS, versus 46.4 in TAU; p = .33). Conclusion(s): When EPI clients are ready to look for work many are successful, compared to clients in later stages of illness. In our early psychosis clients, IPS increased the likelihood of getting work, but did not significantly affect job tenure. Further analyses will assess the nature and timing of differential employment outcomes attributable to IPS.
Early Intervention in Psychiatry, 12 (Supplement 1) : 209
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
Devoe, D., Farris, M. S., Townes, P., Addington, J.
Objective: The primary objective of this systematic review and metaanalysis was to summarize the impact of all treatments on transition to psychosis in high risk samples. Method(s): PsycINFO, Embase, CINAHL, EBM, and MEDLINE were searched from inception to May 2017 using keywords psychosis, risk, and treatment with no language restrictions. The following data was extracted: study characteristics (e.g., sample size), participant characteristics (e.g., mean age), and clinical outcome data (e.g., number and percent transited for each intervention group at each time-point and transition assessment employed). Data were analyzed using randomeffects pairwise meta-analysis, and secondly, multivariate network meta-analyses (NMA), and reported as risk ratios (RR). Result(s): A total of 38 independent studies met the inclusion criteria. In pairwise meta-analyses, CBT studies were associated with a significant reduction in transition compared to controls at 12-month and 18-month follow-up (RR = 0.57; 95% CI, 0.35 to 0.93; I2 = 7%; P = 0.02 versus RR = 0.54; 95% CI, 0.32 to 0.92; I2 = 0%; P = 0.02). In the NMA, integrated psychological therapy, CBT, supportive therapy, family therapy, needs-based interventions, omega-3, risperidone plus CBT, ziprasidone, and olanzapine were not significantly more effective at reducing transition at 6- and 12-months relative to any other intervention. Conclusion(s): This systematic review and meta-analysis demonstrated a reduced risk for transition favoring CBT at 12- and 18-months. No interventions were significantly more effective at reducing transition compared to all other interventions in the NMA.
Early Intervention in Psychiatry, 12 (Supplement 1) : 173
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
Devoe, D., Farris, M., Addington, J.
Youth at clinical high risk (CHR) for psychosis often present with symptoms of depression and anxiety, which can reduce quality of life. Therefore, the aim of this systematic review was to determine the impact of all interventions on symptoms of depression and anxiety in CHR samples. We systematically searched Embase, EBM, PsycINFO, CINAHL, and MEDLINE. Studies were selected if they reported changes in depression or anxiety symptoms in youth at CHR and included an intervention. Data was evaluated using pairwise metaanalyses, stratified by time, and reported as the standardized mean difference (SMD). Twenty-three studies met our inclusion criteria, including a total of 1,831 CHR participants. The mean age was 19.35 years and 49% were female. Interventions included family therapy, glycine, antipsychotics, cognitive remediation, however analysis could only be performed on cognitive behavioural therapy (CBT) and omega-3. CBT did not significantly improve depression at 6-months (SMD = 0.02; 95% CI = -0.25, 0.28), 12-months (SMD = -0.04; 95%CI = -0.23, 0.14), 18-months (SMD = -0.11; 95%CI = -0.41, 0.20), or at 24-48-month follow-up (SMD = -0.21; 95%CI = -0.50, 0.08). CBT did not significantly improve anxiety at 6-months (SMD = -0.10; 95% CI = -0.29, 0.08), 12-months (SMD = 0.05; 95%CI = -0.14, 0.23), 18-months (SMD = 0.09; 95%CI = -0.22, 0.39), or at 24-48-months (SMD = -0.06; 95%CI = -0.55, 0.43). Omega-3 did not significantly improve depression at 6-months (SMD = -0.46; 95CI = -1.15, 0.23) and 12-months (SMD = -0.29; 95%CI = -1.10, 0.51). In conclusion, no interventions significantly impacted symptoms of depression or anxiety in CHR samples. However, no trials in this review were designed to target and treat these symptoms and the CBT used was specifically designed to address attenuated psychotic symptoms.
Early Intervention in Psychiatry, 12 (Supplement 1) : 174
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy, Family therapy, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Thompson, A., Winsper, C., Marwaha, S., Haynes, J., Alvarez-Jimenez, M., Hetrick, S., Realpe, A., Vail, L., Dawson, S., Sullivan, S. A.
Background Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice.Method A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP.Results Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis.Conclusions There is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies.Declaration of interest A.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals. Copyright © The Royal College of Psychiatrists 2018.
BJPsych Open, 4(4) : 215-225
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Medication dose reduction/discontinuation