Disorders - Psychosis Disorders
Castilla, R.
International Journal of Neuropsychopharmacology, 5(Suppl 1) : S51
- Year: 2002
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
McGorry, Patrick D., Yung, Alison R., Phillips, Lisa J., Yuen, Hok Pan, Francey, Shona, Cosgrave, Elizabeth M., Germano, Dominic, Bravin, Jenny, McDonald, Tony, Blair, Alison, Adlard, Stephen, Jackson, Henry
BACKGROUND: Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period. However, only recently has it been possible to engage people in treatment during this phase. METHODS: A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis. We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies. Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 1.3 mg/d) and cognitive behavior therapy. Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention. Assessments were performed at baseline, 6 months, and 12 months. RESULTS: By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=.03). After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=.24). However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use. CONCLUSIONS: More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined. This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence.
Archives of General Psychiatry, 59(10) : 921-8
- Year: 2002
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Merlo, Marco C. G., Hofer, Helene, Gekle, Walter, Berger, Gregor, Ventura, Joseph, Panhuber, Ingrid, Latour, Gabriela, Marder, Stephen R.
BACKGROUND: The aim of this study was to examine differences in the improvement of clinical psychopathology and in fine motor functions at 2 doses of risperidone in first-episode, acutely psychotic patients. METHOD: In a double-blind, fixed-dose study, 49 acutely psychotic, neuroleptic-naive patients who were admitted for the first time and who met DSM-IV criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder were randomly assigned to 2 or 4 mg/day of risperidone. Treatment efficacy was measured using the Brief Psychiatric Rating Scale, the Scale for the Assessment of Negative Symptoms, The Clinical Global Impressions scale, and the Social and Occupational Functioning Assessment Scale. Fine motor functions were assessed using a computerized device (the Vienna Test System) and were compared with those of a control group of 20 healthy subjects who were matched for age, gender, and educational level. RESULTS: Treatment with doses of 2 and 4 mg of risperidone daily significantly reduced positive (p < .0001) and negative (p < .01) symptoms at 8 weeks. Although there were no significant differences in motor movements as measured using the Barnes Akathisia Scale and the Simpson-Angus Scale, computerized fine motor assessment showed significantly less motor dysfunction in the 2-mg/day group at 8 weeks. No significant correlations to plasma concentration of active moiety were found for data on psychopathology and fine motor functions. CONCLUSION: The 2 doses of risperidone did not differ in terms of clinical improvement, but the 2-mg/day dose produced fewer fine motor dysfunctions. These results suggest that a dose as low as 2 mg/day of risperidone may be effective for patients with first-episode psychosis.
Journal of Clinical Psychiatry, 63(10) : 885-91
- Year: 2002
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Lenior, Marie E., Dingemans, Peter M., Schene, Aart H., Hart, Augustinus A., Linszen, Don H.
The stability of parental expressed emotion (EE) is analysed over about 9 yrs, and related to course of illness in patients (aged 15-26 yrs at intake) with recent-onset schizophrenia in The Netherlands. Families, who participated in a 15-mo intervention, were randomised over two intervention conditions. Psychotic episodes were measured over 5 yrs after discharge. The Five Minute Speech Sample (FMSS) EE was elicited 2 times during the 12-mo outpatient intervention and 2 times over 8 yrs after discharge on average. EE is expressed as criticism/dissatisfaction (CRIT), emotional overinvolvement (EOI), and as the classical dichotomous index. EE is not stable over the years. Intervention condition had no differential effect on EE as measured with CRIT and the dichotomous index. For EOI, an interaction between intervention condition and time was found. EE as assessed during intervention does not predict psychotic episodes during follow-up. An association was found between psychotic episodes and CRIT as assessed at 34 mo after discharge. Family intervention may inhibit the development of high EOI for a limited period. Our results may be in support of the hypothesis that psychotic episodes in patients can affect the critical attitude in parents. (PsycINFO Database Record (c) 2007 APA, all rights reserved).
Schizophrenia Research, 57(2-3) : 183-190
- Year: 2002
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Lenior, M. E., Dingemans, P. M., Linszen, D. H., deHaan, L., Schene, A. H.,
BACKGROUND: Schizophrenia implies severe social impairments. Since the treatment of patients with schizophrenia shifted from long-term hospital admissions to community services, research on social functioning has become increasingly important. AIMS: Follow-up assessment of social functioning in young patients with schizophrenia during a 5-year period after intervention. METHOD: During intervention, families were randomised into two conditions: standard intervention and standard plus family intervention. RESULTS: Although no differential treatment effect with regard to the course of the illness was found, patients from the standard plus family intervention condition stayed for fewer months in institutions for psychiatric patients than patients from the standard intervention condition. CONCLUSIONS: Family intervention has helped parents to support their children, thereby diminishing institutional care.
British Journal of Psychiatry, 179 : 53-8
- Year: 2001
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Emsley, R. A., RisperidoneWorkingGroup
An international, multicenter, double-blind study was conducted in 183 patients with a first psychotic episode (provisional schizophreniform disorder or schizophrenia; DSM-III-R) treated with flexible doses of risperidone or haloperidol for 6 weeks. At endpoint, 63 percent of risperidone-treated patients and 56 percent of haloperidol-treated patients were clinically improved (> or = 50% reduction in Positive and Negative Syndrome Scale total scores). Risperidone was better tolerated than haloperidol: the severity of extrapyramidal symptoms was significantly lower in the risperidone-treated patients; significantly fewer risperidone-treated patients required antiparkinsonian medication; and significantly fewer discontinued treatment because of adverse events. A post hoc analysis revealed that low doses of these antipsychotics were efficacious in some patients. Furthermore, the severity of extrapyramidal symptoms and the use of antiparkinsonian medications were significantly lower in patients receiving low doses (maximum, < or = 6 mg/day) than high doses (maximum, > 6 mg/day) of risperidone or haloperidol. These findings are consistent with the suggestion that patients with a first psychotic episode may require low doses of antipsychotic medications. Studies designed specifically to compare low and high doses of antipsychotics are warranted to help optimize treatment for these patients.
Schizophrenia Bulletin, 25(4) : 721-9
- Year: 1999
- 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)
Linszen, D. H., Dingemans, P. M., Lenior, M. E., Scholte, W. F., Goldstein, M.
The present study was designed to test the effectiveness of delivering two intervention programs with patients with recent onset schizophrenia and related disorders. The 76 patients in the study were young (mean age 20.5 SD 2.5). Overall relapse rates during the two intervention programs were low (16%). Adding a family intervention to the standard intervention did affect the relapse rate. Patients from low EE families relapsed slightly more in the intervention group with additional behavioral family therapy. Behavioral family intervention in low EE families may increase stress, thus influencing relapse. Inpatient family involvement may be a critical ingredient in successful individually oriented outpatient relapse prevention programs. Collaboration between professionals and relatives may form an optimal basis for extended continuity of care.
Italian Journal of Psychiatry & Behavioural Sciences., 8(2) : 77-84
- Year: 1998
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Ferrari, M. C. L., Elkis, H.
Schizophrenia Research, 1, 2(special) :
- Year: 1997
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Nugter, A., Dingemans, P., VanDoes, J. W. D., Linszen, D., Gersons, B.
A controlled longitudinal treatment study was carried out to investigate the effect of a behavioral family treatment on Expressed Emotion (EE) and to examine the correspondence between EE changes and relapse rates. Subjects were 52 patients with recent onset schizophrenia or related disorders and their parents. After completion of inpatient treatment they were randomly allocated to individual treatment or individual treatment plus family treatment. The family treatment consisted of education and training in communication and problem-solving skills. Expressed Emotion was measured with the Five-Minute Speech Sample (FMSS). The findings show that family treatment did not have a significant positive effect on EE level. The dichotomous FMSS/EE did not systematically change and these findings were comparable with the results of prior EE research. A scoring system that included all subscores of the FMSS was somewhat more sensitive to changes. In the individual treatment condition relapse rates tended to co-occur with a change in FMSS/EE level, irrespective of the direction of this change.
Psychiatry Research., 72(1) : 23-31
- Year: 1997
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Kumra, S., Frazier, J. A., Jacobsen, L. K., McKenna, K., Gordon, C. T., Lenane, M. C., Hamburger, S. D., Smith, A. K., Albus, K. E., Alaghband-Rad, J., Rapoport, J. L.
BACKGROUND: Childhood-onset schizophrenia is a rare but severe form of the disorder that is often treatment-refractory. In this study, the efficacy and adverse effects of clozapine and haloperidol were compared for children and adolescents with early-onset schizophrenia. METHODS: Twenty-one patients (mean [+/-SD] age, 14.0 +/- 2.3 years) with onset of Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition-defined schizophrenia that began by age 12 years and who had been nonresponsive to typical neuroleptics participated in the study. Patients were randomized to a 6-week double-blind parallel comparison of clozapine (mean [+/-SD] final dose, 176 +/- 149 mg/d), or haloperidol, (16 +/- 8 mg/d). RESULTS: Clozapine was superior to haloperidol on all measures of psychosis (P = .04-.002). Positive and negative symptoms of schizophrenia improved. However, neutropenia and seizures were major concerns. To date, one third of the group has discontinued using clozapine. CONCLUSIONS: Clozapine has striking superiority for positive and negative symptoms in treatment-refractory childhood-onset schizophrenia. However, due to possibly increased toxic effects in this pediatric population, close monitoring for adverse events is essential.
Archives of General Psychiatry, 53(12) : 1090-7
- Year: 1996
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
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Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Linszen, D., Dingemans, P., VanDerDoes, J. W., Nugter, A., Scholte, P., Lenior, R., Goldstein, M. J.
The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.
Psychological Medicine, 26(2) : 333-42
- Year: 1996
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Lambert, T., Keks, N., McGrath, J., Catts, S., Hustig, H., Vaddadi, K., Burrows, G., Varghese, F., George, T., Kerr, K., Johnson, G., Burnett, P., Zorbas, A., Hill, C., Copolov, D.
Remoxipride, a substituted benzamide, is a selective D2 antagonist with an atypical neuroleptic profile. Previous studies have demonstrated its antipsychotic efficacy against haloperidol and, more recently, thioridazine. Of the 144 patients enrolled in the Australian remoxipride-thioridazine comparative trial, 28 presented for their first episode of schizophrenia and/or had no previous neuroleptic treatment. These patients form the subject of this paper. The study found that in persons presenting for their first admission for schizophrenia, remoxipride showed equal antipsychotic efficacy compared to thioridazine. Treatments were comparable in terms of generating few extrapyramidal symptoms but thioridazine caused more significant general side-effects. Patients are more likely to be compliant with remoxipride due to its tolerability. Despite remoxipride being withdrawn from the market due to a suggested association with aplastic anaemia, this class of substituted benzamides warrants further examination as a treatment agent for first and subsequent episodic psychosis.
Human Psychopharmacology., 10(6) : 455-460
- Year: 1995
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)