Disorders - psychosis disorders
McGorry, P. D., Nelson, B., Markulev, C., Yuen, H. P., Schafer, M. R., Mossaheb, N., Schlogelhofer, M., Smesny, S., Hickie, I. B., Berger, G. E., Chen, E. Y., de-Haan, L., Nieman, D. H., Nordentoft, M., Riecher-Rossler, A., Verma, S., Thompson, A., Yung, A. R., Amminger, G.
Importance: A promising treatment to prevent onset and improve outcomes in patients at ultrahigh risk for psychosis is dietary supplementation with long-chain omega-3 polyunsaturated fatty acids (PUFAs). Objective: To determine whether treatment with omega-3 PUFAs in combination with a high-quality psychosocial intervention (cognitive behavioral case management [CBCM]) is more effective than placebo plus CBCM. Design, Setting, and Participants: NEURAPRO, a double-blind, placebo-controlled, randomized clinical trial, was conducted from March 1, 2010, to September 30, 2014, in 10 specialized early psychosis treatment services in Australia, Asia, and Europe. The primary analysis used the intention-to-treat approach. Interventions: A daily dose of 1.4 g of omega-3 PUFAs or placebo (paraffin oil), plus 20 or fewer sessions of CBCM over the 6-month study period. Main Outcomes and Measures: The primary outcome was transition to psychosis status at 6 months. The secondary outcomes were general levels of psychopathology and functioning, as assessed by the Brief Psychiatric Rating Scale (BPRS) (range, 24-168), Scale for the Assessment of Negative Symptoms (SANS) (range, 0-125), Montgomery-Asberg Depression Rating Scale (MADRS) (range, 0-60), Young Mania Rating Scale (YMRS) (range, 0-44), Social and Occupational Functioning Assessment Scale (SOFAS) (range, 0-100), and the Global Functioning: Social and Role scale (range, 0-10). For SOFAS and Global Functioning: Social and Role scale, higher scores were better; for other measures, lower scores were better. Results: In this study of 304 adults at ultrahigh risk for psychotic disorders, 153 (50.3%) received omega-3 PUFAs and 151 (49.7%) received placebo. In all, 139 (45.7%)were male; mean (SD) agewas 19.1 (4.6) years. The Kaplan-Meier-estimated 6-month transition rates were 5.1% (95%CI, 1.3%- 8.7%) in the control group and 6.7%(95% CI, 2.3%-10.8%) in the omega-3 PUFA group. At 12 months, the rates were 11.2%(95%CI, 5.5%-16.7%) in the control group and 11.5%(95%CI, 5.8%-16.9%) in the omega-3 PUFA group. No significant difference was observed between the transition rates of both groups (hazard ratio, 1.1; 95%CI, 0.55-2.23; P = .76, stratified log-rank test). Conclusions and Relevance: This trial clearly failed to replicate the findings of the original single-center trial. The most likely explanation is that omega-3 PUFAs lack efficacy under these conditions. However, the lower-than-expected transition rate may have prevented a test of the main hypothesis. Given the substantial symptomatic and functional improvement in both groups, the other treatments received (ie, CBCM and antidepressants) likely produced a ceiling effect beyond which omega-3 PUFAs, even if effective, could not be shown to confer additional benefits. Nevertheless, the main conclusion is that omega-3 PUFAs are not effective under conditions where good quality, evidence-based psychosocial treatment is available. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
JAMA Psychiatry, 74(1) : 19-27
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
, Case management
Krause, M., Zhu, Y., Schneider-Thoma, J., Huhn, M., Salanti, G., Chaimani, A., Leucht, S.
Introduction: Children and adolescents with schizophrenia are a particulary vulnerable group. On the one hand, an early onset can be a sign of a less favourable prognosis, therefore it may be important to reach for the maximum efficacy at this stage. On the other hand, children and adolescents are even more sensitive to the side-effects of antipsychotics, and hormone related adverse events maybe particularly problematic. Therefore, when using antipsy chotics in this population efficacy and side-effects must be carefully weighted [1]. Aims: We therefore attempted to integrate all the randomized evidence from the available antipsychotics used for schizophrenic children and adolescents by performing a network meta-analysis. Methods: As data sources we searched MEDLINE, EMBASE, PsycINFO, Cochrane Library, PubMed, Biosis, and ClinicalTrials. gov up to Nov 17, 2016. At least 2 independent reviewers selected published and unpublished single-and double-blind RCTs children and adolescents with schizophrenia (any study-defined criterion) that compared any antipsychotic (at any dose and in any oral form of administration) with another antipsychotic or placebo. At least 2 independent reviewers extracted all data into standard forms and assessed the quality of all included trials with the Cochrane Collaboration's risk-of-bias tool. Data were pooled using a random-effects model in a frequentist setting. The primary outcome was efficacy as measured by overall Change/endpoint in symptoms of schizophrenia. Secondary outcomes included change in positive and negative symptoms of schizophrenia, categorical response to treatment, dropouts for any reason and for inefficacy of treatment, measures of quality of life and social functioning or important side effects like weight gain, sedation, prolactin increase, EPS and use of antiparkinsonian medication. Results: Twenty seven unique open and blinded RCTs with 2328 unique participants (62% men; mean age 14.35 years). published from 1967 to March 2015 were identified through the literature search. Few significant differences were found in all outcomes. In the primary outcome clozapine was significantly more effective than all others analyzed antipsychotics except olanzapine. For olanzapine there was just a significant better efficacy compared to olanzapine. Nearly all antipsychotics were more efficacious compared to placebo. In terms of preventing weight gain, molindone and ziprasidone were better as placebo. The highest weight gain was found for clozapine and olanzapine. Conclusions: In summary we can say that there is a gap of evidence for some drugs and a lot of outcomes, especially safety outcomes. Most of the comparisons are based only on one study or just on indirect evidence. Never the less the available direct and indirect evidence showed that the treatment effects were very similar compared to the results in our previous meta-analyses on adult people with schizophrenia [2], [3]. The evidence in this area is rapidly growing making it important to keep these systematic reviews up to date.
European Neuropsychopharmacology, 27(Suppl 4) : S948
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
Lutgens, D., Gariepy, G., Malla, A.
Background: Negative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination. Aims: To conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders. Method: We searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure. Results: A total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy (pooled SMD 70.34, 95% CI 70.55 to 70.12), skills-based training (pooled SMD 70.44, 95% CI 70.77 to 70.10), exercise (pooled SMD 70.36, 95% CI 70.71 to 70.01), and music treatments (pooled SMD 70.58, 95% CI 70.82 to 70.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD 70.38, 95% CI 70.53 to 70.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity. Conclusions: Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
British Journal of Psychiatry, 210(5) : 324-332
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy, Family therapy, Skills training, Creative expression: music, dance, drama, art
, Physical activity, exercise, Other service delivery and improvement interventions
Zheng, W., Cai, D., Yang, X., Ungvari, G., Ng, C., Muller, N., Ning, Y., Xiang, Y.
Neuroinflammation has been implicated in the neurobiological pathways of schizophrenia. This meta-analysis evaluated the efficacy and tolerability of adjunctive celecoxib as a noncompetitive anti-inflammation drug in treating schizophrenia. Data were searched, extracted, checked and entered into the RevMan (version 5.3) software by two independent investigators. Standardized/weighted mean differences (SMDs/WMDs), risk ratio (RR) and their 95% confidence intervals (CIs) were calculated, as appropriate. Included were 8 randomized controlled trials (RCTs) with a total of 626 patients with schizophrenia including 316 (50.5%) treated on celecoxib (400 mg/day) and 310 (49.5%) on placebo over 8.3 +/- 2.3 weeks of treatment. Adjunctive celecoxib outperformed placebo with respect to total psychopathology [3 RCTs, n = 180; SMD: -0.47; 95%CI: -0.81, -0.14; P = 0.005; I2 = 18%; 'moderate quality'], symptoms positive [3 RCTs, n = 180; SMD: -0.50; 95%CI: -0.79, -0.20; P = 0.001; I2 = 0%; 'moderate quality'], negative symptoms [3 RCTs, n = 180; SMD: -0.32; 95%CI: -0.66, 0.02; P = 0.06; I2 = 22%; 'moderate quality'], and general psychopathology scores [3 RCTs, n = 180; SMD: -0.35; 95%CI: -0.65, -0.06; P = 0.02; I2 = 0%; 'moderate quality'] in first-episode, but not chronic patients. Additionally, superiority of celecoxib for the Positive and Negative Syndrome Scale (PANSS) total scores was moderated by higher PANSS positive scores and lower PANSS negative scores at baseline. All-cause discontinuation [RR: 1.02; (95%CI: 0.56, 1.86); P = 0.94; I2 = 0%] and adverse drug reactions were similar between the two groups. Adjunctive celecoxib appears to be an efficacious and safe treatment in improving psychotic symptoms, particularly in first-episode schizophrenia. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Psychiatric Research, 92 : 139-146
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Zhu, Y., Krause, M., Huhn, M., Rothe, P., Schneider-Thoma, J., Chaimani, A., Li, C., Davis, J., Leucht, S.
Background: The first episode of schizophrenia is a pivotal phase of this debilitating illness. Which drug to use remains controversial without a summary of all direct or indirect comparisons of drugs. We did a systematic review with pairwise and network meta-analyses of efficacy and tolerability. Methods: We searched MEDLINE, Embase, PsycINFO, Cochrane Library, PubMed, Biosis, and ClinicalTrials.gov for randomised controlled trials of antipsychotics for the acute treatment of first-episode schizophrenia, published up to Nov 17, 2016. Our primary outcome was overall change in symptoms. Secondary outcomes were change in positive and negative symptoms, categorical response to treatment, study dropout for any reason and for inefficacy of treatment, use of drugs to treat parkinsonian symptoms, weight gain, sedation, increase in prolactin release, overall functioning, and quality of life. We did the meta-analyses with a random-effects model to calculate standardised mean differences (SMDs) or odds ratios (ORs) with 95% CIs. Findings: We identified 19 relevant randomised controlled trials of 12 antipsychotic drugs that involved 2669 participants. 13 of the studies presented data on the primary outcome. For overall reduction of symptoms, amisulpride (SMD -0.37, 95% CI -0.61 to -0.14), olanzapine (-0.25, -0.39 to -0.12), ziprasidone (-0.25, -0.48 to -0.01), and risperidone (-0.14, -0.27 to -0.01) were significantly more efficacious than haloperidol, but the evidence was very low to moderate quality. Amisulpride was superior for reduction of symptoms to quetiapine (SMD -0.25, 95% CI -0.50 to -0.01). Olanzapine was superior to haloperidol and risperidone for reduction of negative symptoms. Several second-generation antipsychotics were superior to haloperidol in terms of all-cause discontinuation. Olanzapine was associated with at least one use of drugs to treat parkinsonian symptoms and quetiapine with less akathisia than haloperidol, aripiprazole, risperidone, and olanzapine, but, again, evidence was very low to low quality. Molindone was superior to risperidone, haloperidol, and olanzapine in terms of weight gain, and superior to risperidone in terms of increase in prolactin release. Interpreation: Haloperidol seems to be a suboptimum treatment option for acute treatment of first-episode schizophrenia, but we found little difference between second-generation antipsychotics. The evidence was generally of low quality and the numbers of patients for each drug were small. Thus, the choice of treatment should be guided primarily by side-effects. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Lancet Psychiatry, 4(9) : 694-705
- Year: 2017
- 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)
Zhu, Y., Li, C., Huhn, M., Rothe, P., Krause, M., Bighelli, I., Schneider-Thoma, J., Leucht, S.
It is often stated that first-episode patients tend to respond better to antipsychotics than chronic patients, but the exact numbers and moderators of response in this population are unclear. We, therefore, present the first systematic review on response rates of first episode patients with schizophrenia in randomized trials. We searched multiple databases for randomized-controlled trials of antipsychotics in acutely ill patients with a first episode of schizophrenia (last search: November 17, 2016). The outcomes were response rate based on two criteria, at least 50% PANSS or BPRS total score reduction from baseline and at least 20% reduction. Data were pooled in a single-group summary meta-analysis using Comprehensive Meta-Analysis software. Moreover, several potential moderators of response to antipsychotics were examined by meta-regression. We included 17 studies with a total of 3156 participants. On the average, 81.3%/51.9% of the first-episode patients reached an at least 20%/50% PANSS or BPRS reduction from baseline, respectively. Meta-regressions revealed a better treatment response in female patients, in more severely ill patients at baseline, in antipsychotic naive patients, in patients with a shorter illness duration and in open studies. Study duration and dosage were no significant moderators of response. Our finding suggest that more than 80% of first-episode patients achieved 20% PANSS/BPRS reduction from baseline and around 50% achieved a 50% PANSS/BPRS reduction. Several patient characteristics moderated response rates. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
European Neuropsychopharmacology, 27(9) : 835-844
- Year: 2017
- 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)
Ochoa, S., Lopez-Carrilero, R., Barrigon, M., Pousa, E., Barajas, A., Lorente-Rovira, E., Gonzalez-Higueras, F., Grasa, E., Ruiz-Delgado, I., Cid, J., Birules, I., Esteban-Pinos, I., Casanas, R., Luengo, A., Torres-Hernandez, P., Corripio, I., Montes-Gamez, M., Beltran, M., De-Apraiz, A., Dominguez-Sanchez, L., Sanchez, E., Llacer, B., Pelaez, T., Bogas, J., Moritz, S.
Background: Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. Method: A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition. Results: Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions: (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032). Conclusions MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Psychological Medicine, 47(9) : 1573-1584
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Psychoeducation, Other Psychological Interventions
Pagsberg, A. K., Jeppesen, P., Klauber, D. G., Jensen, J. G., Ruda, D., Stentebjerg-Olesen, M., Jantzen, P., Rasmussen, S., Saldeen, E. A-S., Lauritsen, M-B. G., Bilenberg, N., Stenstrom, A. D., Nyvang, L., Madsen, S., Werge, T. M., Lange, T., Gluud, C., Skoog, M., Winkel, P., Jepsen, J. R. M., Fagerlund, B., Correll, C. U., Fink-Jensen, A.
Background Head-to-head trials to guide antipsychotic treatment choices for paediatric psychosis are urgently needed because extrapolations from adult studies might not be implementable. In this superiority trial with two-sided significance testing, we aimed to compare the efficacy and safety of quetiapine-extended release (quetiapine-ER) versus aripiprazole in children and adolescents with first-episode psychosis, to determine whether differences between the two treatments were sufficient to guide clinicians in their choice of one drug over the other. Methods In this multicentre, double-blind, randomised trial in seven Danish university clinics, we recruited children and adolescents aged 12-17 years with a diagnosis of ICD-10 schizophrenia-spectrum disorder, delusional disorder, or affective-spectrum psychotic disorder, and psychotic symptoms scoring at least 4 on at least one of the following Positive and Negative Syndrome Scale (PANSS) items: P1 (delusions), P2 (conceptual disorganisation), P3 (hallucinations), P5 (grandiosity), P6 (suspiciousness/persecution), and G9 (unusual thought content), and a total PANSS score greater than 60. Patients were randomly assigned (1:1) to 12 weeks of treatment with target doses of 600 mg/day of quetiapine-ER (starting from 50 mg/day) or 20 mg/day of aripiprazole (starting from 2.5 mg/day). The assigned drug was titrated over five levels, with 2 days at each dose, and the final dose achieved on day 9. Randomisation was done using a computer-generated concealed sequence with a block size of 8, and stratified by baseline PANSS positive score (<=20 points or >20 points) and age (12-14 years or 15-17 years). Study drugs were administered in identical capsules, and interventions, assessments, and data analysis were done masked. The primary outcome was PANSS positive score. Key adverse outcomes were bodyweight, homoeostatic model of insulin resistance (HOMA-IR), akathisia, and sedation. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01119014. Findings Between June 10, 2010, and Jan 29, 2014, 231 participants were assessed for elegibility, of whom 113 were randomly assigned to quetiapine-ER (n=55) or aripiprazole (n=58). PANSS positive score did not differ between groups after 12 weeks (adjusted mean change -5.05 [5.46] for quetiapine-ER, -6.21 [5.42] for aripiprazole; p=0.98), but decreased over time in both groups (p<0.0001). Weight gain was more rapid with quetiapine-ER (p=0.0008), with an adjusted mean weight group difference at week 12 of 3.33 kg (SD 7.23; effect size 0.64; p<0.0001). The HOMA-IR group difference at week 12 favoured aripiprazole (adjusted mean log-transformed group difference 0.259 [SD 0.906]; effect size 0.35; p=0.0060). Akathisia was more common with aripiprazole at week 2 (observed in 34 [60%] of 57 patients; estimated 63.5%) than with quetiapine-ER (15 [30%] of 50; estimated 31.3%; p=0.0021), but not at other timepoints. Sedation proportions did not change significantly over time with either intervention (observed at weeks 2, 4, and 12, respectively, for quetiapine-ER in 43 [83%] of 52, 40 [83%] of 48, and 34 [72%] of 47 patients and for aripiprazole in 49 [89%] of 55, 52 [96%] of 54, and 44 [92%] of 48 patients), and the overall estimated probability combining all timepoints was significantly higher for aripiprazole (97.1%) than for quetiapine-ER (89.2%; p=0.012). In addition to sedation and akathisia, the most common adverse events were tremor, increased duration of sleep, orthostatic dizziness, depression, tension/inner unrest, failing memory, and weight gain. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Lancet Psychiatry, 4(8) : 605-618
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Pos, K., Meijer, C. J., Verkerk, O., Ackema, O., Krabbendam, L., de-Haan, L.
Cognitive biases, negative affect and negative self-esteem are associated with paranoia in people with psychotic disorders. Metacognitive group training (MCT) aims to target these biases although research has shown mixed results. Our objective was to establish the effect of MCT on paranoid ideation in patients with recent onset psychosis in a powerful experience sampling design. 50 patients between the age of 18 and 35 were included in a single-blind, parallel group RCT comparing MCT with occupational therapy (OT) as an active control condition. We assessed via questionnaires and experience sampling treatment effects on paranoid ideation, delusional conviction, the cognitive bias jumping to conclusion (JTC), and cognitive insight, as well as treatment effects on associations between negative affect, negative self-esteem and paranoid ideation. Patients in the MCT group did not show a decrease in paranoid ideation, delusional conviction, JTC-bias or an increase in cognitive insight compared with OT. However, negative affect showed a weaker association with paranoid ideation post-treatment in the MCT condition. In the OT condition, this association was stronger post-treatment. We tentatively suggest that patients with an early psychosis seemed to benefit from MCT in emotional learning compared with the OT condition. Despite the fact that the group training is well-received by patients, subsequent individual MCT (MCT+) may be indicated for stronger favorable effects on paranoid ideation. Copyright © 2017 The Author(s)
European Archives of Psychiatry and Clinical Neuroscience, 268 : 57-64
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Rasmussen, S. A., Rosebush, P. I., Mazurek, M. F.
Objective: Early antipsychotic response within the first 2-3 weeks of treatment can predict short-term outcomes after several months. We conducted the current study to determine whether the predictive value of early antipsychotic response persists throughout long-term treatment over multiple years. Methods: In this observational study, we conducted follow-up assessments of 64 patients with first-episode psychosis an average of 25 months after they began antipsychotic treatment. Patients were initially randomized to receive haloperidol or olanzapine, but treatment after the acute hospitalization period was not controlled. Regression analyses were used to determine whether early improvement on the Brief Psychiatric Rating Scale at 2 or 3 weeks predicted longer term improvement at follow-up. We conducted secondary analyses to determine whether early response could predict extrapyramidal side effects at follow-up. Results: Early response to haloperidol at 2 weeks predicted Brief Psychiatric Rating Scale improvement on longer term follow-up (p =.002). Longer term improvement was not predicted by early response to olanzapine at 2 weeks (p =.726) or 3 weeks (p =.541). Rates of extrapyramidal side effects did not differ between treatment groups and were not predicted by early response. Conclusion: These results demonstrate the long-term prognostic value of early haloperidol response. The predictive value of early olanzapine response may be less robust. Copyright © 2017 John Wiley & Sons, Ltd.
Human Psychopharmacology, 32 : e2633
- Year: 2017
- 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)
Retsa, C., Knebel, J. F., Geiser, E., Ferrari, C., Jenni, R., Fournier, M., Alameda, L., Baumann, P. S., Clarke, S., Conus, P., Do, K. Q., Murray, M. M.
Sensory impairments constitute core dysfunctions in schizophrenia. In the auditory modality, impaired mismatch negativity (MMN) has been observed in chronic schizophrenia and may reflect N-methyl-d-aspartate (NMDA) hypo-function, consistent with models of schizophrenia based on oxidative stress. Moreover, a recent study demonstrated deficits in the N100 component of the auditory evoked potential (AEP) in early psychosis patients. Previous work has shown that add-on administration of the glutathione precursor N-acetyl-cysteine (NAC) improves the MMN and clinical symptoms in chronic schizophrenia. To date, it remains unknown whether NAC also improves general low-level auditory processing and if its efficacy would extend to early-phase psychosis. We addressed these issues with a randomized, double-blind study of a small sample (N = 15) of early psychosis (EP) patients and 18 healthy controls from whom AEPs were recorded during an active, auditory oddball task. Patients were recorded twice: once prior to NAC/placebo administration and once after six months of treatment. The N100 component was significantly smaller in patients before NAC administration versus controls. Critically, NAC administration improved this AEP deficit. Source estimations revealed increased activity in the left temporo-parietal lobe in patients after NAC administration. Overall, the data from this pilot study, which call for replication in a larger sample, indicate that NAC improves low-level auditory processing in early psychosis. Copyright © 2017 Elsevier B.V.
Schizophrenia Research, :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Addington, J., Devoe, D., Piskulic, D., Romanowska, S., Townes, P.
Background: In youth at clinical high risk (CHR) of psychosis cognitive deficits have been observed across multiple domains of cognition. Currently, there are no reviews evaluating the impact of treatments on cognition in those at CHR. Therefore, we conducted a systematic review and meta-analysis to examine the impact of treatments on cognition in youth at CHR of psychosis. Methods: The authors conducted database searches of Embase, CINAHL, PsycINFO, Medline, and EBM from 1951 to May 2017. Studies were selected if they included any intervention that reported changes in cognition in youth at CHR. Treatment comparisons were evaluated using both pairwise and paired meta-analyses. Due to the differences in cognitive measures effect sizes were calculated as Hedges g and reported as the standardized mean difference (SMD). Results: Of 6,612 citations, 16 studies met our inclusion criteria, including a total of 514 CHR participants. Cognitive remediation (CR) was associated with a significant improvement in global cognition (SMD, 0.48; P<0.01), processing speed (SMD, 0.29; P<0.05), reasoning and problem solving (SMD, 0.21; P<0.05), working memory (SMD, 0.28; P<0.01), and visual learning and memory (SMD, 0.29; P<0.05) from baseline to follow-up. Other treatments (i.e. antipsychotics, glycine) had no pooled impact on cognition. Conclusions: This systematic review and meta-analysis demonstrated small to moderate effect sizes for CR interventions and subsequent improvement of cognition from baseline to follow-up. However, CR studies were not significant when compared to computer games at improving cognitive outcomes.
Neuropsychopharmacology, 43(Suppl 1) : S591-S592
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Typical Antipsychotics (first generation)
, Atypical Antipsychotics (second generation)
, Other biological interventions, Psychological Interventions (any)
, Cognitive remediation therapy