Disorders - Psychosis Disorders
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
Arango, C., Mayoral, M.
Early specialized care may improve short-term outcomes in firstepisode psychosis. We implemented a psychoeducational group program
(PIENSA) and showed that it helped adolescent patients and their families manage crises, improved patients' negative symptoms, and increased their
involvement in social activities in the short-term. However, it was unclear whether the benefits persist over time. Objective(s): To investigate
whether the beneficial effects of a structured psychoeducational group program for adolescents with earlyonset psychosis and their families, observed
immediately after the intervention, were maintained two years later. Method(s): The current study examines the two-year longitudinal efficacy of a
randomized controlled trial based on a structured psychoeducational problem-solving group intervention for adolescents with early-onset psychosis and
their families (PE) compared with a nonstructured group intervention (NS). We analyzed whether the differences found between PE and NS after the
intervention persisted two years later. Result(s): At the two-year follow-up, 89% of patients were able to be reassessed. In the PE group, 13% of
patients visited the Emergency Department as compared with 50% in the NS group (p = 0.019). However, no statistically significant differences were
found between the two groups in terms of negative symptoms or number and duration of hospitalizations. Conclusion(s): A psychoeducational group
intervention showed sustained effects on diminishing the number of Emergency Department visits two years after the intervention. However, improvement
in negative symptoms is not maintained. We will present the new actions implemented by the PIENSA team in order to enhance the long-term effects of
our intervention.
Early Intervention in Psychiatry, 12
(Supplement 1) : 41
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Problem solving therapy (PST)
Firth, J.
Background: Extensive research has established that nutritional
deficiencies are common in long-term schizophrenia. Randomised controlled trials (RCTs) also demonstrate that adjunctive nutritional interventions
can improve outcomes in long-term schizophrenia. Therefore, we examined nutritional deficiencies and clinical correlates in first-episode of
psychosis (FEP), in order to design a nutritional intervention for young patients in early stages of illness. Method(s): We reviewed all studies
examining blood nutrient levels and outcomes of supplementation in FEP: Meta-analytic techniques compared nutrient levels in FEP to healthy controls,
and systematic synthesis was applied to all clinical correlates of nutritional deficiencies in FEP. Additionally, we conducted an independent
systematic review of all nutrient-based treatment trials in FEP to date. Result(s): A total of 28 studies examined blood levels of six vitamins and
ten dietary minerals in FEP, across 2,612 individuals. Random effects meta-analyses comparing FEP to healthy control groups showed large, significant
deficits for Vitamin-D, Vitamin-C, and folate. Lower levels of folate and vitamin-D were associated with more severe symptoms in FEP. Our separate
systematic review of 8 experimental studies indicated that supplementation with certain amino acids and antioxidants may also improve treatment
outcomes in FEP. Conclusion(s): Our meta-analysis was the first to examine the extent and clinical correlates of nutritional deficits in FEP. Results
showed that vitamin D and folate deficits exist from illness onset, even prior to antipsychotic treatment - and are associated with more severe
psychiatric symptoms. Our upcoming RCT (the 'NATURE' trial) will assess if targeting these deficiencies can improve recovery in FEP.
Early Intervention in Psychiatry, 12 (Supplement
1) : 69
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Vinogradov, S., Ramsay, I., Biagianti, B., Loewy, R., Fisher,
M., Mathalon, D., Ma, S., Ragland, D., Niendam, T., Carter, C.
The cognitive deficits that characterize patients with
schizophrenia are present in the prodrome, worsen as the illness progresses, and predict functional outcome. Cognitive dysfunction thus must be a
primary target for aggressive early intervention in in early phases of schizophrenia. We report on behavioral and imaging data from a randomized
controlled trial of targeted auditory-system training (AT) in participants with recent onset schizophrenia (N = 144, mean age 21 years). These
findings begin to point to personalized psychiatry approaches. 1. Auditory training subjects demonstrated significant improvements in Global
Cognition, Verbal Memory, and Problemsolving compared to computer games control subjects. Traininginduced cognitive gains at 40 hours showed
significant associations with improved auditory processing speed at 20 hours. 2. Global Cognition showed durable improvements at 6-month follow-up.
Within the AT group, Global Cognition improvement after training was significantly correlated with positive symptom improvement at 6-month follow-up.
3. Baseline auditory MMN was significantly reduced in participants and associated with worse Global Cognition. MMN did not show changes after AT and
exhibited trait-like stability. Greater deficits in double-deviant MMN predicted greater gains in Global Cognition in response to AT. 4. Change in
Global Cognition was significantly related to change in left thalamus volume in the AT group. Greater symptom severity at baseline reduced the
likelihood of response to AT both with respect to improved cognition and change in thalamic volume. 5. A model selection and regression analytic
approach (LASSO) identified baseline Global Cognition, education, and gender in a model predictive of improvement on cognition following AT.
Early Intervention in Psychiatry, 12 (Supplement
1) : 42
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Devoe, D. J., Peterson, A., Addington, J.
Objective: Youth at clinical high
risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a
reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-
analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis.\rMethod: The authors searched PsycINFO,
Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up
negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the
differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD).\rResults: Of 3027 citations, 32
studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments.
N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI
= -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more
effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive
therapy, and integrated psychological interventions.\rConclusions: Efficacy and effectiveness were not confirmed for any negative symptom treatment.
Many studies had small samples and the majority were not designed to target negative symptoms.
Schizophrenia Bulletin, 44(4) : 807-823
- 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), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Grossman, M., Bowie, C. R.
Social cognition has gained widespread acceptance as a major
contributor to functional outcomes in psychotic illness, yet limited research has examined the role of motivation in the context of this model.
Cross-sectional research has reported significant associations between domains of social cognition and motivation, with correlations in the moderate
range. Motivational difficulties in psychosis may undermine an individual's ability to put forth adequate effort on tasks of social cognition;
however, the directionality of this relationship remains unclear. For the present study, individuals with first-episode psychosis (n = 35) and
community controls (n = 35) were randomized to a reward condition in which they received $0.25 per correct response on the TASIT, a measure of theory
of mind (ToM), or a nonreward condition in which they completed the TASIT without any feedback. A mixed-model ANOVA demonstrated a significant Group
x Condition interaction, F(1,65) = 6.96, p = .01. Post-hoc analyses revealed that community controls showed no difference in their ToM performance
across conditions, whereas first-episode patients who received monetary reinforcement displayed clinically and statistically significant improvement
in ToM performance relative to those who did not receive monetary reinforcement. Results from this study suggest that social cognitive performance
may underrepresent actual ability for patients in the early stages of psychosis. Moreover, ToM performance appears to be directly influenced by
performancecontingent incentives, corrective feedback, and/or a combination of these factors. Future research is needed to identify the most salient
motivational factor, and further disentangle what is driving performance differences between conditions, which seems to be uniquely observed in
first-episode patients.
Early Intervention in Psychiatry, 12 (Supplement 1) : 137
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Contingency
management
Loewy, R., Fisher,
M., Carter, C., Ragland, J. D., Niendam, T., Stuart, B., Schlosser, D., Vinogradov,
S.
Cognitive deficits in early psychosis
predict functional outcomes and should be aggressively targeted for early intervention. We have recently conducted two parallel studies of targeted
cognitive training of auditory/verbal processing in early psychosis: one with adolescents and young adults at clinical high risk (CHR) for psychosis
and a second with young adults with recent-onset schizophrenia (ROS). Both studies were double-blind randomized controlled trials in which
participants performed 40 hours of auditory training (AT) or commercial computer games (CG) via laptop computer. They were assessed on symptoms,
functioning and an abbreviated MATRICS-recommended neurocognitive battery at baseline, post-training and 6-month followup. In a modified Intent-To-
Treat (ITT) analysis with 147 randomized ROS participants there were significant condition-by-time interactions for Global Cognition (p = 0.007),
Verbal Memory (p = . 042) and a trend towards significance for Problem Solving (p = .054). Planned contrasts revealed gains for the AT group compared
to CG group from baseline to follow-up in Global Cognition (p = .001) and PANSS Positive symptoms (p = .0017). In a similar modified ITT analysis, 83
randomized CHR participants demonstrated a significant condition-bytime interaction in Verbal Memory, with the AT group showing more improvement from
baseline to post-training than the CG group (p = .04). Analysis of the CHR 6-month follow-up data is currently underway. Neuroscience-informed
cognitive training represents a promising treatment approach for cognitive dysfunction in adolescents and young adults in the early phases of
psychosis. Future research should focus on personalization, improving training adherence, and combination with coordinated specialty care
interventions to more strongly impact real-world functioning.
Early Intervention in Psychiatry, 12 (Supplement
1) : 74
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Addington,
J., Devoe, D.
The main focus of psychological treatment for youth at clinical high risk (CHR) of psychosis has been to prevent transition
to full-blown psychosis and less often attenuated psychotic symptoms. However, in addition to the attenuated psychotic symptoms, these young people
often present with negative symptoms, as well as other comorbid disorders. They typically have cognitive difficulties that are intermediate to
healthy controls and individuals with full-blown psychosis. Many have poor social and role functioning. Through a series of network and pairwise
meta-analyses this presentation reviews all treatment studies to date including cognitive behavior therapy (CBT), family intervention, cognitive
remediation, integrated psychological treatment and a range of pharmacotherapies and includes outcomes such as transition, attenuated psychotic
symptoms, negative symptoms, cognition and social and role functioning. There are some positive results in support of CBT in preventing transition to
psychosis and reducing attenuated psychotic symptoms. None of the treatments reviewed appear to have an impact on negative symptoms or social
functioning, which is of concern since many of these young people continue to have poorer social functioning even when they do not make the
transition to psychosis and attenuated psychotic symptoms have remitted.
Early Intervention
in Psychiatry, 12 (Supplement 1) : 10
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Grant, P., Munk, A. J. L., Hennig, J.
BACKGROUND: While individuals at ultra-risk for schizophrenia are characterized by
high negative/disorganised but low positive schizotypy, schizophrenia patients are usually high in all three schizotypy facets. Thus, avoiding
increases in positive schizotypy in ultra-high risk individuals may constitute of form of schizophrenia-prevention. A possible method of reducing
positive schizotypy could be Positive-Psychological intervention (PI).\rMETHODS: We present results from 2 independent studies, including a 12-month
follow-up from study 1, using an easy-to-perform intervention based on Positive Psychology to reduce positive schizotypy.\rRESULTS: A PI can
significantly and sustainably reduce positive schizotypy compared to a placebo-condition. Furthermore, our results show very high response-rates to
said intervention, with responsiveness to the intervention increasing significantly with disorganised schizotypic traits.\rCONCLUSIONS: As especially
disorganised schizotypy is of relevance for the risk of transition from high benign schizotypy to schizophrenia and is found most closely associated
to familial schizophrenia-risk and highly elevated in at-risk mental states, our results are encouraging. We suggest, thus, that positive psychology
can not only reduce positive schizotypy, but may be increasingly useful with rising schizophrenia-risk and, thus, be worthy of further investigation
regarding it potential in schizophrenia-prevention.
Schizophrenia Research, 199 : 414-
419
- Year: 2018
- Problem: Psychosis Disorders
- Type:
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Positive
psychology
Lewis, S., Fraccaro, P., Machin, M., Hopkins, R., Sanders, C., He, Z., Stockton-Powdrell, C., Ainsworth, J., Whelan, P., Wykes, T.
Improving recovery from acute symptoms and preventing relapse are two major
challenges in psychosis. We previously developed a smartphone-based personalised technology to monitor symptoms in real time, which showed good
acceptability, reliability and validity for active remote monitoring of symptoms. We now report an RCT testing its efficacy when embedded into the
ICT systems of mental health services. Participants with early psychosis/SMI received a semirandom beep 2-4 times per day on their smartphone app and
answer 14 key symptom rating items using a touchscreen slider. Responses are uploaded wirelessly in real time to a central server and build into a
graphical readout on the handset. This was built into an end-to-end system in two NHS Hospital Trusts to stream data into ECRs and enable detection
by the clinical team of SMI EWS when key symptoms exceeded a personalised severity threshold. 81 people were randomised to either active symptom
monitoring or TAU. PANSS positive subscale score showed a significant mean reduction in treatment over 12 weeks in the early psychosis group. EWS
alerts generated by the system occurred in 92% of cases and blind comparison with electronic case record data suggested good sensitivity and lower
specificity, with clear indications of how to adjust the gain of the system to improve future event-detection efficiency. When the symptom-monitoring
system was built into clinical management workflows to enable personalised alerts of symptom deterioration, it was shown to have potential use in
promoting earlier intervention for relapse.
Early Intervention in Psychiatry, 12 (Supplement
1) : 31
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)