Disorders - psychosis disorders
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
Ventura, J., McEwen, S., Subotnik, K., Hellemann, G., Nuechterlein, K.
Background: Meta-analyses have shown that
various forms of exercise in schizophrenia patients are associated with symptom reduction, improved quality of life, and increased levels of
functioning. We examined whether combining cognitive training and aerobic exercise could improve symp-toms and social functioning in frst episode
schizophrenia patients more effectively than cognitive training alone. Some evidence would indicate that intervening during this early phase of
psychosis might be especially benef-cial for maximizing treatment effects. Methods: In this RCT, 46 patients with a frst episode of schizophrenia
were assigned to Cognitive Training plus Exercise (CT&E: n = 23) or Cognitive Training alone (CT; n = 23) for 6 months. Both groups received 24 weeks
of cognitive training, 4 hours per week. The CT&E group, in addition to CT, participated in aerobic exercise, 150 minutes per week. The frst 12 weeks
involved neurocognitive training (BrainHQ). The second 12 weeks involved social cognitive training (SocialVille). The aerobic conditioning exercises
included 45 minutes at UCLA two days a week and 30 minutes at home two days a week. Intensity of aerobic exercise was tailored to maintain an
individualized target heart rate zone. A weekly one-hour Bridging Skills Group was used to aid generalization of training to everyday life
situations. Negative symptoms were assessed every two weeks with the BPRS and every 3 months with the SANS. The Global Functioning Scale: Social was
rated every 3 months. Results: A Generalized Linear Mixed Model (GLMM) was used to compare the trajectories of changes in negative symptoms and
social functioning. Analysis of the BPRS negative symptoms indicated that a signifcantly larger decrease in expressive negative symptoms occurred for
patients in CT&E vs CT alone (F(1, 376) = 4.9, P =.03). SANS Blunted Affect also showed a differential decrease over time favoring CT&E (F(1, 30) =
4.1, P =.05). The SANS Avolition-Apathy domain also showed a differential effect of treatment favoring CT&E (F(1, 33) = 7.6, P =.01). Analysis of GFS
Social showed a statistically signifcant difference in the trajectories of the two groups, again favoring CT&E (F(1, 38) = 4.1, P =.05). Conclusion:
Our preliminary fndings support the use of exercise to boost the effects of cognitive training for reducing negative symptoms and improving social
functioning. In particular, we found signifcant differential reductions on the BPRS negative symptom factor and on SANS Blunted Affect and
Avolition/Apathy. The enhancing effect of adding exercise to cognitive training appears to extend the benefcial effects beyond cognitive gains alone.
Promoting exercise interventions in frst episode patients might lead to early gains that could promote recovery.
Schizophrenia Bulletin, 43(Suppl
1) : S52
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive remediation
therapy, Physical activity, exercise
Ventura, J., Subotnik, K. L., Gretchen-Doorly, D., Casaus, L., Boucher,
M., Hellemann, G. S., Nuechterlein, K. H.
BACKGROUND: Meta-analyses have
reported that the effects of cognitive remediation might go beyond improvement in cognition to include unexpected benefits for schizophrenia patients
such as negative symptom reduction and improvements in functioning. In addition, some evidence indicated that these potentially beneficial effects
are also present in the initial course of schizophrenia, but work in this area is still developing.\rMETHOD: A RCT compared Cognitive Remediation
(CR) to Healthy Behaviors Training (HBT) in 80 patients (78% male) with a mean age of 21.9years and mean education of 12.3years who had a first
psychotic episode within two years of study entry. Participants were trained using CR programs or received HBT involving 50 sessions over 6months and
then booster sessions over the next 6months. The SANS and BPRS were used to assess symptoms. The UCLA Social Attainment Survey assessed social
functioning.\rRESULTS: Using GLMM, improvements over 12months were found favoring CR for SANS Expressive Symptoms (p<0.01), which was composed of
Affective Flattening (p<0.01) and Alogia (p=0.04), and for SANS Experiential Symptoms, composed of Avolition/Apathy (p=0.04) and Anhedonia/Asociality
(p<0.01). CR was associated with improvements in social functioning (p=0.05) as compared to HBT.\rCONCLUSIONS: We confirmed that the beneficial
effects of CR appear to extend beyond cognition to improvements in negative symptoms and social functioning in early course schizophrenia patients.
These results suggest that cognitive remediation might have an impact when the reduction of risk factors for chronicity is most critical for
promoting recovery.
Schizophrenia
Research, 08 : 08
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Other Psychological Interventions
Vohs, J. L., Leonhardt, B. L., James, A. V., Francis, M. M., Breier, A., Mehdiyoun, N., Visco, A. C., Lysaker, P. H.
Poor insight impedes treatment in early phase psychosis (EPP). This manuscript outlines preliminary
findings of an investigation of the novel metacognitively oriented integrative psychotherapy, Metacognitive Reflection and Insight Therapy, for
individuals with early phase psychosis (MERIT-EP). Twenty adults with EPP and poor insight were randomized to either six months of MERIT-EP or
treatment as usual (TAU). Therapists were trained and therapy was successfully delivered under routine, outpatient conditions. Insight, assessed
before and after treatment, revealed significant improvement for the MERIT-EP, but not TAU, group. These results suggest MERIT-EP is feasible to
deliver, accepted by patients, and leads to clinically significant improvements in insight.
Schizophrenia Research, 03 : 03
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Wang, C., Shi, W., Huang, C., Zhu, J., Huang, W., Chen, G.
Background: Differences in effectiveness and tolerability between different atypical antipsychotics may affect schizophrenic patients'
treatment adherence or prognosis. However, which kind of antipsychotic was more effective and safe in the treatment of schizophrenia is still being
debated. This study attempted to understand whether there are any differences in efficacy, acceptability, and safety between the five atypical
antipsychotics in patients with first-episode schizophrenia. Methods: Two hundred cases of inpatients with first-episode drug-naive schizophrenia
were randomly assigned to 6-8 weeks of treatment with either of aripiprazole, risperidone, quetiapine, olanzapine, or ziprasidone from October 2012
to November 2014. The efficacy, acceptability, and safety measurement after 6-8 weeks of treatment of the five kinds of antipsychotics were evaluated
by the deduction rate of Brief Psychiatric Rating Scale (BPRS) total score, the proportion of treatment discontinuation, and adverse events,
respectively. Whether the treatment discontinuation or combination therapy for baseline antipsychotics after titration mainly depended on ineffective
or less effective on an initial-assigned antipsychotic during the study period. Results: BPRS total scores in each antipsychotic group were
significantly decreased at the end of the study (P < 0.01), and only the deduction rate of BPRS total scores in the risperidone group was markedly
higher than those in the groups of aripiprazole (P < 0.01) and olanzapine (P < 0.05) after controlling the impact of the differences of age of onset.
There were significant differences between quetiapine (chi 2 = 5.46, P = 0.019), olanzapine (chi 2 = 5.6, P = 0.018), and
ziprasidone regarding the proportion of maintaining on initially allocated therapy. In addition, the difference in treatment discontinuation between
male and female patients was also significant (chi 2 = 9.897, P = 0.002), and odds ratio of treatment discontinuation in male and female
patients was 0.37 (95% CI 0.198-0.693); however, no difference in treatment discontinuation was found between five antipsychotics. Extrapyramidal
symptoms in the groups of quetiapine and olanzapine were notably less than the other three kinds of antipsychotics (P < 0.05), but there were no
significant differences in other adverse events between the five antipsychotic groups. Conclusions: Risperidone was more effective than aripiprazole
and olanzapine in treating first-episode schizophrenia. The present study revealed the superiority of quetiapine and olanzapine over ziprasidone with
remarkably less severe extrapyramidal adverse effects, especially with lower drop-out and treatment discontinuation. There were no differences in
terms of other adverse events although the risk of treatment discontinuation was higher in female patients. Trial registration 2012-3-88. Registered
20 July 2012 Copyright © 2017 The Author(s).
Annals of General
Psychiatry, 16(47) :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Woods, S., Saksa, J., Compton, M., Daley, M., Rajarethinam, R., Graham, K., Breitborde, N., Cahill, J., Srihari, V., Perkins, D., Bearden, C., Cannon, T., Walker, E., McGlashan, T.
Background: Treatment guidelines
for the clinical high risk (CHR) syndrome for psychosis currently recommend psychotherapies such as cognitive behavior therapy and focused family
therapy as frst line treatment. Antipsychotic medications are generally discouraged for routine use, partly because of concern for adverse effects
and partly due to a paucity of effcacy data, although some guidelines recommend them for more severe cases. The current study evaluated the safety
and effcacy of ziprasidone in delaying or preventing conversion to psychosis among individuals meeting CHR syndrome criteria. Methods: Eligible
subjects were treatment-seeking individuals 16 to 40 years old who met diagnostic criteria for CHR according to the Structured Interview for
Psychosis-risk Syndromes. Exclusions were (1) use of antipsychotic med-ication in the previous 3 months, (2) initiation or increase in dosage of an
antidepressant within 6 weeks, or (3) medical contraindications to taking ziprasidone (QTcF>=450 msec at screening or baseline, history of arrhythmia
or QTc prolongation or syncope, family history of QTc prolongation, current receipt of medication known to prolong QTc, or K+, Mg++, or Ca++ below
the normal range). Randomized subjects received ziprasidone 20-160 mg/d vs matching placebo for 24 weeks in two divided doses with meals. In
addition, each subject was offered a Supportive Interpersonal Therapy session at each visit. Target enrollment was 80. Analyses were conducted in
SPSS 21. Results: Six sites randomized 51 subjects, 27 to placebo, and 24 to zipra-sidone. One ziprasidone case was never dispensed medication and
was removed from analysis. Two conversions were identifed in the placebo group and one in the active group; Cox regression showed no signifcant
effect. Mixed regression on the SOPS positive symptom subscale with slope and intercept each modeled as random effects revealed a signifcant
difference favoring ziprasidone (F = 6.64, df = 1.21, P =.017, slope difference-0.19 points per week, 95% CI-0.35 to-0.04). Two patients met QTcF
criteria for safety withdrawal; both were assigned to placebo. Maximum QTcF across follow-up (placebo mean 407 msec, ziprasidone mean 403 msec) did
not differ signifcantly. Mixed regression on weight measurements revealed no signifcant treatment effect (F = 0.22, df = 1.37, P = 0.645, slope
difference-0.05 pounds per week, 95% CI-0.29 to 0.18). Conclusion: The primary outcome was not met, in part because the study did not meet its
enrollment target and was consequently underpowered. The signifcant drug effect on attenuated positive symptoms provides some evidence for effcacy of
ziprasidone in CHR syndrome. Together with the lack of QTc prolongation or signifcant weight gain in this study, the current evidence of effcacy
supports consideration of ziprasidone when an antipsychotic is selected for clinical use in CHR syndrome.
Schizophrenia Bulletin, 43(Suppl
1) : S58
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Interpersonal therapy (IPT), Supportive
therapy
Tor, J., Dolz, M., Sintes, A., Munoz, D., Pardo, M., de-la-Serna, E., Puig, O., Sugranyes, G., Baeza, I.
The concept of
being at risk for psychosis has been introduced both for adults and children and adolescents, but fewer studies have been conducted in the latter
population. The aim of this study is to systematically review the articles associated with clinical description, interventions, outcome and other
areas in children and adolescents at risk for psychosis. We searched in MEDLINE/PubMed and PsycINFO databases for articles published up to 30/06/16.
Reviewed articles were prospective studies; written in English; original articles with Clinical High Risk (CHR) for psychosis samples; and mean age
of samples younger than 18 years. From 103 studies initially selected, 48 met inclusion criteria and were systematically reviewed. Studies show that
CHR children and adolescents present several clinical characteristics at baseline, with most attenuated positive-symptom inclusion criteria observed,
reporting mostly perceptual abnormalities and suspiciousness, and presenting comorbid conditions such as depressive and anxiety disorders. CHR
children and adolescents show lower general intelligence and no structural brain changes compared with controls. Original articles reviewed show
rates of conversion to psychosis between 17 and 20% at 1 year follow-up and between 7 and 21% at 2 years. While 36% of patients recovered from their
CHR status at 6-year follow-up, 40% still met CHR criteria. Studies in children and adolescents with CHR were conducted with different methodologies,
assessments tools and small samples. It is important to conduct studies on psychopharmacological and psychological treatment, as well as replication
of the few studies found. Copyright © 2017 Springer-Verlag GmbH Germany
European Child and Adolescent Psychiatry, : 1-18
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Veerman, S. R. T., Schulte,
P. F. J., de-Haan, L.
Negative symptoms (such as amotivation and
diminished expression) associated with schizophrenia are a major health concern. Adequate treatment would mean important progress with respect to
quality of life and participation in society. Distinguishing primary from secondary negative symptoms may inform treatment options. Primary negative
symptoms are part of schizophrenia. Well-known sources of secondary negative symptoms are psychotic symptoms, disorganisation, anxiety, depression,
chronic abuse of illicit drugs and alcohol, an overly high dosage of antipsychotic medication, social deprivation, lack of stimulation and
hospitalisation. We present an overview of reviews and meta-analyses of double-blind, controlled randomised trials, in which the efficacy of
pharmacological and non-pharmacological interventions for negative symptoms was assessed. Unfortunately, there have been very few clinical trials
focusing on primary negative symptoms and selecting chronically ill patients with predominant persistent negative symptoms. An important limitation
in many of these studies is the failure to adequately control for potential sources of secondary negative symptoms. At present, there is no
convincing evidence regarding efficacy for any treatment of predominant persistent primary negative symptoms. However, for several interventions
there is short-term evidence of efficacy for negative symptoms. This evidence has mainly been obtained from studies in chronically ill patients with
residual symptoms and studies with a heterogeneous study population of patients in both the acute and chronic phase. Unfortunately, reliable
information regarding the distinction between primary and secondary negative symptoms is lacking. Currently, early treatment of psychosis, add-on
therapy with aripiprazole, antidepressants or topiramate, music therapy and exercise have been found to be useful for unspecified negative symptoms.
These interventions can be considered carefully in a shared decision-making process with patients, and are promising enough to be examined in large,
well-designed long-term studies focusing on primary negative symptoms. Future research should be aimed at potential therapeutic interventions for
primary negative symptoms since there is a lack of research in this field.
Drugs, 77(13) : 1423-1459
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Rosenheck, R., Mueser, K. T., Sint, K., Lin, H., Lynde, D. W., Glynn, S. M., Robinson, D. G., Schooler, N. R., l
Marcy, P., Mohamed, S., Kane, J. M.
Background: Participation in work and school are central objectives for first
episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education
(SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies. Methods: FEP participants (N = 404) at
thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a
comprehensive, team-based treatment program that included >=5h of SEE services per week, , grounded in many of the principles of the Individual
Placement and Support model of supported employment combined with supported education services. All study participants were offered SEE regardless of
their initial interest in work or school. Monthly assessments over 24 months recorded days of employment and attendance at school, days of
participation in SEE, and both employment and public support income (including disability income). General Estimation Equation models were used to
compare CC and NAVIGATE on work and school participation, employment and public support income, and the mediating effect of receiving >=3 SEE visits
on these outcomes. Results: NAVIGATE treatment was associated with a greater increase in participation in work or school (p = 0.0486) and this
difference appeared to be mediated by SEE. No group differences were observed in earnings or public support payments. Conclusion: A comprehensive,
team-based FEP treatment approach was associated with greater improvement in work or school participation, and this effect appears to be mediated, in
part, by participation in SEE. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Schizophrenia
Research, 182 : 120-128
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions, Other service delivery and improvement
interventions
Shi, J., Wang, L., Yao, Y., Zhan, C., Su, N., Zhao, X.
Psychosocial intervention trials for youth at clinical high
risk (CHR) for psychosis have shown promising effects on treating psychotic symptoms but have not focused on psychosocial functional outcomes, and
those studies have been conducted among help-seeking patients; there is a lack of research on non-clinical young CHR individuals. Systemic therapy
(ST) is grounded in systemic-constructivist and psychosocial resilience theories. It has a number of advantages that makes it attractive for use with
CHR individuals in non-clinical context. The present study evaluated the effect of ST for students at CHR on reducing symptoms and enhancing
psychosocial function. This was a single-blind randomized controlled trial for CHR young people comparing ST to supportive therapy with a 6-month
treatment. Psychotic and depressive symptoms (DS) as well as self-esteem and social support (SS) were assessed at pre- and posttreatment. 26 CHR
individuals were randomly divided into intervention group (n = 13) and control group (n = 13). There were no significant differences in severity of
symptoms, level of SS and self-esteem at baseline between the two groups (P > 0.05). At posttreatment, significant improvements in positive and DS as
well as SS and self-esteem were observed in the ST group (P < 0.05); in the control group, these improvements were not significant (P > 0.05). The
findings indicated that systemic intervention for university students at CHR for psychosis may have a positive effect on symptoms and self-esteem as
well as SS in short term. More long-term research is needed to further evaluate this intervention. Copyright © 2017 Shi, Wang, Yao, Zhan, Su and
Zhao.
Frontiers in Psychiatry, 8
(OCT)(211) :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy