Disorders - Psychosis Disorders
Kantrowitz, J. T., Woods, S. W., Petkova, E., Cornblatt, B., Corcoran, C.M., Chen, H., Silipo, G., Javitt, D. C.
Background: Antagonists of N-methyl-D-aspartate-type glutamate receptors (NMDAR) induce symptoms that closely resemble those of
schizophrenia, including negative symptoms. D-serine is a naturally occurring NMDAR modulator that reverses the effects of NMDAR antagonists in
animal models of schizophrenia. D-serine effects have been assessed previously for treatment of established schizophrenia, but not in the early
stages of the disorder. We aimed to assess effects of D-serine on negative symptoms in at risk individuals. Methods: We did a double-blind, placebo-
controlled, parallel-group randomised clinical trial at four academic US centres. Individuals were eligible for inclusion in the study if they were
at clinical high risk of schizophrenia, aged between 13-35 years, had a total score of more than 20 on the Scale of Prodromal Symptoms (SOPS), and
had an interest in participation in the clinical trial. Exclusion criteria included a history of suprathreshold psychosis symptoms (ie, no longer
qualifying as prodromal) or clinical judgment that the reported symptoms from the SOPS were accounted for better by another disorder (eg,
depression). Randomisation was done using a generated list with block sizes of four. Participants were stratified by site, with participants,
investigators, and assessors all masked through use of identical looking placebos and centralised drug dispensation to study assignment. D-serine (60
mg/kg) was given orally in divided daily doses for 16 weeks. The primary endpoint was for negative SOPS, measured weekly for the first 6 weeks, then
every 2 weeks. Participants who received at least one post-baseline assessment were included in analysis. Serum cytokine concentrations were
collected at baseline, midpoint, and endpoint to assess the mechanism of action. Safety outcomes including laboratory assessments were obtained for
all individuals. This trial is registered with ClinicalTrials.gov, number NCT0082620. Findings: We enrolled participants between April 2, 2009, and
July 23, 2012. 44 participants were randomly assigned to receive either D-serine (n = 20) or placebo (n = 24); 35 had assessable data (15 D-serine,
20 placebo). D-serine induced a 35.7% (SD 17.8) improvement in negative symptoms, which was significant compared with placebo (mean final SOPS
negative score 7.6 [SEM 1.4] for D-serine group vs 11.3 [1.2] for placebo group; d = 0.68, p = 0.03). Five participants who received D-serine and
nine participants who received placebo discontinued the study early because of withdrawn consent or loss to follow-up (n = 8), conversion to
psychosis (n = 2), laboratory-confirmed adverse events (n = 2), or protocol deviations (n = 2). Interpretation: This study supports use of NMDAR-
based interventions, such as D-serine, for treatment of prodromal symptoms of schizophrenia. On the basis of observed effect sizes, future studies
with sample sizes of about 40 per treatment group would be needed for confirmation of beneficial effects on symptoms and NMDAR-related inflammatory
changes. Long-term studies are needed to assess effects on psychosis conversion in individuals at clinical high risk of schizophrenia. (PsycINFO
Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Lancet Psychiatry, 2(5) : 403-412
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Ising, H., Smit, F., Veling, W., Rietdijk, J., Dragt, S., Klaassen,
R., Savelsberg, N., Boonstra, N., Nieman, D., Linszen, D., Wunderink, L., vanderGaag,
M.
Background. Although there is evidence for the effectiveness of
interventions for psychosis among ultra-high-risk (UHR) groups, health economic evaluations are lacking. This study aimed to determine the cost
effectiveness and cost-utility of cognitive-behavioural therapy (CBT) to prevent first-episode psychosis. Method. The Dutch Early Detection and
Intervention Evaluation study was a randomized controlled trial of 196 UHR patients with an 18-month follow-up. All participants were treated with
routine care (RC) for non-psychotic disorders. The experimental group (n = 95) received add-on CBT to prevent first-episode psychosis. We report the
intervention, medical and travel costs, as well as costs arising from loss of productivity. Treatment response was defined as psychosis-free survival
and quality-adjusted life years (QALYs) gained. Results. In the cost-effectiveness analysis, the proportion of averted psychoses was significantly
higher in the CBT condition (89.5% v. 76.2%). CBT showed a 63.7% probability of being more cost effective, because it was less costly than RC by US
$844 (551) per prevented psychosis. In the cost-utility analysis, QALY health gains were slightly higher for CBT than for RC (0.60 v. 0.57) and the
CBT intervention had a 52.3% probability of being the superior treatment because, for equal or better QALY gains, the costs of CBT were lower than
those of RC. Conclusions. Add-on preventive CBT for UHR resulted in a significant reduction in the incidence of first psychosis. QALY gains show
little difference between the two conditions. The CBT intervention proved to be cost saving. (PsycINFO Database Record (c) 2015 APA, all rights
reserved) (journal abstract).
Psychological
Medicine, 45(7) : 1435-1446
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Gry Secher, R., Hjorthoj, C.
R., Austin, S. F., Thorup, A., Jeppesen, P., Mors, O., Nordentoft, M.
Introduction : Specialized early
intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis (FEP) at least after 2
and 5 years. Few studies have examined long-term outcomes of these interventions. Aim : To examine the effect of 2 years of OPUS vs treatment as
usual (TAU) within an FEP cohort, 10 years after inclusion into the OPUS trial. Methods : From 1998 to 2000, participants were randomized to OPUS or
TAU. Ten years later, we conducted comprehensive interviews and performed register-based follow-up on all participants in national Danish registers.
We analyzed participants according to the intention-to-treat principle. Results : Of the 547 participants included in the study, 347 (63.4%) took
part in this follow-up. While there was evidence of a differential 10-year course in the development of negative symptoms, psychiatric bed days, and
possibly psychotic symptoms in favor of OPUS treatment, differences were driven by effects at earlier follow-ups and had diminished over time.
Statistically significant differences in the course of use of supported housing were present even after 8-10 years. There were no differences between
OPUS and TAU regarding income, work-related outcomes, or marital status. Conclusion: Most of the positive short-term effects of the OPUS intervention
had diminished or vanished at this long-term follow-up. We observed a clear tendency that OPUS treatment leads to fewer days in supported housing.
There is a need for further studies investigating if extending the intervention will improve outcomes more markedly at long-term follow-ups.
Schizophrenia Bulletin, 41(3) : 617-626
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Harvey, R. C., Shields, G.
E., James, A. C.
OBJECTIVES: Few studies discuss the
effectiveness and side effects of the use of antipsychotics in the pediatric population, despite the poor prognosis associated with the disorder,
including high suicide risk. This study explores the efficacy of trialled antipsychotics for early-onset schizophrenia in order to determine which
treatments are potentially efficacious in this population. METHODS: A systematic literature review was performed to identify trials conducted in
children and adolescents with schizophrenia that reported symptom control (efficacy) using the positive and negative syndrome scale (PANSS), a
medical scale frequently used for assessing the schizophrenia symptom severity in trials. A Bayesian random effects network-meta-analysis was
performed, synthesizing data for relevant outcomes, including mean change from baseline in PANSS scores (including positive and negative subscales),
weight gain and treatment discontinuation due to adverse events. RESULTS: Eleven studies were identified in the systematic review, and ten were
included in the network meta-analysis. All treatments showed a greater reduction in PANSS scores at 6 weeks vs placebo; however, not all results were
statistically significant. Haloperidol had the greatest reduction vs placebo; and treatment ranking probabilities suggested that haloperidol had the
highest probability of being the best treatment in the network for reducing total PANSS scores. All treatments showed a trend of greater odds of
discontinuing treatment due to adverse events vs placebo. However, pairwise comparisons were statistically non-significant. Nine out of thirteen
treatments showed a trend of increased weight compared with placebo, but no pairwise comparisons were statistically significant. CONCLUSIONS: The
analysis demonstrates that many of the treatments are efficacious in controlling symptoms, although side effects resulting from treatment should be
considered; weight gain is commonly observed, and treatment discontinuation due to adverse events is variable between studies. The lack of high-
quality studies in this population highlights a need for further research.
Value in Health, 18(3) : A115-A116
- Year: 2015
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
McFarlane, W. R., Levin, B., Travis, L., Lucas, F., Lynch, S., Verdi, M., Williams, D., Adelsheim, S., Calkins, R., Carter, C. S., Cornblatt, B., Taylor, S. F., Auther, A. M., McFarland, B., Melton, R., Migliorati, M., Niendam, T., Ragland, J., Sale, T., Salvador, M., Spring, E.,
[Correction
Notice: An Erratum for this article was reported in Vol 41(2) of Schizophrenia Bulletin (see record 2015-07862-028). In the original article, Figure
2, \"Regression-Discontinuity Outcome,\" was incorrectly displayed on page 38. The correct version is present in the erratum.] Objective: To test
effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving
functioning in a national sample of at-risk youth. Methods: In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were
assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of
psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to
receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures
and evaluated using the Global Test Procedure that combined all symptom and functional measures. Results: A total of 337 young people (mean age:
16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after
2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3%
CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024
for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025). Conclusion: FACT is effective in improving
positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at
risk for, or experiencing very early, psychosis. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Schizophrenia Bulletin, 41(1) : 30-
43
- Year: 2015
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
McFarlane, W. R., Levin, B., Travis, L., Lucas, F. L., Lynch, S., Verdi, M., Williams, D., Adelsheim, S., Calkins, R., Carter, C. S., Cornblatt, B., Taylor, S. F., Auther, A. M., McFarland, B., Melton, R., Migliorati, M., Niendam, T., Ragland, J.
D., Sale, T., Salvador, M., Spring, E.
OBJECTIVE: To test effectiveness of the Early
Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national
sample of at-risk youth.\rMETHODS: In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment
groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were
assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care.
Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the
Global Test Procedure that combined all symptom and functional measures.\rRESULTS: A total of 337 young people (mean age: 16.6) were assigned to the
treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were
superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and
first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p =
.0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025).\rCONCLUSION: FACT is effective in improving positive,
negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for,
or experiencing very early, psychosis.\rCopyright © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric
Research Center.
Schizophrenia Bulletin, 41(1) : 30-
43
- Year: 2015
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Psychoeducation, Individual placement and support (IPS), vocational
interventions, Other service delivery and improvement
interventions
Lin, J., Chan, S. K., Lee, E. H., Chang, W. C., Tse, M., Su, W. W., Sham, P., Hui, C. L., Joe, G., Chan, C. L., Khong, P. L., So, K. F., Honer, W. G., Chen, E.
Y.
Impairments of attention and memory are
evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine
whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were
recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a
waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of
psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat
principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (P<0.01) with moderate to large effect sizes
compared with the waitlist control group. The yoga group showed additional benefits in verbal acquisition (P<0.01) and attention (P=0.01). Both types
of exercise improved overall and depressive symptoms (all P0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic
exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger
effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early
psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC
funding (C00240/762412) by the Authority of Research, Hong Kong.
npj
Schizophrenia, 1(0) : 15047
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong), Physical activity, exercise
Lin, J., Geng, X., Su, W., Chan, K. W., Lee, E. H. M., Chang, W. C., Honer, W. G., Chen, E. Y.
H.
Background:
Impairments of attention and memory are evident in early psychosis, and often lead to severe, longstanding functional disability. Effective non-
pharmacological interventions are needed due to the unsuccessful results of pharmacological interventions. Aims: To determine whether yoga is
effective for cognitive impairments, and the neural mechanism underlying these effects. Methods: It was a randomized controlled study of 12-week of
yoga and aerobic exercise (walking and cycling) intervention vs wait-list control for female early psychotic patients. Memory was measured with Hong
Kong List Learning Test and Digit Span test, and attention was measured with Letter Cancellation test. Cognitive data analysis was based on the
Intention-to-Treat method using a mixed-model analysis. Seed based functional connectivity was applied using posterior cingulate cortex (PCC) as seed
with AFNI. Cortical thickness analyses were performed using FreeSurfer. Results from yoga and control groups were presented. Results: A total of 140
women were recruited and randomized into three groups. 95 completed the study, and 115 were included for cognitive data analysis. For imaging data,
42 participants were used for cortical thickness analyses; and 60 were included for neural connectivity analyses. Yoga group demonstrated significant
improvements in working memory, verbal acquisition and attention (P=.01). Cortical thickness increased in the postcentral gyrus (P<.01); connectivity
between PCC and bilateral inferior parietal gyrus increased after yoga intervention (P<.005). Conclusions: Yoga has been found to be effective for
memory and attention in early psychotic patients. The increases of thickness and neural connectivity indicate the possible neural mechanisms
underlying the improvements of cognition.
European Psychiatry, 30 : 789
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong), Physical activity, exercise
Lin, J. J. X., Lee, E. H. M., Chang, W.
C., Chan, S. K. W., Tse, M., Phong, P. L., Chan, C. L. W., Honer, W., Chen, E. Y. H.
Background: The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive function and
clinical symptom in female patients with early psychosis. The potential neuromechanism underlying the clinical consequences was also investigated.
Methods: Female patients (n=120) diagnosed with schizophrenia spectrum disorders and psychotic disorder were recruited from outpatient clinic. They
were randomized into integrated yoga therapy group, aerobic exercise programme group, and waiting list as the control group. Both interventions were
held three times weekly for 12 weeks. Neuro-cognition and clinical symptom were compared between baseline and 12 weeks among the three groups using
repeated measures ANOVA . Structural MRI data was collected in 60 patients and analysed using FreeSurfer V5.1 and Qdec V1.4. Results: Both yoga and
aerobic exercise improved verbal memory (p<0.01) and working memory (p<0.01) with moderate to large effect sizes compared to control group.
Additionally, yoga group showed enhanced attention and visual-motor coordination (p<0.05). Both yoga and aerobic exercise reduced overall symptom
(p<0.05) and depressive symptom (p<0.05) after 12 weeks. Furthermore, yoga increased cortical thickness in post-central gyrus (p<0.001) and aerobic
exercise increased cortical thickness in superior frontal gyrus (p<0.001). Conclusion: Both types of exercise improved cognition in early psychosis
patients, with yoga having a superior effect on attention and visual-motor coordination. Observed increments in the cortical thicknesses may indicate
improved neurogenesis. The present study indicates possible interventions for cognitive impairments in the patients with early psychosis, which are
non-invasive and mostly safe.
Schizophrenia Bulletin, 41 : S320
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong), Physical activity, exercise
Kuzmanovic, A., Zivkovic, N., Djokic, G., Curcic, D., Zoric, K., Djordjevic, M.
Schizophrenia
is a chronic illness with a lifetime prevalence of 0.30-0.66%.The first episode of schizophrenia typically occurs in the late teenage years or the
early 20 s. Early recognition is very often difficult because of the nature of the disorder and its premorbid problems in language, cognitive
ability, and behaviour. Although there is no cure, schizophrenia is highly treatable. Successful first episode schizophrenia (FES) treatment is
crucial to minimize personal, social and vocational deterioration. Aripiprazole is a third-generation antipsychotic, is a potent, high-affinity,
partial D2 receptor and 5-HT1A receptor agonist and a potent 5-HT2A antagonist, and has a lower risk of metabolic side effects with second-generation
antipsychotics. Aripiprazole has widely been recommended as a first-line treatment for schizophrenia. Objective: Purpose of this study is to estimate
efficacy of aripiprazole in treatment of first episode schizophrenia. Methods: This prospective clinical study included 60 patients with FES
diagnosed by ICD-10 criteria for FES, who are randomly divided into Haloperidol (30 patients) group and Aripiprazole group (30 patients).
Antipsychotics were tested, and patients were observed for 6 months in hospital and extra hospital (outpatients) conditions, according to specially
designed protocol, which included Positive and Negative Symptom Schedule Scale (PANSS) and Global Clinical Impression Scale (CGI 1-4). Control group
was treated with haloperidol 5-20 mg/24 h (average dose 11.83 mg/24 h) and experimental group was treated with aripiprazole 5-30 mg/24 h (average
dose 13.16 mg/24 h). Statistical analyses were made with SPSS 15.0 for windows. Results: Average pretrial PANSS score was 106.8 in Aripiprazole group
and 107.5 in Haloperidol group. Average PANSS score after 180 days was 53.9 in A group and 55.5 in H group. There is no statistical difference in
pretrial scores between groups, for PANSS score (p = 0.741) and CGI 1 (p = 0.763), CGI 2 (p = 1.000), and CGI 3 (p = 1.000) scores. There is
statistical significance in PANSS score reduction after 180 days in both groups (p <0.001). There is statistical significance in CGI 1-4 score
reduction after 180 days in both groups (p<0.001). There is no statistical difference in PANSS score reduction between O and H group after 180 days
(p = 0.146). Results of CGI 1-4 scores reduction between groups are as follow: CGI 1 (severity of illness subscore), A vs. H, p = 0.132 after 180
days with no statistical significance; CGI 2 (global improvement subscore), A vs. H, p = 0.179 after 180 days with no statistical significance; CGI 3
(efficancy index), A vs. H, p = 0.161 after 180 days with no statistical significance; CGI 4 (adverse effects subscore), A vs. H, p<0.001 after 180
days with high statistical significance. Percentage of adverse effects is significantly lower in Aripiprazole (13.3%) than in Haloperidol (53.3%)
group. Conclusion: Aripiprazole has the same or slightly better efficacy in treatment of FES comparing to haloperidol, with statisticaly significant
lower adverse effects rate.
European Neuropsychopharmacology, 25 : S498-
S499
- Year: 2015
- 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)
Malla, A., Joober, R., Iyer, S., Lutgens, D., Abadi, S.
Objective: Specialized Early Intervention (SEI) services for first episode psychosis (FEP) lead to a better clinical and functional outcome at
2 years following treatment. At the end of 5 years, however, these benefits are not maintained if patients are transferred to regular care. The
objective of this randomized controlled trial is to evaluate the effect of 5 years of SEI versus 2 years of SEI followed up by 3 years of routine
care on outcome at 5 years. Methods: A total of 220 patients were recruited following an initial 2 years of treatment in a SEI and were randomized to
either a further 3 years of specialized early intervention for a total of 5 years (experimental condition,N = 111) or to routine treatment (Control
condition, N = 109) in the community. SEI included modified assertive case management, rational pharmacotherapy, family intervention, cognitive
behavioural therapy and substance abuse treatment and monitoring. Assessments were conducted blind to the treatment assignment. Results: Preliminary
results based on all patients randomized suggest that a significantly higher proportion of patients dropped out in the routine care (control)
compared to those treated at SEI for the entire period (experimental) (56/110, 51 % and 19/108, 17.3 %, respectively) and lower proportion of control
group completed 18 out of 36 months of the study compared to the SEI group (49 vs. 82 %); blind was broken in 16 % of cases only; significantly
higher proportion of patients have completed the study. Additional data will be presented on rate and length of remission and difficulties associated
with transferring patients to routine care. Conclusion: Providing specialized early intervention throughout the 'critical period's 5 years may
solidify the benefits of treatment such that they are sustained in the long term. Findings from this study will have implications for best practices
in first episode psychosis.
European Archives of Psychiatry and Clinical
Neuroscience, 1) : S48
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Case management, Other service delivery and improvement
interventions
Manli, H., Liang, Y., Jianbo, H., Yi, H., Jinkai, C., Pingbo, J., Yi, X.
Purpose: This randomized, 13-week study was conducted to
evaluate the efficacy and safety of paliperidone palmitate (PP) intramuscular injections with oral olanzapine in han Chinese firstepisode
schizophrenia patients. Methods: Eligible patients were randomized to receive PP or olanzapine. Efficacy assessments (PANSS score) and weightrelated
(weight, BMI, waist circumferences, hip circumferences, waist/hip ratio and subcutaneous fat) were assessed at baseline, during weeks 1, 5, 9, and at
the end of the study or early withdrawal. Lipid metabolic, glucose-insulin metabolic and prolactin were evaluated at baseline and the endpoint or
early withdrawal. Results: The PANSS total score was significantly lower in PP group in week 1 (t = 2.009, p = 0.049). The mean (SD) decrease of
PANSS total score was significant in week 1 (PP: -15.07±10.51, olanzapine: -8.72±6.47, t = 2.734, p = 0.009) but not at the endpoint (PP: -
32.71±19.49, olanzapine:- 36.62.72±18.42, t = -0.777, p = 0.441). Response rate at endpoint was no significant difference between the two groups.
Both group showed significant increases in weight-related paramaters, with no significant difference between the two groups. Fasting LDL,
cholesterol, triglyceride, glucose, insulin and HOMA-IR showed a significant increase only in olanzapine group. HbA1c and HOMAß showed no increase in
both group and no difference between the two groups. Both group showed an increase in prolactin level, with significantly greater increase in PP
group (F = 8.848, p = 0.004). Conclusions: The PP shows the faster efficacy, but comparable efficacy at the endpoint compared to the olanzapine in
first-episode schizophrenia patients. This study reinforced the necessity of regularly monitoring metabolic parameters in schizophrenia patients
taking atypical antipsychotics, including PP and olanzapine.
European Neuropsychopharmacology, 25 : S486-
S487
- Year: 2015
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Service Delivery & Improvement, Other service delivery and improvement
interventions