Disorders - psychosis disorders
Restek-Petrovic, B., Bogovic, A., Mihanovic, M., Grah, M., Mayer, N., Ivezic, E.
Background: The \"Sveti Ivan\" psychiatric hospital in Zagreb, Croatia,
offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic
psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning. Aims: The current study examined
changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group
psychotherapy. Methods: The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10
patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic
psychotherapy (experimental group). All patients completed the Revised Beta Examination. Results: We observed a trend in the experimental group to
achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the
experimental group. Conclusions: While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group
psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future
research. © 2014 Informa Healthcare.
Nordic Journal of Psychiatry, 68(5) : 333-
340
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis, Psychoeducation
Miklowitz, D. J., O'Brien, M. P., Schlosser, D. A., Addington, J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., Zinberg, J.
L., De-Silva, S. D., Friedman-Yakoobian, M., Cannon, T. D.
Objective: Longitudinal studies have begun to
clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined
whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and
enhancing functioning among individuals at high risk. Method: Adolescents and young adults (mean age 17.4 +/- 4.1 years) with attenuated positive
psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-
focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]). FFT-CHR
included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC
focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-
role functioning. Results: Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in
attenuated positive symptoms over 6 months than participants in EC (F1,97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial
treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR,
whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy.
Conclusion: Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis.
Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency.
(PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(8) : 848-
858
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Psychoeducation
Nieman, D. H., Ruhrmann, S., Rietdijk, J., Dragt, S., Ising, H., Klaassen, R., Cuijpers, P., Wunderink, L., Linszen, D. H., De-Haan, L., Van-Der-Gaag, M.
In many
serious illnesses (e.g. cancer), early detection and treatment leads to improved prognosis. In light of limited treatment possibilities in late
stages of major mental disorders, early detection and treatment in psychiatry is a promising topic. Clinical experience shows that it is easier to
engage a patient in treatment if insight into illness is still largely intact. Our aim was to investigate the effectiveness of a cognitive
behavioural therapy (CBT) especially developed for subjects with an at risk mental state (ARMS) for developing a first psychotic episode. 201 ARMS
patients were recruited at 4 Dutch sites and randomized. The CBT was provided for 6 months, and the follow-up period was 18 months. The new CBT
(CBTarms; 1) focuses on awareness of cognitive biases (e.g. jumping to conclusions) and normalisation by means of psycho-education. In the CBTarms
condition, 10 patients transitioned to psychosis compared with 22 in the treatment as usual (TAU) condition (?2(1)=5.575, P=0.03). The number needed
to treat (NNT) was 9 (95% confidence interval: 4.7-89.9). At 18-month follow-up the CBTarms group was significantly more often remitted from an at-
risk mental state, with a NNT of 7 (95% CI: 3.7-71.2). Compared with TAU, this new CBT showed a favourable effect on the transition to psychosis and
reduction of subclinical psychotic symptoms in ARMS subjects (2). Future research is warranted into individualized risk estimation with respect to
tailoring the intervention to the actual needs of the patient. We recently developed an optimised prediction model of a first psychosis in ARMS
subjects considering different sources of information (3). Out of a comprehensive set of predictors, the P300 event related potential (signifying
informationprocessing deficits) and premorbid adjustment were identified as the key elements in an individualized prognostic score. The prognostic
score was further stratified into three risk classes establishing a prognostic index. In the class with the worst premorbid adjustment and
information processing deficits, 74% of the subjects made a transition to psychosis whereas in the lowest risk class only 4% transitioned.
Furthermore, in the highest risk class transition emerged on average 17 months earlier than in the lowest risk class. However, transferring our
approach into clinical practice requires validation in an independent sample. A successful transfer would provide new opportunities for developing
targeted intervention strategies based on a subjects' individual risk index.
Schizophrenia
Research, 153 : S42-S43
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Morrison, A. P., Pyle, M., Stewart, S. L. K., French, P., Byrne, R., Flach, C., Birchwood, M., Fowler, D., Jones, P., Gumley, A.
Internalised stigma in young people meeting criteria for at risk mental states (ARMS) has been highlighted
as an important issue, and it has been suggested that provision of cognitive therapy (CT) may increase such stigma. 288 participants meeting criteria
for an at risk mental state were recruited as part of a multisite randomised controlled trial of cognitive behavioural therapy for people meeting
criteria for ARMS (the EDIE-2 trial). Participants were assessed at baseline and at six, twelve, eighteen and twenty-four months using measures of
psychotic experiences, depression, social anxiety and internalised stigma. The Personal Beliefs about Experiences Questionnaire (PBEQ) was validated
for use within our ARMS sample. Correlational analyses at baseline indicated significant relationships between internalised stigma and (1)
depression, (2) social anxiety (3) distress associated with unusual psychological experiences and (1) suicidal thinking. Regression analysis indicate
negative appraisals of unusual experiences contributed significantly to depression scores at 6 month follow up, when controlling for baseline
depression and unusual psychological experiences. Changes in internalised stigma were analysed using random effects regression (ANCOVA) adjusted for
site and baseline symptoms on an intention-to-treat basis. Negative appraisals of experiences were significantly reduced in the group assigned to CT
(estimated difference at 12 months was -1.36 (95% CI -2.69 to -0.02), p=0.047). There was no difference in social acceptability of experiences
(estimated difference at 12 months was +0.46 (95% CI -0.05 to +0.98), p=0.079). These findings suggest that internalised stigma may contribute to the
development and maintenance of depression in young people at risk of psychosis. They also suggest that, rather than increasing internalised stigma,
CT decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this
population.
Schizophrenia
Research, 153 : S42
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Molina,
V., Taboada, D., Aragues, M., Hernandez, J. A., Sanz-Fuentenebro, J.
Cortical thickness may be useful as a treatment response predictor in first-episode (FE)
patients with schizophrenia, although this possibility has been scarcely assessed. In this study we assessed the possible relation between cortical
thickness in regions of interest selected because of previously reported structural alterations in schizophrenia and clinical and cognitive changes
after two years of treatment with risperidone or clozapine in 31 neuroleptic-naïve FE patients with schizophrenia (16 of them treated with clozapine
and 15 with risperidone). Using the last-observation-carried-forward (LOCF), a larger improvement in positive, negative and total symptoms was
predicted by the amount of baseline cortical thinning in the right prefrontal cortex (pars orbitalis). After two years of treatment, cognitive status
was reassessed in the 17 patients (11 on clozapine) who had not dropped out. Working memory improvement after reassessment was associated with a
greater baseline cortical thinning in the left prefrontal cortex (pars orbitalis), and verbal memory improvement with a greater baseline cortical
thinning in the left pars triangularis. Significant but weak cortical thickness decrease from baseline to follow-up was observed in patients in
comparison to controls (left pars triangularis and opercularis, and left caudal middle frontal areas). These results may support a positive
predictive role for cortical thinning in the frontal region with regard to clinical and cognitive improvement with clozapine and risperidone in FE
patients with schizophrenia. © 2014 Elsevier B.V.
Schizophrenia Research, 158(1-3) : 223-
229
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Yuan, Y., Yang, F., Lu, Z., Wang, C. Y., Deng,
H., Zhao, J., Yu, X.
Background: It was well known that different atypical antipsychotics had similar efficacy for
acute phase treatment in first-episode schizophrenic patients. The troublesome problem for clinicians is how to keep the patients in their treatment
as long as possible until full recovery. We compared the effectiveness of three atypical antipsychotic-initiated treatments (risperidone-,
olanzapine-or aripiprazole-initiated) on treatment discontinuation for all cause during 12 months of follow-up. Methods: We did an open randomized
controlled trial of three atypical antipsychotic-initiated treatments in 6 sites located in 4 cities of China. Eligible patients were aged 16-45
years, and fulfilled DSM-IV diagnostic criteria for schizophrenia ascertained by SCID-I/P. A total of 600 unselected first-episode patients were
randomly assigned to risperidone (2-6 mg per day; n=200), olanzapine (5-20 mg per day; n=200), or aripiprazole (10-30 mg per day; n=200); for those
patients with poor efficacy or intolerable side effects (including obvious weight gain), they will be changed into second single-drug stage using
another different drug from risperidone, olanzapine or aripiprazole; and then the third stage using any other antipsychotics including clozapine,
add-ons or combinations; follow-up was at 1 year. The primary outcome measure was treatment discontinuation for any cause. Analysis was by intention
to treat. Results: The proportion of patients (Kaplan-Meier estimate) who discontinued treatment after three stages within 12 months was 25.1% for
risperidone-initiated group, 26.5% for olanzapine-initiated group, and 31.1% for aripiprazole-initiated group, but without no significant difference.
Discussion: This trial suggests that whatever the types of initiated atypical antipsychotic, a clinically satisfactory treatment retention rate for
first-episode schizophrenic patients is achievable for at least 1 year.
Schizophrenia Research, 153 : S218
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Schneider, C., Corrigall, R., Hayes, D., Kyriakopoulos, M., Frangou,
S.
Background: The use of clozapine (CLZ) for treatment-resistant
schizophrenia is well established in adults. However, it is seldom used in youth with early onset schizophrenia (EOS) largely because of lack of
clarity about its risk benefit ratio. This review synthesises and evaluates available evidence regarding the efficacy and tolerability of CLZ in EOS
with the aim to assist clinical decision-making. Methods: We conducted a systematic review of the primary literature on the clinical efficacy and
adverse drug reactions (ADRs) observed during CLZ treatment in EOS. We also identified relevant practice guidelines and summarised current guidance.
Results: CLZ showed superior efficacy than other antipsychotics in treating refractory EOS patients; short-term clinical trials suggest an average
improvement of 69% on the Brief Psychiatric Rating Scale that was sustained during long-term follow-up (up to 9 years). No fatalities linked to CLZ
treatment were reported. Sedation and hypersalivation were the most common complaints, reported by over 90% of patients. Other common ADRs (reported
in 10-60% of patients) were enuresis, constipation, weight gain, and non-specific EEG changes. Less common ADRs (reported in 10-30% of patients) were
akathisia, tachycardia and changes in blood pressure. Neutropenia was reported in 6-15% of cases but was usually transient while agranulocytosis was
rare (< 0.1%). Seizures were also uncommon (< 3%). Metabolic changes were relatively common (8-22%) but emergent diabetes was not frequently observed
(< 6%). Overall the rate of discontinuation was low (3-6%). Current guidelines recommend the use of CLZ in EOS patients who have failed to respond to
two adequate trials with different antipsychotics and provide detailed schedules of assessments to evaluate and assess potential ADRs both prior to
initiation and throughout CLZ treatment. Conclusion: Available data although limited in terms of number of studies are consistent in demonstrating
that CLZ is effective and generally safe in the treatment of refractory EOS provided patients are regularly monitored (PsycINFO Database Record (c)
2014 APA, all rights reserved) (journal abstract).
European Psychiatry, 29(1) : 1-10
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Zdanowicz, N., Mees, L., Jacques, D., Tordeurs, D., Reynaert, C.
Background: When psychosis first presents, and
particularly in the case of schizophrenia, the guidelines recommend rapid institution of treatment with atypical antipsychotics. Two different
clinical pictures can be observed: psychoses with acute onset and those with insidious onset. Acute cases (60% of the total) have a favourable course
in 85% of young patients but where onset is insidious and the symptoms are predominantly negative, the course is poor in 25% of subjects. Since acute
symptoms are relatively easy to diagnose, it is diagnosis of the \"insidious/negative\" cases that represents a major challenge. Is such a diagnosis
possible yet? How can we limit the number of false negatives and false positives with the attendant risk of stigma? What treatment should be
administered? Methods: Review of the literature (PubMed, PsycARTICLES, PsycINFO) and comparison with clinical practice here. Results: Young people
with a high risk of developing psychosis can be identified using scales such as SOPS (Scale of Prodromal Symptoms), PACE (Personal Assessment and
Crisis Evaluation) or from the presence of neuroanatomical and genetic characteristics. Unfortunately, these tools are more specific for positive
symptoms, and therefore identify a sub-population of young people at risk: those at Ultra-High Risk (UHR). It can be argued that effective treatment
is available for these UHR young people to prevent the condition from developing into schizophrenia. On the other hand, the problem persists for
young people presenting an insidious onset and predominantly negative symptoms: to date we have no real way of either screening them or assessing the
efficacy of a treatment. Conclusion: \"Ultra-High Risk\" patients are starting to represent a separate nosological entity. This entity is made up of
young patients, most of whom have positive symptoms. If left untreated, the course will lead to seriously compromised social and psychological
functioning. Rapid diagnosis and treatment for UHRs is therefore essential. In the future we need to refine our diagnostic tools to make them
sufficiently specific and sensitive but also so that the widest category of \"Risk Syndrome for Psychosis\" includes young patients with mostly
negative symptoms. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Psychiatria Danubina, 26(2) : 115-
121
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Zhang, Z., Zhai, J., Wei, Q., Qi, J., Guo, X., Zhao, J.
Background: A combination of psychosocial interventions and medications has been highly recommended as a successful treatment
package for schizophrenia. Its cost-effectiveness has not been fully explored yet. The aim of the present analysis was to evaluate the cost-
effectiveness of antipsychotics combined with psychosocial treatment and treatment as usual for patients with early-stage schizophrenia. Method:
Patients with schizophrenia (N = 1, 268) were assigned to the combination of medication and psychosocial intervention or treatment as usual for up to
12 months. Cost analysis included direct medical costs, direct nonmedical costs and indirect costs. Quality-adjusted life year (QALY) ratings were
assessed with Short- Form 6D. Results: Average monthly psychosocial intervention costs for combined treatment were higher than treatment as usual (p
= 0.005), but no significant differences were found in direct costs, indirect costs, and total costs between two groups (all p-values > 0.556).
Combined treatment was associated with significant higher QALY ratings than treatment as usual (p = 0.039). Compared with treatment as usual,
combined treatment resulted in a gain of 0.031 QALY ratings at an additional cost of US$ 56.4, yielding an incremental cost-effectiveness ratio of
US$ 1819.4 per QALY gained. Conclusions: Despite some limitations, our results supported that medication combined with psychosocial treatment was
more cost-effective than treatment as usual for patients with early-stage schizophrenia. Trial registration: clinicaltrials.gov Identifier:
NCT00654576 (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
BMC Psychiatry, 14 : 212
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychoeducation, Skills training, Other Psychological Interventions
Zhou, F-C., Xiang, Y-T., Wang, C-Y., Dickerson, F., Kreyenbuhl,
J., Ungvari, G. S., Au, R. W., Zhou, J-J., Zhou, Y., Shum, D., Man, D., Lai, K. Y., Tang, W-K., Yu, X., Chiu, H. F.
Purpose: The study examined the rate of remission in individuals experiencing a first episode of schizophrenia (FES) in China and
explored predictors of remission in the acute phase of the illness. Design and Methods: Fifty-five FES patients were randomly treated with
risperidone, olanzapine, or aripiprazole at therapeutic doses for 8 weeks, and their clinical profiles and cognition were assessed using standardized
assessment instruments at entry and the end of the study. Findings: Of the 55 patients, 30 (54.5%) remitted by the end of the 8-week study. In
univariate analyses, shorter duration of untreated psychosis, higher scores on both the time-based prospective memory (TBPM) and event-based
prospective memory tasks and the Hopkins Verbal Learning Test-revised, and less severe negative symptoms were significantly associated with
remission. In stepwise multiple logistic regression analyses, only higher scores on the TBPM significantly predicted remission. Individuals having
higher scores reflecting better TBPM at baseline were more likely to achieve remission after 8 weeks of optimized antipsychotic treatment. Practice
Implications: TPBM may be useful in helping clinicians identify those FES patients most likely to achieve a favorable treatment response. (PsycINFO
Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Perspectives in Psychiatric Care, 50(2) : 102-
110
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Zipursky, R. B., Menezes,
N. M., Streiner, D. L.
The large majority of
individuals with a first episode of schizophrenia will experience a remission of symptoms within their first year of treatment. It is not clear how
long treatment with antipsychotic medications should be continued in this situation. The possibility that a percentage of patients may not require
ongoing treatment and may be unnecessarily exposed to the long-term risks of antipsychotic medications has led to the development of a number of
studies to address this question. We carried out a systematic review to determine the risk of experiencing a recurrence of psychotic symptoms in
individuals who have discontinued antipsychotic medications after achieving symptomatic remission from a first episode of non-affective psychosis
(FEP). Six studies were identified that met our criteria and these reported a weighted mean one-year recurrence rate of 77% following discontinuation
of antipsychotic medication. By two years, the risk of recurrence had increased to over 90%. By comparison, we estimated the one-year recurrence rate
for patients who continued antipsychotic medication to be 3%. These findings suggest that in the absence of uncertainty about the diagnosis or
concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is
associated with a very high risk of symptom recurrence and should thus not be recommended. (PsycINFO Database Record (c) 2014 APA, all rights
reserved) (journal abstract).
Schizophrenia Research, 152(2-3) : 408-
414
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Relapse prevention, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Medication dose
reduction/discontinuation
Malla, A., Joober, R., Iyer, S., Schmitz, N., Norman, R., Brown, T., Jarvis, E., Abdel-Baki, A., Margolese,
H.
In this presentation, two challenges, namely, failure to infl uence pathways to care and optimum length of EI service, will be addressed.
Most patients with a first episode of psychosis (FEP) make their first contact with primary care services but few get into an EI service directly,
resulting in systemic delay. We report the results of a study evaluating the impact of direct training of all potential points of contact by new
patients on the referral portion of duration of untreated psychosis (DUP-R). Following the intervention, the number of referrals from primary care
services (health and education) increased substantially but majority of these did not have a FEP; DUP-R remained longest for patients referred from
primary care and shortest for patients presenting directly to the hospital emergency service; there was little change in the pathways to care for
patients who presented first to primary care; and patients with very long DUP were younger and most likely to have been referred from primary care.
For the challenge of duration of EI service, we will present the methodology and preliminary results of a single blind RCT comparing extension of an
EI service (N = 111) from 2 to 5 years compared to routine care (N = 109), following first 2 years of EI service. Preliminary data suggest that a
higher proportion of patients drop out of the routine care arm (51/109, 47%) compared to the EI (16/108, 15%) arm and obstacles in transferring
patients to routine care and its signifi- cance for interpretation of results are discussed.
Early Intervention in
Psychiatry, 8 : 10
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions