Disorders - Psychosis Disorders
Harder,
S., Koester, A., Valbak, K., Rosenbaum, B.
Objectives: The long-term
outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive
psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in
a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia
spectrum disorder. Method: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for
5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence. Results: Significant
between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of
active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up. Conclusion: The
findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment.
Further research into the curative elements of SPP is needed.
Psychiatry, 77(2) : 155-
168
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Javitt, D. C.
Objective:
Disturbances in N-methyl-D-aspartate receptor (NMDAR) function contribute to schizophrenia (Sz) and are indexed by objective neurophysiological
disturbances. Agents such as glycine and D-serine bind to an allosteric regulatory site of the NMDA receptor complex and may be therapeutically
beneficial in Sz. Methods: Two recent studies were conducted with 60 mg/kg/d (~4 g/d) D-serine. Study 1 investigated D-serine effects (4-6 wks) on
neurophysiological biomarkers including MMN and visual P1 in 35 stabilized, chronic Sz subjects, along with PANSS symptoms and MCCB neurocognitive
function. Study 2 investigated D-serine effects (16-wk) on prodromal symptoms in 44 individuals at clinical high risk (CHR) for Sz based on SIPS/SOPS
criteria. Results: Study#1: D-serine patients showed a significant (8.5±13.2%) decline in PANSS symtpoms vs. placebo, along with a small but
significant improvement in MCCB composite score. Significant improvements were also observed for MMN (p=0.044) and visual P1 (p= 0.043, d=0.67).
Study#2: a highly significant (p= 0.03; d=0.68) 35.7 ±17.8% reduction was observed in effect was observed on SOPS negative symptoms. Furthermore,
>20% improvement was observed in 9/10 subjects who completed all 16 weeks of treatment vs. only 5/11 placebo patients (p=0.023). A 30.9 ±14.9%
reduction was observed on total symptoms that approached significance (p= 0.07, d= 0.67). Conclusion: These are the first double-blind studies of D-
serine at a dose of 60 mg/kg. Although magnitude of symptoms improvement was small in chronic patients, objective effects were observed on brain
function including improvements in both auditory and visual neurophysiological measures. Moreover, in prodromal patients, robust improvements in
symptoms were observed, suggesting that NMDAR-based interventions may be most effective when applied early in the course of Sz.
International Journal of
Neuropsychopharmacology, 17 : 19
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Denia, D. T., Sanz-Fuentenebro, F. J., Alvarez, T. P., Rodriguez, V. M.
Background: The mechanism of action of clozapine, the unique treatment with a demonstrated advantage in resistant
schizophrenia is markedly different as compared to other typical and atypical antipsychotics. Restrictions on clozapine use leave open the question
of its potential utility in the earliest stages of the disease, as a first option, when the deterioration rate may be more pronounced. In the context
of a clinical trial, our group has developed a 2-year longitudinal study to test the hypothesis that the use of clozapine in Treatment-Naïve FES may
limit the degree of prefrontal gray matter loss and, consequently, it can attenuate the cognitive and functional early impairment better than
risperidone. Methods: Up to date, 34 Treatment-Naïve FES patients were included in the trial. They were randomly assigned to clozapine or risperidone
as drug treatment. 52.9% of the sample have completed the trial, 12 patients in the clozapine group and 6 patients in the risperidone group. 23
healthy controls matched for age, sex and educational level were recruited. Patients were evaluated twice by a neuropsychological battery related to
prefrontal functions: in the first week after attending mental health services and 2 years later. For statistical analysis of related samples
Wilcoxon non-parametric test was used. Results: At baseline, FES patients (n:18) yield significantly below controls on all neuropsychological
variables assessed, except in immediate verbal recall. The analysis of the treatment groups did not describe differences between them at baseline. At
2 years follow-up evaluation, the healthy controls still show better performance compared to patients. Patiens group (n=18) showed significance
improvement on their performance at 2 year follow-up on sustained attention-CPT-Hits (M=-11.05 (9.04); Z=-3.59; p<0.001), shifting attention-TMTB-A
(M=28.0 (40.87); Z=-2.35; p=0.018) working memory-WAIS III inverse-digits (M=-1.87 (2.98); Z=-2.20; p=0.022), processing speed-TMTA (M=9.61 (18.52);
Z=-2.14; p=0.032), semantic fluency (M=-5.33 (7.92); Z=-2.46; p=0.014), Visuospatial hability-ROCF Copy (M=-1.36 (3.53); Z=-1.97; p=0.048) and Verbal
Memory RAVL (M=-1.94 (3.38) Z=-2.23; p=0.025). Health-control group improved on fonologic fluency (M=-4.00 (4.47); Z=-2.39; p=0.016) and semantic
fluency (-3.83 (5.73); Z=-1.97; p=0.049). Risperidone group (n:6) significantly improved their performance on visuospatial hability-ROCF Copy-(M=-
3.08 (3.04); Z=-2.21; p=0.027). Clozapine group (n:12) significantly improved their performance on Sustained attention-CPT-Hits (M=-13.91 (8.80);
Z=-3.61; p=0.002), processing speed-TMTA (M=13.08 (21.44); Z=-2.00; p=0.045), working memory-WAIS-III Inverse digits (M=-0.75 (0.86); Z=-2.31;
p=0.021), cognitive flexibility-WSCT Perseverative Errors % (M=7.16 (12.54); Z=-2.08; p=0.037) and resistance to retroactive interference RAVLT
(M=1.42 (1.97); Z=-2.04; p=0.041) Discussion: These preliminary results suggest a better cognitive response in patients treated with clozapine on
several neuropsicological variables related to prefrontal cortex processes. They describe significance improvement on processing speed, sustained and
shifting attention, and working memory processes (manipulation and effective retrieval of information). However, at this time, the hypothesis that
clozapine can attenuate cognitive decline associated with the early stages of schizophrenia cannot be firmly supported due to the small sample
size.
Schizophrenia
Research, 153 : S371
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Drake, R., Day, C., Picucci, R., Warburton, J., Larkin, W., Husain, N., Reeder, C., Wykes, T., Marshall, M.
Background: Cognitive remediation (CR) preceding cognitive-behavioural therapy for psychosis (CBTp) was trialled within routine clinical
services, with the hypothesis that following first-episode non-affective psychosis CR would enhance CBTp efficacy by improving neuropsychological
performance. Method: A total of 61 patients with DSM-IV non-affective psychoses waiting for routine CBTp were randomized to computerized CR over 12
weeks, supported by a trained support worker, or time-matched social contact (SC). Primary outcome was the blind-rated Psychotic Symptoms Rating
Scale (PSYRATS). Secondary outcomes included measures of CBTp progress, cognition, symptoms, insight and self-esteem: all at baseline, after CR (12
weeks) and after CBTp (42 weeks). PSYRATS and global neuropsychological efficacy were tested using mixed-effects models with a groupxtime interaction
term. Measures of CBTp progress and some neuropsychological measures were modelled by regression. Results: There was no significant difference
between the CR and SC groups in PSYRATS (groupxtime coefficient 0.3, 95% confidence interval -0.4 to 1.1, p = 0.39). However, after CR CBTp was
shorter [median 7 sessions, interquartile range (IQR) 2-12 after CR; median 13, IQR 4-18 after SC; model p = 0.011] and linked to better insight (p =
0.02). Global cognition did not improve significantly more after CR (p = 0.20) but executive function did (Wisconsin Card Sort, p = 0.012).
Conclusions: CBTp courses preceded by CR were far shorter but achieved the same outcome as CBTp preceded by an active control, consistent with
neuropsychological improvement enhancing CBTp. CR was delivered by staff with minimal training, offering the potential to reduce the costs of CBTp
considerably. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychological Medicine, 44(9) : 1889-
1899
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy
Dang, J., Zhang, J., Guo, Z., Lu,
W., Cai, J., Shi, Z., Zhang, C.
In this pilot study, we aimed to examine whether
iPad-assisted cognitive training could be beneficial in ameliorating some of the cognitive impairment that accompany schizophrenia. Totally, 20
first-episode schizophrenia patients were randomly assigned to an experiment group (with cognitive training) or to a control group (without cognitive
training). The N-back task was assessed at baseline and after intervention, to see what effects iPad-assisted training might have (week 4). The
experimental group exhibited significant improvement in the accuracy rate at 2-back, and reaction time at 0, 1 and 2-back tasks. These findings
suggest that iPad- or other technically-assisted cognitive training may potentially be a valid strategy for pursuing cognitive rehabilitation among
those with schizophrenia. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Archives of Psychiatric Nursing, 28(3) : 197-199
- Year: 2014
- 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, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Emsley, R., Chiliza, B., Asmal, L., du-Plessis, S., Phahladira, L., van-Niekerk, E., van-Rensburg, S. J., Harvey,
B. H.
Background: While antipsychotics are effective in the
maintenance treatment of schizophrenia they have safety and tolerability risks. We investigated whether a combination of omega-3 polyunsaturated
fatty acids (omega-3 PUFAs) and a metabolic antioxidant, alpha-lipoic acid (alpha-LA), is effective in preventing relapse after antipsychotic
discontinuation in subjects who were successfully treated for 2-3years after a first-episode of schizophrenia, schizo-affective or schizophreniform
disorder. Methods: In this randomized, double-blind, placebo controlled study antipsychotic treatment was tapered and discontinued and participants
received either omega-3 PUFAs (eicosapentaenoic acid 2g/day and docosahexaenoic acid 1g/day)+alpha-LA 300mg/day or placebo. Subjects were followed up
for two years, or until relapse. Results: Recruitment was terminated prematurely due to the high relapse rates in both treatment groups as well as
the severity of some of the relapse episodes. Of the 33 participants, 19/21(90%) randomized to omega-3 PUFAs+alpha-LA relapsed and one (5%) completed
two years without relapse (p = 0.6); and 9/12 (75%) randomized to placebo relapsed and none completed two years without relapse. Mean times to
relapse were 39.8+/-25.4 and 38.3+/-26.6weeks for the omega-3 PUFAs+alpha-LA and placebo groups, respectively (p = 0.9). There were no significant
differences between the groups in relapse symptom severity. Conclusions: We found no evidence that omega-3 PUFAs+alpha-LA could be a suitable
alternative to maintenance antipsychotic treatment in relapse prevention, in this small study. Antipsychotic discontinuation after a single episode
of schizophrenia carries a very high risk of relapse, and treatment guidelines endorsing this practice should be revised. (PsycINFO Database Record
(c) 2014 APA, all rights reserved) (journal abstract).
Schizophrenia
Research, 158(1-3) : 230-235
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil), Vitamins and supplements
Craig, T., Shepherd, G., Rinaldi,
M., Smith, J., Carr, S., Preston, F., Singh, S.
Background: Individual placement and
support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse. Aims:
To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved
patients' occupational outcomes. Method: Two of four early intervention teams that already provided IPS were randomised to receive motivational
interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard
Randomised Controlled Trial Register (ISRCTN71943786). Results: Of 300 eligible participants, 159 consented to the research. Occupational outcomes
were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by
12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants'
gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI
1.5-16.6). Conclusions: Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work. (PsycINFO
Database Record (c) 2014 APA, all rights reserved) (journal abstract).
British Journal
of Psychiatry, 205(2) : 145-150
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Individual placement and support (IPS), vocational
interventions
Choi, J., Corcoran, C., Dixon, L., Fiszdon, J., Javitt, D.
Deficits in processing speed (PS) have been shown to correlate with
social aptitude during critical stages of psychological development in CHR, and have been variably identified as risk markers for psychosis. We
examined the feasibility of improving PS, the sustainability of training effects, and the association of PS with concurrent social function. This was
a doubleblind RCT for 21 participants randomized to 30 hours of Processing Speed Training (PST) or Active Control matched for the same dose and
duration of treatment. PST is a tablet-based program designed to improve reaction time and visual scanning efficiency by inhibiting the selection of
nonessential targets and discriminating figure-ground details. Pupil dilation is measured as an index of cognitive load, and training exercises are
continually titrated based on pupil dilation to provide a tailored and optimal level of cognitive load. Moderate to large effect sizes were found for
PST at post (0.76-0.82) and 2 months (0.52-0.61) on motorical and non-motorical PS measures. PST also showed moderate effects at 2 months on overall
social adjustment (0.29) and engaging in new social situations (0.52). Changes in PS from baseline to 2 months were correlated with changes in
overall social adjustment and avoidance of new social situations (r = - 0.32-0.38, p < 0.05). This was a pilot that experimentally isolated,
controlled and exaggerated speeded response subprocesses. This is the first study to test focal PS training in CHR to address social morbidity.
Focused PST appears to be a promising pathway to improving co-morbidity and mitigating a risk factor for psychosis.
Early Intervention in
Psychiatry, 8 : 109
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Christensen,
T., Vesterager, L., Krarup, G., Olsen, B., Melau, M., Gluud, C., Nordentoft, M.
Objective: This
randomised clinical trial assessed the effects of a 16-week cognitive remediation programme (NEUROCOM) combined with an early intervention service
(EIS) vs. EIS alone. Method: One hundred and seventeen patients with first episode psychosis were randomly assigned to 4 months cognitive remediation
combined with EIS vs. EIS alone. Statistical analysis of effect was based on intention to treat. Results: A total of 98 patients (83.8%) participated
in post-training assessments at 4 months and 92 (78.6%) in 12-month follow-up assessments. No effects were found on the primary outcome measure
functional capacity. At the post-training assessment, the intervention group had improved significantly on Rosenberg Self-Esteem Scale (Cohen's d =
0.54, P = 0.01), Positive and Negative Symptoms Scale (PANSS), General Psychopathology Scale (Cohen's d = 0.51, P = 0.05) and the verbal learning
domain (Cohen's d = 0.46, P = 0.02). At follow-up assessment, the intervention group retained the significant improvements on the verbal learning
domain (Cohen's d = 0.58, P < 0.05). Furthermore, significant improvements were observed on the working memory domain (Cohen's d = 0.56, P = 0.01)
and PANSS positive symptoms (Cohen's d = 0.44, P = 0.04), while improvement on the composite score was marginally significant (Cohen's d = 0.34, P
= 0.05). Conclusion: In accordance with other cognitive remediation programmes, this programme demonstrates some immediate and long-term effect on
cognitive functioning, symptoms and self-esteem. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Acta Psychiatrica
Scandinavica, 130(4) : 300-310
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Other service delivery and improvement
interventions
Amminger, G. P., Schlogelhofer, M., Klier, C., McGorry, P., Schafer, M.
Background: We have shown that a 12-week intervention with long-chain omega-3 polyunsaturated fatty acids (PUFAs) reduced the risk of
progression to psychotic disorder in young people with subthreshold psychotic states for a 12-month period (Amminger et al., 2010, Arch Gen
Psychiatry). Now we have completed a longer-term follow-up of this trial to determine the longer-term efficacy of omega-3-PUFAs in individuals at
ultra-high risk (UHR) for psychosis. Methods: Randomized, double-blind trial of 1.2 g/day omega-3 PUFAs or placebo in 81 UHR individuals. At longer-
term follow-up participants, next of kin, and those involved in assessing outcomes or data entry were blind to group assignments. The primary outcome
measure was transition to psychotic disorder. Secondary outcomes included functional, symptomatic and vocational measures. Analyses were performed on
an intent-totreat basis. Results: The median duration of follow-up in the sample was 6.7 years. The transition to psychosis rate was 9.8% (4/41) in
the omega-3 group and 40% (16/40) in the placebo group. The survival times were significantly different between the treatment groups, with a more
rapid conversion time for the placebo group compared with the omega-3 group (log rank test: ?2 = 9.84, p = 0.002). Functioning was significantly more
improved in the omega-3 PUFA group than in the placebo group. Conclusions: A brief intervention with omega-3 PUFAs prevented psychosis for almost up
to 7 years after baseline in the UHR individuals who participated in the trial.
Early
Intervention in Psychiatry, 8 : 41
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Calvo, A., Moreno, M., Ruiz-Sancho, A., Rapado-Castro, M., Moreno, C., Sanchez-Gutierrez, T., Arango, C., Mayoral, M.
Objective: The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with
early-onset psychosis and their families. The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-
solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease, to mitigate crises,
and to prevent relapses. Method: We performed a 9-month, randomized, rater-blinded clinical trial involving 55 adolescent patients with early-onset
psychosis and either or both of their parents. A psychoeducational problem-solving group intervention (n = 27) was compared with a nonstructured
group intervention (n = 28). The primary outcomes were number of hospitalizations, days of hospitalization, and visits to the emergency department.
The secondary outcome measures were clinical variables and family environment. Results: Assessments were performed before and after the intervention.
At the end of the group intervention, 15% of patients in the psychoeducational group and 39% patients in the nonstructured group had visited the
emergency department (chi2 = 3.62, df = 1, p = .039). The improvement in negative symptoms was more pronounced in the psychoeducational group (12.84
[7.87]) than in the nonstructured group (15.81 [6.37]) (p = .039). Conclusion: A parallel psychoeducational group intervention providing written
instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-
solving strategies within the family, thus reducing the number of visits to the emergency department. Negative symptoms improved in adolescents in
the psychoeducational group. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(6) : 688-
696
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Holzer, L., Urben,
S., Passini, C. M., Jaugey, L., Herzog, M. H., Halfon, O., Pihet, S.
BACKGROUND: Computer assisted cognitive remediation (CACR) was demonstrated to be efficient in improving cognitive
deficits in adults with psychosis. However, scarce studies explored the outcome of CACR in adolescents with psychosis or at high risk. AIMS: To
investigate the effectiveness of a computer-assisted cognitive remediation (CACR) program in adolescents with psychosis or at high risk. METHOD:
Intention to treat analyses included 32 adolescents who participated in a blinded 8-week randomized controlled trial of CACR treatment compared to
computer games (CG). Cognitive abilities, symptoms and psychosocial functioning were assessed at baseline and posttreatment. RESULTS: Improvement in
visuospatial abilities was significantly greater in the CACR group than in CG. Other cognitive functions, psychotic symptoms and psychosocial
functioning improved significantly, but at similar rates, in the two groups. CONCLUSION: CACR can be successfully administered in this population; it
proved to be effective over and above CG for the most intensively trained cognitive ability.
Behavioural and Cognitive Psychotherapy, 42(4) : 421-
434
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), 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)