Disorders - Psychosis Disorders
Eack, S. M., Mesholam-Gately, R. I., Greenwald, D. P., Hogarty, S. S., Keshavan, M. S.
Cognitive
rehabilitation has shown beneficial effects on cognition in patients with schizophrenia, which may also help to improve negative symptoms due to
overlapping pathophysiology between these two domains. To better understand the possible relationship between these areas, we conducted an
exploratory analysis of the effects of Cognitive Enhancement Therapy (CET) on negative symptoms. Early course schizophrenia outpatients (n = 58) were
randomized to 2 years of CET or an Enriched Supportive Therapy (EST) control condition. Results revealed significant and medium-sized (d = 0.61)
differential improvements favoring CET in overall negative symptoms, particularly social withdrawal, affective flattening, and motor retardation.
Neurocognitive improvement was associated with reduced negative symptoms in CET, but not EST patients. No relationships were observed between
improvements in emotion processing aspects of social cognition, as measured by the Mayer-Salovey-Caruso Emotional Intelligence Test, and negative
symptoms. CET represents an effective cognitive rehabilitation intervention for schizophrenia that may also have benefits to negative symptoms.
Future studies specifically designed to examine negative symptoms during the course of cognitive rehabilitation are needed. (copyright) 2013 Elsevier
Ireland Ltd.
Psychiatry Research, 209(1) : 21-
26
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Diaz, I., Pelayo-Teran, J. M., Perez-Iglesias, R., Mata, I., Tabares-Seisdedos, R., Suarez-Pinilla, P., Vazquez-Barquero, J. L., Crespo-Facorro, B.
The aim of the study was to identify predictors associated with a lower likelihood of achieving a
clinical remission 1 year after the first break of the illness. Participants were 174 consecutive subjects included in a first episode programme with
no prior treatment with antipsychotic medication. Patients were assigned to haloperidol, olanzapine or risperidone in a randomized, open-label,
prospective clinical trial. The main outcome variable was the remission criteria developed by the Remission in Schizophrenia Working Group. Clinical
variables were included in a logistic regression analysis in order to predict the remission state at 1 year. At 1 year, 31% of patients met criteria
for remission. The logistic regression analysis revealed that the strongest predictors of achieving clinical remission 1 year away from a first
episode of non-affective psychosis were the length of duration of untreated psychosis (DUP), the severity of negative symptomatology and the
educational level attained at baseline. The results suggest that: (1) patients with a lengthy DUP, a greater severity of negative symptomatology at
baseline and with a lower education level are in a higher risk of not achieving a clinical remission during the first year of treatment; and (2)
early intervention clinical programs should aim to reduce the length of DUP in order to provide a better outcome for patients. Copyright (copyright)
2012 Elsevier Ireland Ltd. All rights reserved.
Psychiatry
Research, 206(2-3) : 181-187
- Year: 2013
- 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)
Emsley, R., Chiliza,
B., Asmal, L., Mashile, M., Fusar-Poli, P.
Aim: There are sound reasons for considering the use of long-acting injectable antipsychotics early in the course of schizophrenia. We
reviewed available literature on the subject. Method: We conducted an electronic database search and critically reviewed all studies in which a
long-acting injectable antipsychotic was evaluated in early psychosis patients. Results: There is a need for well-designed studies as most of those
reported were open-label and non-comparative, and samples were frequently small. Conclusions: The available evidence does suggest that long-acting
injectable antipsychotics can be used safely and effectively in early stages of the illness, and that they may be associated with better outcomes
than with oral medications. However, this is largely supported by evidence from naturalistic cohort studies and a small number of controlled trials
of risperidone long-acting injection. Evidence for olanzapine and paliperidone long-acting injectables in particular is limited. (copyright) 2013
Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 7(3) : 247-
254
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Service Delivery & Improvement, Other service delivery and improvement
interventions
Desamericq, G., Meary, A., Macquin-Mavier, I., Bachoud-Levi, A. C., Maison, P.
Objectives: We conducted a network meta-analysis on all the randomized controlled trials in order to classify
antipsychotic drugs on cognitive outcomes in patients with schizophrenia. Material and methods: To identify relevant publications, we searched
(without language restrictions) MEDLINE and EMBASE (up to week 3 August 2011) for randomized controlled trials (RCTs) in which oral formulations of
second-generation antipsychotic drugs (amisulpride, aripiprazole, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, and zotepine) were
compared to placebo or haloperidol or second-generation antipsychotic drugs, for the treatment of schizophrenia or related disorders. Trials were
required to be of at least 6 months duration and were combined using mixed treatment comparisons models to provide direct and indirect comparisons in
a single analysis. Results: Nine studies were eligible. Quetiapine, olanzapine and risperidone had better effect on global cognitive score than
amisulpride (mean difference MD 0.27, 95% CI 0.10-0.44; MD 0.20, 95% CI 0.04-0.37; MD 0.16, 95% CI -0.03 to 0.34, respectively) and haloperidol (MD
0.27, 95% CI 0.13-0.41; MD 0.21, 95% CI 0.10-0.32; MD 0.16, 95% CI 0.02-0.30). When memory was considered, ziprasidone had better effect than
amisulpride (MD 0.28, 95% CI 0.02- 0.54) and haloperidol (MD 0.32, 95% CI 0.09-0.55). On attention and processing speed, quetiapine was largely
better than others drugs (P < 0.001), followed by ziprasidone (P < 0.05) and olanzapine (P < 0.05). Quetiapine, risperidone and olanzapine were the
best antipsychotics (P < 0.05 vs. amisulpride) on executive function. Theses finding were not modified when only patients in their first episode were
considered Discussion: Significant differences exist between medications on global with highest effect for quetiapine and olanzapine, followed by
risperidone and ziprasidone and finally amisulpride and haloperidol. Significant differences were also observed according to the cognitive task.
Fundamental & Clinical
Pharmacology, 27 : 15
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jimenez, M., Wade, D., Gee, D., Crisp, K., Pearce, T., Spiliotacopoulos,
D., Newman, B., McGorry, P. D.
The effectiveness of a novel 7-
month psychosocial treatment designed to prevent the second episode of psychosis was evaluated in a randomized controlled trial at 2 specialist
first-episode psychosis (FEP) programs. An individual and family cognitive behavior therapy for relapse prevention was compared with specialist FEP
care. Forty-one FEP patients were randomized to the relapse prevention therapy (RPT) and 40 to specialist FEP care. Participants were assessed on an
array of measures at baseline, 7-(end of therapy), 12-, 18-, 24-, and 30-month follow-up. At 12-month follow-up, the relapse rate was significantly
lower in the therapy condition compared with specialized treatment alone (P =. 039), and time to relapse was significantly delayed for those in the
relapse therapy condition (P =. 038); however, such differences were not maintained. Unexpectedly, psychosocial functioning deteriorated over time in
the experimental but not in the control group; these differences were no longer statistically significant when between-group differences in
medication adherence were included in the model. Further research is required to ascertain if the initial treatment effect of the RPT can be
sustained. Further research is needed to investigate if medication adherence contributes to negative outcomes in functioning in FEP patients who have
reached remission, or, alternatively, if a component of RPT is detrimental. (copyright) 2013 The Author.
Schizophrenia Bulletin, 39(2) : 436-
448
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Case management
Loewy,
R., Fisher, M., Mathalon, D. H., Vinogradov, S.
Background: Neurocognitive deficits in schizophrenia often
begin prior to the first psychotic episode, may worsen with psychosis onset and predict real-world functioning. Available medications and
psychotherapies do not improve cognition, but recent randomized controlled trials (RCTs) of computerized cognitive training have demonstrated promise
in established schizophrenia. Intervention prior to full psychosis may provide an opportunity to limit the impact of the disorder during an important
developmental period. Methods: We will present preliminary interim analyses of an ongoing, double- blind RCT of computerized cognitive training among
youth at clinicalhigh- risk (CHR) for psychosis. Participants (N = 47, mean age 19.9 years) met criteria for a prodromal syndrome on the Structured
Interview for Prodromal Syndromes and were randomized to either 40 hours of Positscience, Inc's nullBrain Fitnessnull Program (BFP), or 40 hours of
commercially available computer games (CG). Training was completed at home via laptop computer over an approximate 10-week interval. To date, 14 BFP
and 10 CG subjects have completed training, along with clinical, functional and MATRI CSbased neuropsychological assessments. Groups were matched at
baseline on age, gender, years of education and IQ. Results: For cognitive tests, there was a main effect of Time, such that both groups improved
from pre- to posttesting on Global Cognition and Working Memory, with a trend for Verbal Learning and Memory. There was also a significant Group X
Time interaction for Verbal Learning and Memory, such that the TCT group improved slightly from pre- to post-testing while the CG group declined. A
main effect of Time was found for GAF, positive, disorganized and general symptoms. We will also report available longitudinal follow-up data on this
sample. Conclusion: Consistent with most reports in CHR samples, we found a general improvement, on average, in symptoms and functioning over time.
Also consistent with other CHR RCTs, we encountered a number of challenges, including high attrition rates and considerable heterogeneity within the
CHR sample. Despite these obstacles, our preliminary findings suggest that BFP can be feasibly administered to some CHR adolescents and young adults.
We will discuss the possibility that intense visual games may decrease verbal performance, consistent with our schizophrenia studies, or that BFP may
dampen the deterioration in verbal learning and memory that has been associated with progression to full psychosis.
Schizophrenia
Bulletin, 39 : S238-S239
- Year: 2013
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Madigan, K., Brennan,
D., Lawlor, E., Turner, N., Kinsella, A., O'Connor, J. J., Russell,
V., Waddington, J. L., O'Callaghan, E.
Background: Patients who experience the onset of psychotic
illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce
cannabis use and improve clinical outcome in this population. Aims: We undertook a multi-center, randomized controlled trial of a group psychological
intervention for psychosis with comorbid cannabis dependence to determine whether there was any impact on cannabis use symptoms, global functioning,
insight, attitudes to treatment and subjective quality of life. Method: Across three centers, we compared a group psychological intervention, based
on cognitive behavioral therapy and motivational interviewing, with treatment as usual among patients experiencing their first psychotic episode or
early in the course of psychotic illness. Substance misuse and indices of clinical outcome were assessed at baseline, 3. months and 1. year. Results:
At 3. month and 1. year follow-ups, there was no evidence for an intervention effect on cannabis use, symptoms, global functioning insight or
attitude to treatment. However, the intervention improved subjective quality of life at 3. months and this effect was sustained at 1. year.
Conclusions: Over the early phase of psychotic illness, group psychological interventions for those with comorbid cannabis dependence improved
subjective quality of life. However, this was not associated with reduction in use of cannabis or improvement in clinical outcomes. (copyright) 2012
Elsevier B.V.
Schizophrenia Research, 143(1) : 138-
142
- Year: 2013
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Killackey, E., Allott, K., Cotton, S.
M., Chinnery, G., Jackson, H. J., Baksheev, G.
Background:
It has been proposed that Individual Placement and Support (IPS) may help compensate for the neurocognitive deficits observed in psychosis. The
relationship between neurocognition and employment in people with first-episode psychosis (FEP) receiving IPS has not been examined. This study aimed
to determine whether: a) neurocognition is associated with the number of hours of contact with the IPS employment consultant; and b) neurocognition
predicts employment outcomes following IPS vs. standard care. Methods: 146 FEP participants were randomised to receive 6 months of IPS and treatment
as usual (TAU ) or TAU alone. The current analyses excluded 11 participants with a history of brain impairment: IPS n = 69 and TAU n = 66. At
baseline participants completed a comprehensive neurocognitive battery. Results: Five neurocognitive factors were extracted with principal factor
analysis using promax rotation: i) information processing speed; ii) verbal comprehension and fluency; iii) attention and working memory; iv) visual
organisation and memory; and v) verbal learning and memory. In the IPS group, contact with the IPS consultant ranged from 0 to 73.3 hours (M = 19.4,
SD = 13.2). In regression analysis, poorer information processing speed significantly predicted higher IPS contact hours (p = .030). Bivariate
correlations found no significant relationship between IPS hours provided and employment (yes/no) (rpb = -.024, p = .854) or hours worked (r = -0.13,
p = .393) over 6 months. Logistic regression with employment over 6 months (yes/no) as the dependent variable and treatment group and neurocognitive
factors as predictors, revealed that treatment group was the only significant predictor of employment, with the IPS group significantly more likely
to be employed than the TAU group (OR = 3.03; p = .011). Conversely, linear regression with hours worked over 6 months as the dependent variable and
treatment group and neurocognitive factors as predictors revealed that lower verbal comprehension and fluency (p = .028), higher visual organisation
and memory (p <.001) and higher attention and working memory (p = .034) were associated with more hours worked. Conclusion: Neurocognition was
associated with hours of IPS provided. Neurocognition did not predict whether participants gained employment after accounting for treatment group.
However, neurocognition and not treatment group predicted employment duration. Thus, employment duration may be enhanced with neurocognitive
rehabilitation.
Schizophrenia Bulletin, 39 : S264-
S265
- Year: 2013
- 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
Lee, R. S. C., Redoblado-Hodge, M. A., Naismith, S. L., Hermens, D. F., Porter, M. A., Hickie, I. B.
Background: Cognitive remediation
(CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode
psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in
patients with a first-episode of either major depression or psychosis. Method: Fifty-five patients (mean age=22.8 years, S.D.=4.3) were randomly
assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were
comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat
(ITT) approach with all available data. Results: In comparison to TAU, CR was associated with improved immediate learning and memory controlling for
diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning
irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level.
Conclusions: CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory
potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation
and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability
and the precise mechanisms of CR effects respectively. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Psychological Medicine, 43(6) : 1161-1173
- Year: 2013
- Problem: Depressive Disorders, Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
McGorry, P. D., Nelson, B., Phillips, L. J., Yuen, H. P., Francey, S. M., Thampi, A., Berger, G.
E., Amminger, P., Simmons, M.
B., Kelly, D., Thompson, A. D., Yung, A.
R.
Objective: The ultra-high risk clinical phenotype is associated with substantial distress and functional impairment and
confers a greatly enhanced risk for transition to full-threshold psychosis. A range of interventions aimed at relieving current symptoms and
functional impairment and reducing the risk of transition to psychosis has shown promising results, but the optimal type and sequence of intervention
remain to be established. The aim of this study was to determine which intervention was most effective at preventing transition to psychosis:
cognitive therapy plus low-dose risperidone, cognitive therapy plus placebo, or supportive therapy plus placebo. Method: A double-blind, randomized,
placebo-controlled 12-month trial of low-dose risperidone, cognitive therapy, or supportive therapy was conducted in a cohort of 115 clients of the
Personal Assessment and Crisis Evaluation Clinic, a specialized service for young people at ultra-high risk of psychosis located in Melbourne,
Australia. Recruitment commenced in August 2000 and ended in May 2006. The primary outcome measure was transition to full-threshold psychosis,
defined a priori as frank psychotic symptoms occurring at least daily for 1 week or more and assessed using the Comprehensive Assessment of At-Risk
Mental States. Secondary outcome measures were psychiatric symptoms, psychosocial functioning, and quality of life. Results: The estimated 12-month
transition rates were as follows: cognitive therapy + risperidone, 10.7%; cognitive therapy + placebo, 9.6%; and supportive therapy + placebo, 21.8%.
While there were no statistically significant differences between the 3 groups in transition rates (log-rank test P = .60), all 3 groups improved
substantially during the trial, particularly in terms of negative symptoms and overall functioning. Conclusions: The lower than expected, essentially
equivalent transition rates in all 3 groups fail to provide support for the first-line use of antipsychotic medications in patients at ultra-high
risk of psychosis, and an initial approach with supportive therapy is likely to be effective and carries fewer risks. (copyright) Copyright 2012
Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 74(4) : 349-356
- Year: 2013
- 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), Cognitive & behavioural therapies (CBT), Supportive
therapy
Kumar, A., Datta, SS., Wright, SD., Furtado, VA., Russell, PS.
Background: Schizophrenia often presents in adolescence, but current treatment guidelines are based largely on studies of adults with
psychosis. Over the past decade, the number of studies on treatment of adolescent-onset psychosis has increased. The current systematic review
collates and critiques evidence obtained on the use of various atypical antipsychotic medications for adolescents with psychosis.Objectives: To
investigate the effects of atypical antipsychotic medications in adolescents with psychosis. We reviewed in separate analyses various comparisons of
atypical antipsychotic medications with placebo or a typical antipsychotic medication or another atypical antipsychotic medication or the same
atypical antipsychotic medication but at a lower dose.Search methods: We searched the Cochrane Schizophrenia Group Register (October 2011), which is
based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies and contacted
study authors and relevant pharmaceutical companies to ask for more information.Selection criteria: We included all relevant randomised controlled
trials (RCTs) that compared atypical antipsychotic medication with placebo or another pharmacological intervention or with psychosocial
interventions, standard psychiatric treatment or no intervention in children and young people aged 13 to 18 years with a diagnosis of schizophrenia,
schizoaffective disorder, acute and transient psychoses or unspecified psychosis. We included studies published in English and in other languages
that were available in standardised databases.Data collection and analysis: Review authors AK and SSD selected the studies, rated the quality of the
studies and performed data extraction. For dichotomous data, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect
model. When possible, for binary data presented in the 'Summary of findings' table, we calculated illustrative comparative risks. We summated
continuous data using the mean difference (MD). Risk of bias was assessed for included studies.Main results: We included 13 RCTs, with a total of
1112 participants. We found no data on service utilisation, economic outcomes, behaviour or cognitive response. Trials were classified into the
following groups.1. Atypical antipsychotics versus placebo Only two studies compared one atypical antipsychotic medication with placebo. In one
study, the number of non-responders treated with olanzapine was not different from the number treated with placebo (1 RCT, n = 107, RR 0.84, 95% CI
0.65 to 1.10); however, significantly more (57% vs 32%) people left the study early (1 RCT, n = 107, RR 0.56, 95% CI 0.36 to 0.87) from the placebo
group compared with the olanzapine group. With regard to adverse effects, young people treated with aripiprazole had significantly lower serum
cholesterol compared with those given placebo (1 RCT, n = 302, RR 3.77, 95% CI 1.88 to 7.58).2. Atypical antipsychotics versus typical antipsychotics
When the findings of all five trials comparing atypical antipsychotic medications with a typical antipsychotic medication were collated, no
difference in the mean end point Brief Psychiatric Rating Scale (BPRS) score was noted between the two arms (5 RCTs, n = 236, MD -1.08, 95% CI -3.08
to 0.93). With regard to adverse effects, the mean end point serum prolactin concentration was much higher than the reference range for treatment
with risperidone, olanzapine and molindone in one of the studies. However, fewer adolescents who were receiving atypical antipsychotic medications
left the study because of adverse effects (3 RCTs, n = 187, RR 0.65, 95% CI 0.36 to 1.15) or for any reason (3 RCTs, n = 187, RR 0.62, 95% CI 0.39 to
0.97).3. One atypical antipsychotic versus another atypical antipsychotic The mean end point BPRS score was not significantly different for people
who received risperidone compared with those who received olanzapine; however, the above data were highly skewed. Overall no difference was noted in
the numbe of people leaving the studies early because of any adverse effects between each study arm in the three studies comparing olanzapine and
risperidone (3 RCTs, n = 130, RR 1.15, 95% CI 0.44 to 3.04). Specific adverse events were not reported uniformly across the six different studies
included in this section of the review; therefore it was difficult to do a head-to-head comparison of adverse events for different atypical
antipsychotic medications.4. Lower-dose atypical antipsychotic versus standard/higher-dose atypical antipsychotic Three studies reported comparisons
of lower doses of the atypical antipsychotic medication with standard/higher doses of the same medication. One study reported better symptom
reduction with a standard dose of risperidone as compared with a low dose (1 RCT, n = 257, RR -8.00, 95% CI -13.75 to -2.25). In another study, no
difference was reported in the number of participants not achieving remission between the group receiving 10 mg/d and those who received 30 mg/d of
aripiprazole (1 RCT, n = 196, RR 0.84, 95% CI 0.48 to 1.48). Similarly in the other study, authors reported no statistically significant difference
in clinical response between the two groups receiving lower-dose (80 mg/d) and higher-dose (160 mg/d) ziprasidone, as reflected by the mean end point
BPRS score (1 RCT, n = 17, MD -4.40, 95% CI -19.20 to 10.40).Authors' conclusions: No convincing evidence suggests that atypical antipsychotic
medications are superior to typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be
more acceptable to young people because fewer symptomatic adverse effects are seen in the short term. Little evidence is available to support the
superiority of one atypical antipsychotic medication over another, but side effect profiles are different for different medications. Treatment with
olanzapine, risperidone and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with
dyslipidaemia. Adolescents may respond better to standard-dose as opposed to lower-dose risperidone, but for aripiprazole and ziprasidone, lower
doses may be equally effective. Future trials should ensure uniform ways of reporting.
Cochrane Database of Systematic
Reviews, (10) : CD009582
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Zhang, Jian-Ping, Gallego, Juan A., Robinson, Delbert G., Malhotra, Anil K., Kane,
John M., Correll, Christoph U.
Because early treatment choice is critical in first-episode schizophrenia-spectrum disorders (FES), this meta-analysis compared efficacy
and tolerability of individual second-generation antipsychotics (SGAs) with first-generation antipsychotics (FGAs) in FES. We conducted systematic
literature search (until 12 December 2010) and meta-analysis of acute, randomized trials with =1 FGA vs. SGA comparison; patients in their first
episode of psychosis and diagnosed with schizophrenia-spectrum disorders; available data for psychopathology change, treatment response, treatment
discontinuation, adverse effects, or cognition. Across 13 trials (n = 2509), olanzapine (seven trials) and amisulpride (one trial) outperformed FGAs
(haloperidol: 9/13 trials) in 9/13 and 8/13 efficacy outcomes, respectively, risperidone (eight trials) in 4/13, quetiapine (one trial) in 3/13 and
clozapine (two trials) and ziprasidone (one trial) in 1/13, each. Compared to FGAs, extrapyramidal symptom (EPS)-related outcomes were less frequent
with olanzapine, risperidone and clozapine, but weight gain was greater with clozapine, olanzapine and risperidone. Pooled SGAs were similar to FGAs
regarding total psychopathology change, depression, treatment response and metabolic changes. SGAs significantly outperformed FGAs regarding lower
treatment discontinuation, irrespective of cause, negative symptoms, global cognition and less EPS and akathisia, while SGAs increased weight more (p
< 0.05-0.01). Results were not affected by FGA dose or publication bias, but industry-sponsored studies favoured SGAs more than federally funded
studies. To summarize, in FES, olanzapine, amisulpride and, less so, risperidone and quetiapine showed superior efficacy, greater treatment
persistence and less EPS than FGAs. However, weight increase with olanzapine, risperidone and clozapine and metabolic changes with olanzapine were
greater. Additional FES studies including broader-based SGAs and FGAs are needed.;
International Journal of Neuropsychopharmacology, 16(6) : 1205-
1218
- Year: 2013
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)