Disorders - Psychosis Disorders
Yung, A., Amminger,
P., Berger, G., Thompsom, A., Phillips, L., Nelson, B., Francey, S., Yuen, H. P., McGorry, P.
Background: Cognitive therapy (CT) and/or low-dose antipsychotic administered to individuals deemed as being
at ultra high risk (UHR) for psychotic disorder may prevent or delay the onset of full blown illness. However, it is unclear which of these
treatments are most effective. Method: In order to examine these issues, we conducted a randomized controlled trial of CT plus risperidone (CT+Risp);
CT plus placebo (CT+Plac); and supportive therapy plus placebo (Supp+Plac) in UHR young people. Results 12-month transition rates were: CT+Risp,
10.7%; CT+Plac, 9.6%; ST+Plac, 21.8%. There were no statistically significant differences between the three groups in transition rates. Symptoms and
functioning in all three groups improved over the course of the trial. Discussion: The unexpectedly low, and essentially equivalent, transition rates
in all three groups fail to support the use of antipsychotic medications as a first-line therapy for UHR patients. Other treatments such as CT,
supportive therapy and neuroprotective agents including fish oil need further examination. Ethical issues associated with labeling of UHR people as
such and types and duration of treatment also need further discussion.
Early Intervention in
Psychiatry, 6 : 11
- Year: 2012
- 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
Zhang, Y., Dai, G.
Background There are no direct comparisons of paliperidone
extended-release (ER), aripiprazole and ziprasidone in efficacy and metabolic influence in patients with first-episode schizophrenia. Objective The
present study examined the efficacy and metabolic influence of paliperidone ER, aripiprazole and ziprasidone in patients with first-episode
schizophrenia in China. Methods Subjects were recruited from outpatient and 254 patients entered the trial. These patients received treatment
randomly with paliperidone ER, aripiprazole and ziprasidone and were assessed at baseline, 13, 26 and 52 weeks, respectively with Positive and
Negative Syndrome Scale (PANSS), 7-item Clinical Global Impressions-Severity (CGI-S), anthropometric (weight, body mass index and waist
circumference) and metabolic (fasting blood glucose, HbA1c, cholesterol, high density lipoproteins (HDL), low density lipoproteins and triglycerides)
measures. Results A total of 203 patients completed the trial. Paliperidone group had significant greater reduction in PANSS than aripiprazole group
and ziprasidone group from 13 weeks, although the a reduction in PANSS of each group was more than 20%. There was no difference in CGI-S among the
three groups, and all three groups had a significant reduction from baseline in CGI-S. Aripiprazole group increased in weight and body mass index
despite no statistical change in waist circumference. Other two groups showed no changes in anthropometric measure. At the end of the study, two
glucose metabolic indices (fasting blood glucose and HbA1c) of aripiprazole group were significantly higher than that of baseline. In lipid
metabolism, aripiprazole group reduced triglycerides significantly and had no changes in other indices. Paliperidone group reduced HDL and increased
triglycerides despite no changes in glucose metabolism. Ziprasidone group also had no significant changes in glucose metabolism, but reduced
cholesterol, low density lipoproteins and increased HDL. Furthermore, 22 subjects in three groups reached the diagnostic criteria of metabolic
syndrome. Conclusions Paliperidone ER, aripiprazole and ziprasidone are effective in treating first-episode schizophrenia, and the ranking of
efficacy from high to low is paliperidone ER > aripiprazole > ziprasidone. Paliperidone ER can impair lipid metabolism potentially but had no
influence on glucose metabolism. Aripiprazole can damage glucose metabolism and has little influence on lipid metabolism. Ziprasidone is considered
an atypical antipsychotic with no evidence of harm to glucose and lipid metabolism. Copyright (copyright) 2012 John Wiley & Sons, Ltd. Copyright
(copyright) 2012 John Wiley & Sons, Ltd.
Human Psychopharmacology, 27(6) : 605-
614
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Zhang, Zhang-Jin, Chen, Yun-Chun, Wang, Hua-
Ning, Wang, Huai-Hai, Xue, Yun-Yun, Feng, Shu-Fang, Tan, Qing-Rong
Objective: Previous studies have
demonstrated the effectiveness of electroconvulsive therapy (ECT) in pharmacotherapy-resistant neuropsychiatric conditions. This study aimed to
evaluate the efficacy and safety of ECT in adolescents with first-episode psychosis. Method: This case - control study was conducted in inpatients
aged 13 - 20 years with first-episode psychosis. Every three similar age and same gender patients consecutively recruited were randomly allocated to
control and ECT group at a ratio of 1:2, while they had antipsychotic treatment. ECT treatment was performed for 3 sessions per week with a maximum
of 14 sessions. The endpoint was discharge from hospital. Clinical outcomes were measured using hospital stay days, the Positive and Negative
Syndrome Scale (PANSS) and response rate. Polysomnography (PSG) was conducted at baseline and at week 2. Safety and tolerability were also evaluated.
Results: Between March 2004 and November 2009, 112 eligible patients were allocated to control (n = 38) and ECT (n = 74) group. Additional ECT
treatment significantly reduced hospital stay compared to controls (23.2 ± 8.2 days versus 27.3 ± 9.3 days, mean ± SD, P = 0.018). Survival analysis
revealed that the ECT-treated group had a significantly higher cumulative response rate than controls (74.3% versus 50%, relative risk (RR) = 1.961,
P = 0.001). Additional ECT also produced significantly greater improvement in sleep efficiency, rapid eye movement (REM) latency and density than
control condition. The PSG improvement significantly correlated with reduction in scores on overall PANSS, positive symptoms, and general
psychopathology. No patients discontinued ECT treatment regimen during hospital stay. The incidence of most adverse events was not different in the
two groups, but ECT-treated group had more complaints of transient headache and dizziness than controls. Conclusions: ECT is an effective and safe
intervention used in adolescents with first-episode psychosis. Its antipsychotic effects are associated with improved PSG variables. ECT can be
considered as an early psychosis intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved) (journal abstract)
Schizophrenia Research, 137(1-3) : 97-103
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Electroconvulsive therapy (ECT)
Zhornitsky,
S., Stip, E.
Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to
improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and
tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered
different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their
oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with
first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that
not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas
fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce
risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part,
naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.
Copyright (copyright) 2012 Simon Zhornitsky and Emmanuel Stip.
Schizophrenia Research &
Treatment, :
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Marvin, S. E., Miklowitz, D. J., O'Brien, M. P., Cannon, T. D.
Objective: This study
tested treatment fidelity in a randomized controlled trial of family-focused therapy for adolescents and young adults at clinical high risk for
psychosis (CHR youth). Methods: The treatment sample included 110 youth ages 12-30 with prodromal psychosis and their families. The Therapist
Adherence and Competence Scale (TCAS; Weisman et al., 1998; Miklowitz & O'Brien, 2009) was used to rate 24 therapists across 8 sites on demonstrated
skill in providing the FFT-PY or a 3-session psychoeducation control, enhanced care (EC). The TCAS includes items measuring techniques specific to
FFT-PY as well as nonspecific factors that were not expected to differ across treatment conditions. Results: Raters classified 90% of FFT and EC
cases as 'good' (5) or better (6-7) on a 1-7 scale of overall fidelity. TCAS ratings indicated that FFT-PY included a greater emphasis on
communication ((chi)2(2, n = 82) = 70.11, P = .001) and problem solving skills ((chi)2(2, n = 83) = 44.73, P = .001) training, but that the quality
of nonspecific factors, such as rapport, did not differ between FFT-PY and EC, F(1,170) = .28, P > .05. Levels of family conflict and levels of
prodromal symptomatology were not associated with fidelity ratings. Conclusion: High levels of fidelity were obtained in a multi-site study of family
intervention for CHR youth, despite variability in level of prodromal symptom severity and family conflict. Future studies should examine which
specific therapeutic components of FFT are associated with positive outcomes of clinical high-risk conditions.
Early Intervention in Psychiatry, 6 : 95
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Malla, A., Norman, R., Iyer, S., Joober, R., Brown, T., Schmitz, N., Nordentoft, M., Latimer, E., Jarvis, E., Abdel-Baki, A.
The benefits of specialized early intervention services (SEIS) for
psychotic disorders in the first two years have been reasonably well established. Recent evidence suggests that returning to regular care after 2
years of SEIS results in failure to sustain the benefits over the subsequent 3 years, achieved during SEIS tenure. Recently we have reported that a
reduced intensity SEI services for an additional three years results in significantly better outcome (Norman et al., 2011). In order to influence
mental health policy in publicly funded mental health systems, further evidence is required through a randomized controlled evaluation of an
extension of SEIS from 2 to 5 years in comparison to regular care after the initial 2 years of SEIS. In this presentation we will report such an
approach and interim results from a RCT using rates of sustained engagement, length of remission and health economic indices as outcome measures. We
will present methodological issues and data based on interim analyses (N = 162, SEIS = 82, RC = 80; mean length in the study = 24 months) to show
that sustained disengagement rates are significantly higher in the regular care condition (27%) compared to SEIS (13%) and higher proportion of
patients in SEIS are in complete remission compared to RC (34% vs. 23% at 12 months, and 50% vs. 33% at 24 months). These preliminary results, based
on 80% of the total sample (N = 212) thus far recruited and at a mean of 24 months in the study, are encouraging. Difficulties associated with
conducting a servicebased trial are also discussed.
Early Intervention in Psychiatry, 6 : 36
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Lawlor, E., Madigan, K., Russell, V., O'Connor, J. J., Turner, N., Clarke, M., Waddington, J., O'Callaghan, E.
Background: A Cochrane
review of 25 randomized controlled trials of psychosis and comorbid substance use found little evidence of effective strategies to improve outcome
amongst this cohort. Few studies have evaluated a group based intervention and none have utilized a group based cognitive behavioural therapy
approach combined with motivational interviewing. Aim: We adapted the Cannabis and Psychosis (CAP) individual programme to a group-based format for
those with early phase psychosis and cannabis abuse. The final intervention consisted of 12 weekly sessions and was based upon motivational
interviewing, cognitive behavioural therapy and psychoeducation. The six phases included: (i) entry: gaining commitment to treatment; (ii)
commitment: building commitment to a goal of nonproblematic substance misuse; (iii) goal setting: reinforcing commitment to change and development of
goal achievement strategies; (iv) challenges: withdrawal counseling; (v) relapse prevention and lifestyle: early warning signs, healthy living; (vi)
maintenance: coping skills. Results: In total 230 individuals were referred to the trial. Of those referred, 72 (31%) did not meet inclusion criteria
and 70 (30.4%) refused. Of the remainder, 88 were randomized on a 2 : 1 ratio, 59 (26%) to intervention and 29 (13%) to treatment as usual. However
32 (14%) individuals allocated to the intervention declined to participate in the group based programme. Conclusion: It is difficult to engage
participants with early phase psychosis and comorbid cannabis use with a group psychological intervention aimed at improving outcome in psychosis.
Innovative engagement strategies are needed with this cohort.
Early Intervention in
Psychiatry, 6 : 28
- Year: 2012
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation
Killackey, E.
Background: While first episode psychosis (FEP) services have
developed in Australia since the mid 1980s, there has been less consideration of interventions around employment until recently. This presentation
will summarize the system context in Australia and the results of an Australian randomized controlled trial of individual placement and support
(IPS). Methods: A group of 41 people with FEP wanting to find work were randomized to IPS (n=20) or treatment-asusual (TAU, n=21). The IPS group
worked with an employment consultant for a six month period. Those in TAU could access clinical services and external vocational agencies.
Assessments were at baseline and six months. Findings: More of the IPS group were employed or education than those in TAU (17 vs 6, p=0.000) at
follow up. For employment only there was a significant difference (13 vs 2, p=0.000). Those in IPS had a higher median income ($2432 vs $0, p=0.012)
and worked more hours per week (median 38 vs 22.5, p=0.006) and more weeks (median 5.0 vs 0, p=0.021). The IPS group also showed significantly
reduced use of welfare benefits. Conclusions: The IPS approach has great potential for those with FEP. This study shows that the results achieved at
outcome are significantly better than high quality TAU. These results also indicate that this approach is well suited to the Australian labour market
and mental health system.
Australian & New Zealand Journal of Psychiatry, 46 : 47
- Year: 2012
- 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
Kopelowicz, A., Zarate, R., Wallace, C. J., Liberman, R. P., Lopez, S. R., Mintz, J.
Context: Evidence-based interventions to improve medication adherence among patients with schizophrenia are
lacking. Although family psychoeducation has demonstrated efficacy in improving outcomes in schizophrenia, empirical support for its ability to
enhance medication adherence is scarce. Objective: To determine whether a culturally adapted, multifamily group (MFG) therapy would increase
medication adherence and decrease psychiatric hospitalizations for Spanish-speaking Mexican Americans with schizophrenia. Design: A total of 174
Mexican American adults with schizophrenia-spectrum disorder and their key relatives were studied in a 3-armed, randomized controlled trial of MFG
therapy focused on improving medication adherence. Assessments occurred at baseline and at 4, 8, 12, 18, and 24 months. Setting: Two community mental
health centers in Los Angeles, California. Participants: Patients had a diagnosis of schizophrenia or schizoaffective disorder with a recent
exacerbation of psychotic symptoms and nonadherence to medication before enrollment. Intervention: Patients participated in 1 of 2 MFGs (MFG-
adherence or MFG-standard) or treatment as usual. Groups convened twice monthly in 90-minute sessions for 1 year. Main Outcome Measures: The
Treatment Compliance Interview uses multiple sources of information to quantify medication adherence. Computerized records were used to collect
information on the use of inpatient resources. Results: At the end of the 1-year treatment, MFG-adherence was associated with higher medication
adherence than MFG-standard or treatment as usual only (F=6.41; P=.003). The MFG-adherence participants had a longer time to first hospitalization
((chi)2=13.3; P=.001) and were less likely to be hospitalized than those in MFG-standard ((chi)2=8.2; P=.04) and treatment as usual alone
((chi)2=11.3; P<.001). Increased adherence accounted for one-third of the overall effect of treatment on the reduced risk for psychiatric
hospitalization. Conclusion: Multifamily group therapy specifically tailored to improve medication adherence through a focus on the beliefs and
attitudes of the target population is associated with improved outcome for Mexican American adults with schizophrenia-spectrum disorders. Trial
Registration: clinicaltrials.gov Identifier: NCT01125267. (copyright)2012 American Medical Association. All rights reserved.
Archives of General Psychiatry, 69(3) : 265-
273
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Killackey, E. J., Allott, K. A., Cotton, S. M., Chinnery, G. L., Sun, P., Collins, Z., Massey, J., Baksheev, G., Jackson, H. J.
Vocational recovery has been consistently shown to be a
number one priority of people with mental illness generally, and schizophrenia and first-episode psychosis (FEP) specifically. Two previous
randomized controlled trials (RCT) demonstrated the benefit of an employment intervention called Individual Placement and Support (IPS) for young
people with FEP. The current study was conducted in order to examine not only the vocational benefits of such an approach, but to study a wide range
of predictors and consequences of vocational recovery in FEP. The aims of this presentation will be to present the data pertaining to vocational
recovery within the first 6 months of this study. The study was a RCT of IPS plus treatment as usual (TAU) compared with TAU alone, conducted at
EPPIC in Australia. Participants were 146 young people with FEP. Assessments were conducted at baseline, 6, 12 and 18 months. The IPS intervention
was conducted between baseline and the 6-month assessment. There was no difference between groups in number currently in paid work at the 6-month
time-point (IPS 44.8% and TAU 29.0%; (chi)2(1) = 3.42, p = 0.065). Over the 6-month period, there was no difference between groups in enrolment in
formal education (IPS 53.7% and TAU 41.0%; (chi)2(1) = 2.08, p = 0.149). However, there was a significant difference favouring IPS in competitive
employment rate over 6 months (IPS 70.3% and TAU 49.2%; (chi)2(1) = 5.74, p = 0.017). The preliminary results of this study indicate that IPS is
effective at getting people into employment. Development of further interventions arising from these results will be discussed.
Early Intervention in Psychiatry, 6 : 13
- Year: 2012
- 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
Malla,
A., Chue,
P., Jordan, G., Stip, E., Koczerginski, D., Milliken, H., Joseph, A., Williams, R., Adams, B., Manchanda, R., Oyewumi, K., Roy, M. A.
Few studies have examined effectiveness and tolerability of
Risperdal Long Acting Injections (RLAI) in the early phase of psychosis using a randomized controlled design. Eighty four patients in early phase of
a schizophrenia spectrum psychosis were randomized to receive either oral medications (n = 42) or RLAI (n = 42) over 2 years. Intent to treat
analyses were conducted on all eligible participants (N = 77) for the stabilization (maximum 18 weeks) and maintenance phases (up to week 104) on
outcome measures of symptoms, functioning, cognitive evaluations and side effects. Change over time within groups and differences between groups were
evaluated. Time to stabilization and relapse were compared across groups using survival analyses. Participants in both groups showed improvement on
Positive and Negative Symptoms Scale (PANSS) scores and Clinical Global Impression (CGI) scores as well as scores on Social Occupational Functioning
Assessment Scale (SOFAS) but there were no significant differences between groups on time to stabilization or relapse. RLAI participants showed
greater change on CGI and PANSS total and negative symptom scores during the stabilization phase while the oral medication group reached the same
level of improvement during the maintenance phase. No significant differences were observed between the two groups on any other measure. The current
study suggests RLAI is as safe, tolerable and efficacious as oral medications for those in the early phases of psychotic- illness. Thus, RLAI may be
as appropriate as oral medications early in illness but may offer no particular advantage to patients willing to take medication.
Early
Intervention in Psychiatry, 6 : 100
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Li, Y. M., Zhao, J. P., Ou, J. J., Wu, R. R.
Introduction: Although some previous studies have compared the 2 medicines, ziprasidone and olanzapine most
selected chronic patients as subjects. Therefore, the present study was designed to compare the efficacy and safety of ziprasidone vs. olanzapine in
naive first-episode schizophrenia.; Methods: 80 patients were randomly assigned to a 6-week treatment either with 80-160 mg/day of ziprasidone or 10
-20 mg/day of olanzapine. The primary efficacy measurements were the Positive and Negative Syndrome Scale and Clinical Global Impression-severity
scale scores. The second efficacy measurement was the response rate of treatment. Tolerability assessments were also performed.; Results: 79 patients
completed the trial. The average dose was 127.5 mg/day with ziprasidone and 19.1 mg/day with olanzapine. No significant differences were found
between the 2 groups in primary or secondary efficacy measurements at each visit point (all p>0.05). Body weight significantly increased with
olanzapine, and more extrapyramidal symptoms were observed with ziprasidone (all p<0.05). Both medicines were well tolerated, and no serious
adverse events were observed.; Conclusion: Ziprasidone was as effective as olanzapine in short-term treatment for first-episode schizophrenia, and
both medicines were well tolerated.; © Georg Thieme Verlag KG Stuttgart · New York.
Pharmacopsychiatry, 45(5) : 177-181
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)