Disorders - Psychosis Disorders
Lecomte, T., Leclerc, C., Wykes, T.
Our team recently conducted a randomized controlled trial
comparing group cognitive behavior therapy for psychosis (CBTp) to group social skills training for symptom management and a wait-list control group,
for early psychosis. The results at post-therapy and six months provided considerable empirical support for the efficacy of the group CBTp. The
results of the one-year follow-up are described here. Given the high attrition rates, mostly in the comparison and control conditions, imputations
were not possible, so that only the results of those having completed more than 50% of the group CBTp are presented. Significant improvements at 12
months were found for social support and insight. Negative symptoms remained low, whereas positive symptoms went back to pre-therapy levels.
Challenges regarding attrition with this clientele are discussed.
International
Journal of Group Psychotherapy, 62(2) : 309-321
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Skills training
Leweke, F. M., Piomelli,
D., Pahlisch, F., Muhl, D., Gerth, C. W., Hoyer,
C., Klosterkotter, J., Hellmich, M., Koethe, D.
Cannabidiol is a component of marijuana that does not activate cannabinoid receptors, but moderately inhibits the
degradation of the endocannabinoid anandamide. We previously reported that an elevation of anandamide levels in cerebrospinal fluid inversely
correlated to psychotic symptoms. Furthermore, enhanced anandamide signaling let to a lower transition rate from initial prodromal states into frank
psychosis as well as postponed transition. In our translational approach, we performed a double-blind, randomized clinical trial of cannabidiol vs
amisulpride, a potent antipsychotic, in acute schizophrenia to evaluate the clinical relevance of our initial findings. Either treatment was safe and
led to significant clinical improvement, but cannabidiol displayed a markedly superior side-effect profile. Moreover, cannabidiol treatment was
accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement. The results suggest
that inhibition of anandamide deactivation may contribute to the antipsychotic effects of cannabidiol potentially representing a completely new
mechanism in the treatment of schizophrenia.;
Translational Psychiatry, 2 : e94-
e94
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Gleeson, J. F. M., Cotton, S. M., Alvarez-Jiminez,
M., Wade, D., Crisp, K., Newman,
B., Spiliotacopoulos, D., Lederman, R., McGorry, P. D.
The EPISODE II study was designed to evaluate the effectiveness of a combined
individual and family-based psychosocial intervention for the purpose of preventing relapse in young first-episode patients who have reached
remission on positive psychotic symptoms. Patient participants were recruited from the Early Psychosis Prevention and Intervention Centre and Barwon
Health, Victoria Australia and randomized either to the relapse prevention therapy plus specialist first-episode treatment or to specialist treatment
alone. Of the 81 patients who consented to be randomized, 63 of their carers participated in the study. Carers were followed up at 6-monthly interval
for 30 months on measures of psychological morbidity and stress related to caregiving. The primary hypothesis was that, compared to family members
receiving treatment as usual, family participants who received relapse prevention therapy would have signifi- cantly improved appraisals of stressors
related to caregiving. Secondary hypotheses were that RPT would be associated with reduced expressed emotion and improved psychological distress.
Outcome data showed that carers who received the relapse prevention therapy sustained significant improvements in stress related to caregiving over
the 30 months follow-up. Time effects were evident for emotional over-involvement and for aspects of the appraisal of care giving. There were no
significant effects for psychological morbidity. Despite the promising findings from this RCT, problems with sustaining specialist family
interventions within mental health services are wide spread. In order to avoid this problem, the potential benefits of adapting the EPISODE II family
intervention utilizing the 'moderated online social therapy (MOST)' model will be discussed.
Early Intervention in Psychiatry, 6 : 19
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Gleeson, J. F. M., Chanen, A., Cotton, S. M., Pearce, T., Newman, B., McCutcheon, L.
Aim: First-episode psychosis and borderline
personality disorder are severe mental disorders that have their onset in youth. Their co-occurrence is clinically well recognized, is associated
with significant risks and is complex to treat. Yet, there is no published specific intervention for this problem. This study reports a pilot
randomized controlled trial comparing combined specialist first-episode treatment plus specialist early intervention for borderline personality,
entitled Helping Young People Early, with specialist first-episode treatment alone. We aimed to evaluate the safety and feasibility of adding early
intervention for borderline personality. Methods: The study investigated the safety of specialist first-episode treatment plus specialist early
intervention for borderline personality in relation to deterioration in psychosis, aggression, self-harm and suicidality, and feasibility in relation
to the completion of therapy phases. Sixteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision
(DSM-IV-TR) criteria for first-episode psychosis and borderline personality (four or more DSM-IV criteria) were randomized either to specialist
first-episode treatment alone or specialist first-episode treatment plus specialist early intervention for borderline personality and were followed
up at the end of treatment and 6months later. Results: The results showed that it was feasible to recruit and assess a high risk and complex group of
patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality
was an acceptable and safe treatment. Conclusion: A larger-scale randomized controlled trial of early intervention for borderline personality for
young first-episode psychosis patients with co-occurring full or subsyndromal borderline personality is warranted. (copyright) 2011 Blackwell
Publishing Asia Pty Ltd.
Early Intervention in Psychiatry, 6(1) : 21-
29
- Year: 2012
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive analytic therapy (CAT), Case management
Gallego, J. A., Robinson, D. G., John, M., Guveneck-Cokol, P. E., Greenberg, J.
L., Kane, J.
Background: Antipsychotic maintenance treatment is critical to prevent the re-emergence of psychotic symptoms after the successful
treatment of a first episode of schizophrenia. What level of adherence (and therefore actual dose ingested) is required to prevent the return of
symptoms? We tested the hypothesis that patients who are partially adherent compared to those who were fully adherent to maintenance antipsychotic
treatment would have greater levels of positive symptoms and also shorter time to first recurrence of positive symptoms. Methods: The sample
consisted of 47 first-episode schizophreniaspectrum disorder patients who fulfilled stringent response criteria (a rating of mild or less on the
positive symptom items on the Schedule for Affective Disorders and Schizophrenia Change version with psychosis and disorganization items [SADS C +
PD] for two consecutive visits) within 16 weeks of starting randomized, controlled treatment with flexible-dosed olanzapine or risperidone. Subjects
were assessed weekly, then biweekly and finally monthly for 3 years. For this analysis, follow-up data were censored at the time that subjects left
their randomly assigned treatment for any reason. Adherence was determined based on data obtained from patients, family members and clinicians
treating subjects. We defined the adherence reference dose as the antipsychotic dose at the time subjects first achieved response criteria. A mean
adherence level was determined for each subject based on all weekly adherence ratings; this was converted to a percentage of the adherence reference
dose. Based on mean adherence levels, subjects were classified as being fully adherent (>80% adherence reference dose), partially adherent (20-80%)
or non-adherent ((less-than or equal to)20%). Survival analysis compared time to reemergence of positive symptoms (i.e. a rating of moderate or
greater on one or more SADS C + PD psychosis items) between groups. Mixed model analyses were conducted to determine the longitudinal effect of
partial adherence on repeated measures of positive symptoms, using a composite score of seven positive symptoms items (severity of hallucinations,
severity of delusions, impaired understandability, derailment, illogical thinking, bizarre behavior and grandiosity) from the SADS C + PD scale.
Results: The subjects were young (mean age of 22.7 years (SD=4.4)) and mostly male (n=32, 68%). Twenty (42.6%) patients had responded to olanzapine
and 27 (57.4%) to risperidone. Mean dose at the time of response was 7.9 mg (SD: 3.7) with olanzapine and) and 2.9 mg (SD: 1.2) with risperidone.
Analysis by adherence groups showed that 15 patients were in the 20-80% category and 32 patients were in the >80% category. No subjects were in the
(less-than or equal to)20% category. Overall, 25 (53.2%) patients experienced a re-emergence of positive symptoms while on their original assigned
antipsychotic. Fifteen of 31 (48.4%) fully adherent subjects and 10 of 16 (62.5%) partially adherent subjects experienced a recurrence of positive
symptoms. Time to recurrence of positive symptoms did not differ between fully adherent and partially adherent groups (log rank test, x2=0.44,
p=0.5). However, the mixed model analysis revealed a significant (P=0.0046) increase in positive symptom scores over time in those subjects who were
partially adherent to treatment, contrary to the effect observed in fully adherent subjects, in whom positive symptom scores decreased or did not
change over time. Conclusions: We found that first-episode schizophrenia spectrum disorder patients who were partially adherent to their maintenance
antipsychotic medication had greater levels of positive symptoms over time compared to patients who are fully adherent to their maintenance
medication. This is consistent with a prior study (Subotnik et al., 2011) that also examined the effect of partial adherence in a first episode
schizophrenia sample. Our study design employed a low dose strategy for initial treatment. Our data suggest that further dose reduction during
maintenance treatmen is not advisable.
Neuropsychopharmacology, 38 : S324-
S325
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Guo, Xiaofeng, Zhang, Zhanchou, , Zhai, Jinguo, Fang, Maosheng, Hu, Maorong, Wu, Renrong, Liu, Zhening, Zhao, Jingping
Background: The relative effects of the atypical antipsychotic drugs and conventional agent on quality
of life and psychosocial functioning in patients with early-stage schizophrenia is still uncertain because of an insufficient number of studies
examining this issue.; Methods: In a 12 months open-label, prospective observational, multicenter study, 1029 subjects with schizophrenia or
schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine, sulpiride, clozapine, risperidone, olanzapine, quetiapine or
aripiprazole. The health-related quality of life and psychosocial functioning were assessed using Medical Outcomes Study 36-Item Short Form Health
Survey (SF-36), the Global Assessment Scale (GAS) and the Activities of Daily Living Scale (ADL), respectively.; Results: At 12 months, treatment
resulted in significant improvements in all 8 domain scores of SF-36, GAS and ADL score (all P-values< .001). However, only olanzapine and
quetiapine groups demonstrated greater improvement in the role-psychical score of SF-36 and GAS score than did the chlorpromazine group (all P-values
= .002).; Conclusions: All antipsychotics may improve quality of life and social function in patients with early-stage schizophrenia, but further
studies are needed to determine whether atypical antipsychotics are superior to conventional agents.; Copyright © 2012 Elsevier Inc. All rights
reserved.
Comprehensive Psychiatry, 53(7) : 1006-
1012
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Hegde, S., Rao, S. L., Raguram, A., Gangadhar, B. N.
Objective: We examined the effectiveness of a 2-month-long home-based cognitive retraining program together with treatment as
usual (TAU; psychoeducation and drug therapy) on neuropsychological functions, psychopathology, and global functioning in patients with first episode
schizophrenia (FES) as well as on psychological health and perception of level of family distress in their caregivers. Materials and Methods: Forty-
five FES patients were randomly assigned to either treatment group receiving home-based cognitive retraining along with TAU (n=22) or to control
group receiving TAU alone (n=23). Patients and caregivers received psychoeducation. Patients and one of their caregivers were assessed for the above
parameters at baseline, post-assessment (2 months) and at 6-months follow-up assessment. Results: Of the 45 patients recruited, 12 in the treatment
group and 11 in the control group completed post-intervention and follow-up assessments. Addition of home-based cognitive retraining along with TAU
led to significant improvement in neuropsychological functions of divided attention, concept formation and set-shifting ability, and planning. Effect
sizes were large, although the sample size was small. Conclusions: Home-based cognitive retraining program has shown promise. However, further
studies examining this program on a larger cohort with rigorous design involving independent raters are suggested.
Indian Journal of Psychiatry, 54(1) : 15-
22
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Jaugey, L., Urben, S., Pihet, S., Halfon, O., Holzer, L.
Background: The purpose of the present study was to investigate the short- and long-term effectiveness of a computer-assisted
cognitive remediation (CACR) program in adolescents with psychosis or at high risk. Methods: 32 adolescents participated in a blinded 8-week
randomized controlled trial of CACR treatment compared to computer games (CG). Clinical and neuropsychological evaluations were undertaken at
baseline, at the end of the program and 4 months after finishing the study. Results: At short-term (N=28), results indicated that visuospatial
abilities (Repeatable Battery for the Assessment of Neuropsychological Status, RBANS; p = .005) improved significantly more in the CACR group
compared to the CG group. Other cognitive functions, psychotic symptoms and psychosocial functioning improved significantly, but at similar rates, in
the two groups. At long-term (N=22), cognitive abilities did not demonstrated any amelioration in the control group while, in the CACR group,
significant improvements in inhibition (Stroop; p = .040) and reasoning (Block Design Test; p = .005) were observed. In addition, symptom's severity
decreased significantly in the control group (p = .046) and marginally in the CACR group (p = .088). Conclusions: CACR can be successfully
administered in this population. CACR proved to be effective over and above CG for the most intensively trained cognitive ability. Finally, on the
long-term, enhanced cognitive abilities (reasoning and inhibition abilities), which are necessary to execute higher-order goals or to adapt behavior
to the ever-changing environment, were observed in adolescents benefiting from a CACR.
Biological Psychiatry, 71(8) : 84S
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), 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)
Crespo-Facorro, Benedicto, Perez-Iglesias, Rocío, Mata,
Ignacio, Martínez-Garcia, Obdulia, Ortiz, Victor, Pelayo-Teran, Jose Maria, Valdizan, Elsa, Vazquez-
Barquero, José Luis
Rationale: To enhance the effectiveness of antipsychotics in first-episode psychosis is crucial in order to achieve the
most favourable prognosis. Difference in effectiveness between antipsychotics is still under debate.; Objective: The purpose of this study is to
determine the long-term (3-year) effectiveness and efficacy of haloperidol, risperidone and olanzapine in first-episode schizophrenia-spectrum
disorders.; Method: This is a prospective, randomized, open-label study. Data for the present investigation were obtained from a large epidemiologic
and 3-year longitudinal intervention programme of first-episode psychosis. One hundred seventy-four patients were randomly assigned to haloperidol
(N?=?56), olanzapine (N?=?55), or risperidone (N?=?63) and followed up for 3 years. The primary effectiveness measure was all-cause of treatment
discontinuation. In addition, an analysis based on per-protocol populations was conducted in the analysis for clinical efficacy.; Results: The
treatment discontinuation rate for any cause differed significantly between treatment groups (? (2)?=?10.752; p?=?0.005), with a higher rate in
haloperidol than in risperidone and olanzapine. The difference in the discontinuation rate between risperidone and olanzapine showed a tendency
towards significance (? (2)?=?3.022; p?=?0.082). There was a significant difference in the mean time to all-cause discontinuation between groups
(log-rank ? ( 2 )?=?12.657;df?=?2; p?=?0.002). There were no significant advantages to any of the three treatments in reducing the psychopathology
severity.; Conclusions: After 3 years of treatment, a lower effectiveness was observed in haloperidol compared to second-generation antipsychotics
(SGAs). The use of SGAs for the treatment of early phases of nonaffective psychosis may enhance the effectiveness of antipsychotics.;
Psychopharmacology, 219(1) : 225-
233
- Year: 2012
- 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)
Faber, G., Smid, H. G. O. M., VanGool, A. R., Wiersma, D., VanDenBosch, R. J.
Objective: To assess the effects of second generation antipsychotics on neurocognitive function in patients with stable remission of
first episode psychosis.; Methods: Fifty-three patients with first onset psychosis in the schizophrenia spectrum entered a randomised controlled
trial of guided discontinuation (GD) versus maintenance treatment (MT) with second generation antipsychotics. A comprehensive neurocognitive test
battery was administered at the time of remission and shortly after dose reduction or discontinuation (GD-group) or at the same time in the MT-
group.; Results: With the exception of negative symptoms, PANSS scores decreased over time and neurocognition improved significantly on most tests in
both groups. The GD-group, however, improved significantly more than the MT-group on three neurocognitive measures in the domain of speed of
processing.; Conclusion: These data suggest that, in first episode patients, dose reduction or discontinuation of second generation antipsychotics
after stable remission is achieved, might improve neurocognitive function more than continuing second generation antipsychotics, suggesting a
negative role for second generation antipsychotics, specifically in the domain of speed of processing.; Copyright © 2011 Elsevier Masson SAS. All
rights reserved.
European Psychiatry, 27(4) : 275-
280
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Medication dose
reduction/discontinuation, Service Delivery & Improvement, Other service delivery and improvement
interventions
Bucur, M., Whale, R.
Evidence for efficacy of interventions in patients identified as 'at risk of
psychosis' is developing. This review explores overall effect of such interventions. Search strategy: Electronic databases and reference lists.
Study selection: Randomised controlled trials of interventions for patients with Yung (1996) defined 'at risk mental state' and recording switch to
operationally defined psychosis. Data extraction: Dichotomous rates of transition to psychosis at 6 and 12 months following treatment onset. Results:
Six published studies met inclusion criteria: McGorry 2002 (low dose risperidone + CBT + needs based intervention for 6 months vs needs based
intervention alone), Morrison 2004 (CBT+monitoring for 6 months vs monitoring alone), McGlashan 2006 (olanzapine for 1 year vs placebo), Amminger
2010 (omega 3 fatty acids for 12 weeks vs placebo), Yung 2010 (cognitive therapy + risperidone vs. cognitive therapy + placebo vs supportive therapy
+ placebo; all over 12 months), Addington 2011 (cognitive behavioural therapy vs supportive therapy for 6 months). The pooled Peto fixed effect odds
ratios for dichotomous switch to psychosis at 6 and 12 months were 0.24 (95% CI 0.13-0.43) and 0.33 (0.19-0.56) respectively. Corresponding NNTs were
5 and 6. Study heterogeneity was remarkably low (I2 = 0% on both occasions). Interventions for 'at risk mental state' appear more effective than
control in reducing switch to psychosis at both 6 and 12 months later. Diversely different interventions have remarkably similar beneficial effects
vs control which warrants further exploration. Further trial results are awaited to clarify this finding and examine between treatment
differences.
Early Intervention in
Psychiatry, 6 : 123
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Barlati, S., dePeri, L., Deste, G., Fusar-Poli, P., Vita, A.
Background: The aim of cognitive remediation is to target the
cognitive impairments of patients with psychosis, including attentional deficits, memory problems, and limitations in planning and problem solving.
It is hoped that by addressing these deficits, patients will be more able to take advantage of other interventions and will be more able to function
in social and other domains. Many results in controlled trials of cognitive remediation in adult patients affected by schizophrenia have demonstrated
its effectiveness on different cognitive domains and on patient's functioning. Some researchers speculate that deficits in cognition are more
amenable to remediation during earlier phases of illness than when chronicity has developed. For these reasons cognitive rehabilitation should be a
key component of early intervention programs, seeking to produce durable functional changes in the early course of schizophrenia. Although there is
strong evidence that cognitive remediation is effective in adult schizophrenia, there is little evidence about its efficacy and long-term generalized
effectiveness in the early course of the disease, and its possible application in the prodromal phase of the disease. Purpose Of Review: The aim of
this paper is to review the available literature on cognitive remediation in the prodromal phase and in the early course of schizophrenia. This
review summarizes especially findings of cognitive changes induced in the early course or in the prodromal phases of schizophrenia by different
remediation methods. Controlled studies of cognitive training are discussed in more detail. Conclusion: Few studies on the effects of cognitive
training programs have been conducted in first episode or in early schizophrenia and only one study has been conducted in the prodromal phase of the
disease. Although preliminary positive results have been achieved, more empirical research is needed to confirm the efficacy of cognitive remediation
in the early course of schizophrenia, and future studies should address the issue of the usefulness of cognitive remediation in the prodromes of
psychosis. (copyright) 2012 Bentham Science Publishers.
Current Pharmaceutical Design, 18(4) : 534-541
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy