Disorders - Psychosis Disorders
Girgis, Ragy R., Phillips, Michael R., Li,
Xiaodong, Li, Kejin, Jiang, Huiping, Wu, Chengjing, Duan, Naihua, Niu, Yajuan, Lieberman, Jeffrey A.
Background: Aims: Method: Results: Conclusions: The differential effects of so-called 'first- and second generation'
antipsychotic medications, when given in the first episode, on the long-term outcome of schizophrenia remain to be elucidated.We compared the 9-year
outcomes of individuals initially randomised to clozapine or chlorpromazine.One-hundred and sixty individuals with treatment-naive, first episode
schizophrenia or schizophreniform disorder in a mental health centre in Beijing, China were randomised to clozapine or chlorpromazine treatment for
up to 2 years,followed by up to an additional 7 years of naturalistic treatment. The primary outcome was remission status for individuals in each
group.Individuals in both groups spent essentially equal amounts of time in each clinical state over the follow-up time period(remission, 78%;
intermediate, 8%; relapse, 14%). There were no significant differences on other measures of illness severity. The clozapine group was more likely
than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01). There were no significant
differences between the two groups on other secondary efficacy outcomes.These findings support the comparability in effectiveness between
antipsychotic medications but with slightly greater tolerability of clozapine in the treatment of first-episode psychosis.
British Journal of Psychiatry, 199(4) : 281-288
- Year: 2011
- 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)
Kayo, M., Tassell, I., Hiroce, V. Y., Menezes, A. K., Oliveira, G. M., Iso, S., Elkis, H.
Background: Recent reviews have led to the hypothesis of
early-onset of action of antipsychotics in the treatment of schizophrenia, within the first 2 weeks of treatment. However, such data come mainly from
randomized controlled trials in chronic schizophrenia.We assessed time to response to antipsychotics in subjects with recent onset schizophrenia in
an outpatient setting. Methods: We conducted an open trial with patients with exacerbation of recent onset schizophrenia. Subjects were randomized to
first generation antipsychotic (FGA) or second generation antipsychotic (SGA) and then assessed with PANSS at baseline and weeks 2, 4, 6, 8 and 12.
We followed the IPAP algorithm (International Psychopharmacology Algorithm Project): monotherapy with an antipsychotic for 4-6 weeks, and in case of
non response, patients should undergo another trial with a second antipsychotic for 4-6 weeks. If a patient does not respond to 2 antipsychotic
trials, he/she is considered refractory and candidate to clozapine. Response was defined as 30% improvement of PANSS score in comparison with
baseline. Remission was defined according to Andreasen's et al criteria. Results: Twenty-two patients were included (SGA = 12; FGA = 10); 17
completed the 12-week period of study. Baseline PANSS was 94,16 ((plus or minus)21,98).Mean age was 30,33 years ((plus or minus)7,9) and mean time
since schizophrenia diagnosis was 1,5 year ((plus or minus)1,92).Mean duration os untreated disease was 1,6 year ((plus or minus)2,60). Completer
analyses showed an initial improvement of at least 20% of the PANSS in 50% of the subjects; 41.2% responded in the first 4-6 weeks and 58.8% did not
respond in the first 6 weeks. At 8-12 weeks, 76.5% have responded to the treatment and 23.5% have not. Nine patients achieved remission; 12 did not
respond to the first antipsychotic and switched to a second one; 9 (75%) responded to the second antipsychotic. A regression analysis using the
general linear model with time as a factor, showed a significant improvement at PANSS only at week 8. No differences were observed between FGA and
SGA. Initial improvement of at least 20% at PANSS in the first 2 weeks was not related with response or remission rates at week 12. Conclusion: In
this small open pilot trial we did not observe a rapid response to antipsychotic but a cumulative higher response rate over time. Initial improvement
did not predict better response.
Schizophrenia Bulletin, 37 : 309
- Year: 2011
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Grootens, K. P., vanVeelen, N. M. J., Peuskens, J., Sabbe, B. G. C., Thys, E., Buitelaar, J. K., Verkes, R. J., Kahn, R. S.
Introduction: Head-
to-head comparisons of antipsychotics have predominantly included patients with chronic conditions. The aim of the present study was to compare the
efficacy and tolerability of ziprasidone and olanzapine in patients with recent-onset schizophrenia. Methods: The study was an 8-week, double-blind,
parallel-group, randomized, controlled multicenter trial (NCT00145444). Seventy-six patients with schizophreniform disorder, schizophrenia or
schizoaffective disorder (diagnosis < 5 y), and a maximum lifetime antipsychotic treatment <16 weeks participated in the study. Efficacy of
ziprasidone (80–160 mg/d) and olanzapine 10–20 mg was measured using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global
Impression (CGI) Scale, the Calgary Depression Scale for Schizophrenia (CDSS), and the Heinrich Quality of Life Scale (HQLS); tolerability
assessments included laboratory assessments, body weight, and electroencephalogram. Results: Olanzapine (n = 34) and ziprasidone (n = 39) showed
equal efficacy as measured by the PANSS, CDSS, CGI, and HQLS. However, mean weight gain was significantly higher in the olanzapine group (6.8 vs 0.1
kg, P < .001). Ziprasidone was associated with decreasing levels of triglycerides, cholesterol, and transaminases, while these parameters increased
in the olanzapine group (all P values < .05). There were no significant differences in fasting glucose and prolactin levels or in cardiac or sexual
side effects. Patients on ziprasidone used biperiden for extrapyramidal side effects more frequently (P < .05). Discussion: The results of this study
indicate that ziprasidone and olanzapine have comparable therapeutic efficacy but differ in their side effect profile. However, there is a risk of a
type II error with this sample size. Clinically significant weight gain and laboratory abnormalities appear early after initiating treatment and are
more prominent with olanzapine, while more patients on ziprasidone received anticholinergic drugs to treat extrapyramidal symptoms. (PsycINFO
Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Schizophrenia Bulletin, 37(Suppl 2) : 352-361
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Larrison, Abigail L., Babin, Shelly L., Xing, Yuan, Patel, Saumil S., Wassef, Adel A., Sereno, Anne B.
Objective: Methods: Results: Conclusions: Valproic acid (VPA) has been suggested as a potential adjunct therapy in schizophrenia for the
treatment of clinical symptoms and cognitive deficits. Here, we investigate the effects of VPA on clinical symptoms and saccadic eye movements while
controlling for multiple medication effects.Remitted and first-episode schizophrenia patients taking haloperidol were given adjunct VPA for
approximately 2 weeks and tested using a measure of clinical symptoms (Positive and Negative Syndrome Scale) and saccadic eye movement tasks over
three testing periods. The effects of VPA were compared with schizophrenia patients medicated with equivalent doses of haloperidol alone (HAL group)
and normal controls.Schizophrenia patients had higher error rates on the antisaccade task (AS task) compared with normal controls. Adjunct VPA did
not affect AS task error rates but was associated with an increase in response times for both saccade and AS tasks, with a significantly greater and
dose-dependent increase in response times for the AS task. There were no differences in clinical improvement between VPA and HAL schizophrenia
patient groups when controlling for haloperidol medication state.These results suggest that adjuvant VPA therapy results in both sensorimotor and
cognitive slowing but does not either help or further impair inhibitory control in schizophrenia, as measured by the elevated AS task errors.
\rCopyright © 2011 John Wiley & Sons, Ltd.
Human
Psychopharmacology, 26(7) : 517-525
- Year: 2011
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only), Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Anticonvulsants/mood stabilisers (excl. lithium)
McFarlane, W. R., Cook, W. L., Woodberry, K. A.
Background: This report describes a randomized clinical trial that compared (a)
family-aided assertive community treatment (FACT) and psychotropic medication to (b) medication, family education and family crisis intervention
(Comparison)in reducing symptom levels, improving functioning, and preventing the onset of psychosis in young people at clinical high risk (CHR) for
psychosis. Methods: CHR subjects were identified via community education about attenuated psychotic symptoms, targeting school counselors,
pediatricians, and mental health professionals in a catchment of 340 000 people. Community-referred young people aged 12-35 were assessed using the
Structured Interview for Prodromal Syndrome (McGlashan, et al., 2002). The test treatment was a comprehensive, prodrome- specific combination of
psychoeducational multifamily group (PMFG), supported education/employment and assertive community treatment. Psychotropic medication was prescribed
by symptom indication. Patients received independent assessments at baseline and 24 months, blinded to experimental condition. The outcomes were
conversion to psychosis, clinical symptoms and psychosocial functioning. Results: 100 CHR young people (53 males, 47 females, mean age 16.3 years)
were identified and randomly assigned to FACT vs. Comparison conditions. By 24 months, conversion to psychosis occurred in 8% of the FACT cohort and
16% in the comparison condition; however, the difference was not statistically significant (P = .22). Positive, negative, disorganized and general
symptoms all improved significantly but equally, as did functioning. Mean GAF was 40.2 and 36.4 at baseline and 55.5 and 52.7 at 24 months,
respectively, (pre-post, P < .01), but treatment differences were non-significant. 94% and 90% were functioning in expected roles (n.s.). Post-hoc
deconstruction analysis found that, controlling for other significant treatment components, PMFG intervention accounted for functional outcomes (B =
0.417, t(56.85)=3.29, P = .002), while antipsychotic and antidepressant medication did not. Conclusion: Outcomes for psychosis onset, symptoms and
functioning were equally positive in the 2 test conditions. The PMFG component was individually associated with functional benefit. Less intensive
interventions may be effective in the treatment of some CHR youth.
Schizophrenia
Bulletin, 37 : 314
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Marin Mayor, M., Martinez Martin, N., Verdura Vizcaino, E., Codesal Julian, R. A.
Introduction: Childhood or Early Onset
Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant,
associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice,
atypical agents have become the treatment of choice in patients with EOS. Aims: To review the different pharmacological strategies, in which an
atypical antipsychotic was used in the management of EOS in childhood and adolescence. Methods: We conducted a literature search of articles related
to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database. Results: Several atypical
antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic
symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics,
it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of
extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults. Conclusions:
Antipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics
over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this
problem and be careful when monitoring this type of treatment.
European Psychiatry, 26 :
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Marshall, Max, Rathbone, John
Background: Objectives: Search Strategy: Selection Criteria: Data Collection and Analysis: Main Results:
Authors' Conclusions: Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the
early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from
standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or
modified, specifically for use with people at an early stage of the illness).Early detection and phase-specific treatment may both be offered as
supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a
therapeutic approach in America, Europe and Australasia.To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c)
specialised early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis.We searched the Cochrane
Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews and contacted experts in the
field.We included all randomised controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms, or to
improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific
treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials.We reliably
selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals
(CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT).Studies were
diverse, mostly small, undertaken by pioneering researchers and with many methodological limitations (18 RCTs, total n=1808). Mostly, meta-analyses
were inappropriate. For the six studies addressing prevention of psychosis for people with prodromal symptoms, olanzapine seemed of little benefit
(n=60, 1 RCT, RR conversion to psychosis 0.58 CI 0.3 to 1.2), and cognitive behavioural therapy (CBT) equally so (n=60, 1 RCT, RR conversion to
psychosis 0.50 CI 0.2 to 1.7). A risperidone plus CBT plus specialised team did have benefit over specialist team alone at six months (n=59, 1 RCT,
RR conversion to psychosis 0.27 CI 0.1 to 0.9, NNT 4 CI 2 to 20), but this was not seen by 12 months (n=59, 1 RCT, RR 0.54 CI 0.2 to 1.3). Omega 3
fatty acids (EPA) had advantage over placebo (n=76, 1 RCT, RR transition to psychosis 0.13 CI 0.02 to 1.0, NNT 6 CI 5 to 96). We know of no
replications of this finding.The remaining trials aimed to improve outcome in first-episode psychosis. Phase-specific CBT for suicidality seemed to
have little effect, but the single study was small (n=56, 1 RCT, RR suicide 0.81 CI 0.05 to 12.26). Family therapy plus a specialised team in the
Netherlands did not clearly affect relapse (n=76, RR 1.05 CI 0.4 to 3.0), but without the specialised team in China it may (n=83, 1 RCT, RR admitted
to hospital 0.28 CI 0.1 to 0.6, NNT 3 CI 2 to 6). The largest and highest quality study compared specialised team with standard care. Leaving the
study early was reduced (n=547, 1 RCT, RR 0.59 CI 0.4 to 0.8, NNT 9 CI 6 to 18) and compliance with treatment improved (n=507, RR stopped treatment
0.20 CI 0.1 to 0.4, NNT 9 CI 8 to 12). The mean number of days spent in hospital at one year were not significantly different (n=507, WMD, -1.39 CI
-2.8 to 0.1), neither were data for 'Not hospitalised' by five years (n=547, RR 1.05 CI 0.90 to 1.2). There were no significant differences in
numbers 'not living independently' by one year (n=507, RR 0.55 CI 0.3 to 1.2). At five years significantly fewer participants in the treatment
group were 'not living independently' (n=547, RR 0 42 CI 0.21 to 0.8, NNT 19 CI 14 to 62). When phase-specific treatment (CBT) was compared with
befriending no significant differences emerged in the number of participants being hospitalised over the 12 months (n=62, 1 RCT, RR 1.08 CI 0.59 to
1.99).Phase-specific treatment E-EPA oils suggested no benefit (n=80, 1 RCT, RR no response 0.90 CI 0.6 to 1.4) as did phase-specific treatment brief
intervention (n=106, 1 RCT, RR admission 0.86 CI 0.4 to 1.7). Phase-specific ACE found no benefit but participants given vocational intervention were
more likely to be employed (n=41, 1 RCT, RR 0.39 CI 0.21 to 0.7, NNT 2 CI 2 to 4). Phase-specific cannabis and psychosis therapy did not show benefit
(n=47, RR cannabis use 1.30 CI 0.8 to 2.2) and crisis assessment did not reduce hospitalisation (n=98, RR 0.85 CI 0.6 to 1.3). Weight was unaffected
by early behavioural intervention.There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be
helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there
is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but
again, this needs replicating with larger and longer trials.
Cochrane Database of
Systematic Reviews, (6) : CD004718
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Masi, Gabriele, Liboni, Francesca
Schizophrenia in subjects younger than 13
years is defined as very-early-onset schizophrenia, and its prevalence is estimated at 1 in 10‚Äâ000, while early-onset schizophrenia occurs between
13 and 17 years, and its prevalence is about 0.5%. Only a minority of youths show a complete recovery, and the majority of patients present a
moderate to severe impairment at the outset. Treatment of schizophrenia always needs both pharmacological and nonpharmacological interventions.
Nonpharmacological interventions include counselling for the patients and the family, psychological support, behavioural treatments, social and
cognitive rehabilitation, assistance in social and scholastic activities, enhancement of social skills and family support. Pharmacological treatment
is necessary for remission and control of positive and negative symptoms. Furthermore, proper pharmacotherapy can greatly increase the efficacy of
psychosocial interventions. Available literature on pharmacotherapy in children and adolescents with schizophrenia is critically reviewed, including
both first- and second-generation antipsychotics. Data on efficacy and safety are reported for all the marketed atypical antipsychotics (clozapine,
risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole), based on randomized, placebo-controlled studies and the most relevant open-label
or naturalistic studies. Adverse effects of concern are closely analysed, such as extrapyramidal side effects and tardive dyskinesia, metabolic
syndrome (including hyperglycaemia and hyperlipidaemia), weight gain, hyperprolactinaemia, hepatotoxicity, seizures, and cardiovascular and
haematological adverse effects. Finally, practical guidelines for the management of specific clinical situations are provided: the first phases and
the long-term approach to pharmacotherapy, the treatment refractoriness and the use of clozapine in youths, the agitated adolescent and the treatment
of negative symptoms and of affective co-morbidity. Current experience indicates that, based on low rates of remission, low effect size of
medications and frequent adverse effects, mainly metabolic syndrome, further research is warranted, with both randomized, placebo-controlled studies
and long-term, naturalistic follow-up of large samples of patients with different age ranges.
Drugs, 71(2) : 179-208
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder), Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Kishimoto, T., Agarwal, V., Kishi, T., Leucht, S., Kane, J. M., Correll, C. U.
Few controlled trials compared second-generation antipsychotics (SGAs)
with first-generation antipsychotics (FGAs) regarding relapse prevention in schizophrenia. We conducted a systematic review/meta-analysis of
randomized trials, lasting (greater-than or equal to)6 months comparing SGAs with FGAs in schizophrenia. Primary outcome was study-defined relapse;
secondary outcomes included relapse at 3, 6 and 12 months; treatment failure; hospitalization; and dropout owing to any cause, non-adherence and
intolerability. Pooled relative risk (RR) ((plus or minus)95% confidence intervals (CIs)) was calculated using random-effects model, with numbers-
needed-to-treat (NNT) calculations where appropriate. Across 23 studies (n=4504, mean duration=61.9(plus or minus)22.4 weeks), none of the individual
SGAs outperformed FGAs (mainly haloperidol) regarding study-defined relapse, except for isolated, single trial-based superiority, and except for
risperidone's superiority at 3 and 6 months when requiring (greater-than or equal to)3 trials. Grouped together, however, SGAs prevented relapse
more than FGAs (29.0 versus 37.5%, RR=0.80, CI: 0.70-0.91, P=0.0007, I2=37%; NNT=17, CI: 10-50, P=0.003). SGAs were also superior regarding relapse
at 3, 6 and 12 months (P=0.04, P<0.0001, P=0.0001), treatment failure (P=0.003) and hospitalization (P=0.004). SGAs showed trend-level superiority
for dropout owing to intolerability (P=0.05). Superiority of SGAs regarding relapse was modest (NNT=17), but confirmed in double-blind trials, first-
and multi-episode patients, using preferentially or exclusively raw or estimated relapse rates, and for different haloperidol equivalent comparator
doses. There was no significant heterogeneity or publication bias. The relevance of the somewhat greater efficacy of SGAs over FGAs on several key
outcomes depends on whether SGAs form a meaningful group and whether mid- or low-potency FGAs differ from haloperidol. Regardless, treatment
selection needs to be individualized considering patient- and medication-related factors.Molecular Psychiatry advance online publication, 29 November
2011; doi:10.1038/mp.2011.143.
Molecular
Psychiatry, :
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Scoriels, Linda, Barnett, Jennifer H., Murray, Graham K., Cherukuru, Srinivasarao, Fielding, Mark, Cheng, Frances, Lennox, Belinda R., Sahakian, Barbara J., Jones, Peter
B.
Background: Emotional impairments are important
determinants of functional outcome in psychosis, and current treatments are not particularly effective. Modafinil is a wake-promoting drug that has
been shown to improve emotion discrimination in healthy individuals and attention and executive function in schizophrenia. We aimed to establish
whether modafinil might have a role in the adjuvant treatment of emotional impairments in the first episode of psychosis, when therapeutic endeavor
is arguably most vital. Methods: Forty patients with a first episode of psychosis participated in a randomized, double-blind, placebo-controlled
crossover design study testing the effects of a single dose of 200 mg modafinil on neuropsychological performance. Emotional functions were evaluated
with the emotional face recognition test, the affective go-no go task, and the reward and punishment learning test. Visual analogue scales were used
throughout the study to assess subjective mood changes. Results: Modafinil significantly improved the recognition of sad facial expressions (z =
2.98, p = .003). In contrast, there was no effect of modafinil on subjective mood ratings, on tasks measuring emotional sensitivity to reward or
punishment, or on interference of emotional valence on cognitive function, as measured by the affective go-no go task. Conclusions: Modafinil
improves the analysis of emotional face expressions. This might enhance social function in people with a first episode of psychosis. (PsycINFO
Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Biological Psychiatry, 69(5) : 457-
464
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Zhang, J., Gallego, J., Robinson, D., Malhotra, A., Kane, J., Correll, C.
Background: Although early treatment choice in first episode schizophrenia is considered important, no meta-analysis has compared
individual first-generation antipsychotics (FGAs) with second-generation antipsychotics (SGAs). Methods: Meta-analysis of randomized, head-to-head
trials comparing SGAs with FGAs in first episode schizophrenia. Primary outcomes were total psychopathology change, response rate and all-cause
discontinuation. Secondary outcomes included specificcause discontinuation, psychopathology ratings and adverse effects. Results: Pooling data by
antipsychotic class across 13 trials (n=2509), SGAs were not different from FGAs regarding total psychopathology change, response rates, positive
symptoms, Clinical Global Impressions, patient's choice discontinuation, long-term remission, and metabolic changes. Conversely, SGAs significantly
outperformed FGAs regarding negative symptoms, depression, global cognition, lower discontinuation due to any cause, inefficacy and intolerability,
and less EPS, akathisia, use of anticholinergics and benzodiazepines, being associated with significantly greater weight gain (p values: <0.05-0.01).
Concerning individual SGA comparisons with an FGA, amisulpride and olanzapine outperformed FGAs in 8 and 9 out of 13 efficacy outcomes, respectively,
risperidone in 4, quetiapine in 3, and clozapine and ziprasidone in 1, each. Weight gain occurred significantly more with olanzapine, clozapine and
risperidone. Olanzapine caused significantly greater cholesterol increase, whereas amisulpride and ziprasidone were associated with lower
triglycerides and glucose changes, respectively (p values: <0.05-0.01). Discussion: Amisulpride and olanzapine and, to a lesser degree, risperidone
and quetiapine were superior to FGAs in first episode schizophrenia, but weight and metabolic problems were also greater with olanzapine. Clinicians
need to individualize treatment decisions, weighing different aspects of efficacy, tolerability, availability and cost.\r\r* ABSTRACT ONLY*
Neuropsychopharmacology, 36 : S175
- Year: 2011
- 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)
Lloyd-Evans, Brynmor, Crosby, Michelle, Stockton, Sarah, Pilling, Stephen, Hobbs, Lorna, Hinton, Mark, Johnson, Sonia
Background: Long duration of untreated psychosis (DUP) is common and
associated with poor outcomes. Strategies to enhance early detection of first-episode psychosis have been advocated. Aims: To evaluate initiatives
for early detection of psychosis. Method: Systematic review of available evidence on the effectiveness of early detection initiatives to reduce the
DUP. Results: The review included 11 studies which evaluated 8 early detection initiatives. Evidence suggests that general practitioner education
campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases. Evidence for multifocus
initiatives is mixed: intensive campaigns targeting the general public as well as relevant professionals may be needed. No studies evaluated
initiatives targeting young people or professionals from non-health organisations. Conclusions: How early detection can be achieved is not clear.
Evidence is most promising for intensive public awareness campaigns: these require organisation and resourcing at a regional or national level. More
good-quality studies are needed to address gaps in knowledge. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
British Journal of Psychiatry, 198(4) : 256
-263
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement