Disorders - Psychosis Disorders
Keshavan, M., Eack,
S. M.
Background: Schizophrenia is highly disabling, and much of the disability is related to cognitive
impairments. Cognitive remediation is effective in improving cognition in patients with schizophrenia but the underlying neurobiologic changes that
occur during these treatments and support cognitive improvement are not well known. Methods: We examined differential changes in brain morphology in
early course schizophrenia patients during cognitive enhancement therapy vs. supportive therapy. In a randomized controlled trial involving 53
symptomatically stable but cognitively disabled outpatients in the early course of schizophrenia or schizoaffective disorder. Results: Patients who
received cognitive enhancement therapy demonstrated significantly greater preservation of gray matter volume over 2 years in the left hippocampus,
parahippocampal gyrus, and fusiform gyrus, and significantly greater gray matter increases in the left amygdala compared with those who received
enriched supportive therapy. Less gray matter loss in the left parahippocampal and fusiform gyrus and greater gray matter increases in the left
amygdala were significantly related to improved cognition and mediated the beneficial cognitive effects of cognitive enhancement therapy. Conclusion:
Cognitive enhancement therapy may offer neuroprotective effects in early schizophrenia that are associated with improved long-term cognitive
outcomes.
Schizophrenia
Bulletin, 37 : 310
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Morrens, M., Dewilde, B., Sabbe, B., Dom, G., DeCuyper, R., Moggi, F.
Background: About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and
functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two
conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues,
among which are heterogeneous patient samples. Methods: In this comparative study, two well-described patient samples diagnosed with schizophrenia
and co-morbid substance abuse disorders either received an integrated treatment (IDDT) or treatment as usual (TAU). Results: Patients in the IDDT
condition showed significant reductions in illicit drug and alcohol use, improvements on all psychiatric symptom domains, reported higher quality of
life and improved on social and community functioning. In contrast, patients' improvements in the TAU group were moderate and limited to a few
substance use and psychiatric outcomes. The TAU group had significantly higher dropout rates 6 and 12 months after baseline, suggesting that the IDDT
programme was more successful in committing patients. Conclusions: Our results suggest that an integrated approach to schizophrenic patients and co-
morbid substance use disorders is superior to standard treatment and may be considered as the treatment of choice for this patient group. Copyright
(copyright) 2011 S. Karger AG, Basel.
European Addiction Research, 17(3) : 154-
163
- Year: 2011
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Case management, Other service delivery and improvement
interventions
Ojeda, N., Pena, J., Bengoetxea, E., Segarra, R., Sanchez, P. M., Elizagarate,
E., Garcia, J., Eguiluz, J. I., Garcia, A.
Objective: The efficacy of cognitive remediation in patients with
psychosis has been widely recognized for cognitive impairment. However, clinical symptoms, particularly negative symptoms do not show the same
pattern of improvement. Therefore, the goal of this study was to test if clinical symptoms improve after cognitive remediation with REHACOP program.
Methods: Seventy-two patients with first-episode psychosis (FEP) and schizophrenia were randomly allocated into experimental or control groups. The
patients allocated on the experimental group (N = 44) received a cognitive rehabilitation treatment using REHACOP. They attended 36 sessions of 90
min during 3 months. Patients under control condition (N = 28) received Occupational Therapy during the same period of time. Both groups received
treatment as usual. Patients underwent clinical and neuropsychological pre- and post treatment assessments. Results: Repeated measures of MANOVA
showed that experimental group improved significantly in most cognitive domains, when compared to controls. Group (REHACOP vs.1 Control) null Time
(pre vs. post-treatment) interactions were significant for attention (F = 12.36, P<0.001), verbal memory (F = 5.30, P<0.05), processing speed (F =
5.30, P<0.05), and executive functioning (F = 4.13, P<0.05). On the contrary, verbal fluency (F = 3.75, P = 0.56) did not show significant
improvement in any of the groups. Regarding clinical symptoms (PANSS), Group null Time interaction was significant for negative symptoms (F = 4.24,
P<0.05), showing that experimental group obtained significant improvement when compared to controls. Nevertheless, positive (F = 1.23, P = 0.29),
disorganization (F = 0.28, P = 0.60), excitement (F = 1.87, P = 0.18) and emotional distress (F = 0.07, P = 0.79) symptoms did not significantly
improved. Conclusion: Our findings with a large sample of patients suggest that REHACOP is an effective cognitive remediation program for minimizing
existing cognitive but also negative clinical symptoms. The relevance of this finding is strength by the strong relation that both, cognitive and
negative symptoms present with functional outcome in psychosis.
European Archives of Psychiatry &
Clinical Neuroscience, 261 : S97
- Year: 2011
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Nordentoft, M., Vesterager,
L., Melau, M., Christenseen, T. O.
Background:ARandomised Clinical
Trial of Computer-Assisted Cognitive Training plus a Psychosocial Treatment Programme vs. a Psychosocial Treatment Programme for First-Episode
Schizophrenia Patients Methods: One-hundred and seventeen patients with first episode schizophrenia spectrum disorders were assessed on cognitive and
daily functioning and randomly assigned to either 38 sessions of CT plus psychosocial treatments vs. 38 psychosocial treatments alone. The CT program
was based on scaffolding and errorless learning and divided into modules of attention, memory, and executive functioning. Computerized exercises as
well as daily tasks were conducted, and competence dialogues built a bridge to everyday life of patients. Examinations were carried to at baseline,
post training (after 4 months) and at 10-month follow-up. Intention- to- treat analyses were carried out, and repeated measurements in mixed model
with unstructured variance was applied. Outcomes were everyday skills capacity (UPSA-B), neuropsychological tests, self-esteem (Rosenberg SES),
association with the labor market, and PANSS symptom severity. Results: CT significantly improved Rosenbergs Self Esteem 1.96 (0.6-3.3) and Panss
general score -2.2 (-4.7 to -0.3)post training. At 10-month follow-up the-CT-group significantly differed from control group with regard to Panss
positive scale -1.3 (-2.6 to 0.8), Compt 2.3 (0.0-4.6), WMT 3.6 (0.9-6.3) LNS 1.3 (0.3-2.4), HVLTR 2.1 (0.48-3.65) and Trail making B (-5.89 (-12 to
7-0)). Panss negative symptoms were not influenced Conclusion: CT did improve cognition in several areas and psychotic and general symptoms and self
esteem in first episode schizophrenia.
Schizophrenia
Bulletin, 37 : 223
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Nordentoft,
M., Secher, G., Bertelsen, M., Thorup, A., Austin, S., Albert,
N., Jeppesen, P., Krarup, G., Jorgensen, P., Petersen, L.
Objective: Intensive early treatment for first episode
psychosis have shown to be effective. It is unknown if the positive effects are sustainable over time. The aim was to determine long term effects of
specialised assertive early intervention programme (OPUS) for first episode psychotic patients. Methods: 547 first-episode psychotic patients were
enrolled in a single-blinded randomised clinical trial of 2 years of a specialised assertive early-intervention programme versus standard treatment.
OPUS treatment consisted of ACT with family involvement and social skills training. Follow-up was 2, 5 and 10 years. 369 patients were interviewed
after 2 years, 301 after 5 years and most likely approximately 310 after 10 years. All patients were followed for at least 5 years in the registers.
Results: At five-year follow-up, the effect of the treatment seen after 2 years (psychotic dimension: -0.32 95% CI -0.58 to -0.06, P = 0.02, negative
dimension: -0.45 95% CI -0.67 to -0.22, P = 0.001) had equalized between treatment groups. A significantly smaller percentage of patients from the
experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1-4.8, P = 0.02) and were hospitalized fewer days (mean days 149
vs. 193, mean difference 44, 95% CI 0.15-88.12, P = 0.05) during the fiveyear period. Results of the 10-year follow-up will be presented. Conclusion:
The OPUS treatment improved clinical outcome after 2 years, but the effects were not sustainable up to 5 years after. A difference on supported
housing and use of bed days were found after 5 years in favor of the OPUS treatment.
European Archives of Psychiatry &
Clinical Neuroscience, 261 : S37-S38
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Palma-Sevillano, Carol, Canete-Crespillo, Jose, Farriols-Hernando, Naria, Cebria-Andreu, Jordi, Michael, Maria, Alonso-
Fernandez, Isabel, Fernandez-Vargas,
Maria, Segarra-Gutierrez, Gerard
Background and Objectives: The aim of
this study is to investigate the relative effectiveness of routine care (RC) in addition to a specific early intervention program (PIPE) compared to
routine care alone. Methods: A total of 34 participants in the initial phase of schizophrenia took part in randomized, single-blind controlled trial.
Participants were randomized to receive either routine care (RC; n = 13) or routine integrated with Cognitive-Motivational Therapy (PIPE; n = 21).
PIPE comprised individual and family Cognitive-Motivational therapy plus routine care for 12 months. In this paper we present preliminary results at
6 months after the beginning of the intervention. Clinical assessments were carried out at pre-treatment, and in this manuscript the results at 3 and
6 months after starting the intervention by external raters are presented, using the Positive and Negative Syndrome Scale, Brief Psychiatry Rating
Scale, the Clinical Global Impression Scale, the Global Assessment of Functioning scale, and relapses. Mann-Whitney test and MANOVAs analysis for
variance effects were used for the statistical analysis Results: Significant greater clinical effects were observed in those patients treated in RC +
PIPE at three months from baseline assessment and at six months in PANSS scale (Mann-Whitney test; p < 0 000). Other benefits of the program included
increase in global activity, reduced relapse rates, and reduction of the pharmacological treatment Conclusions: These findings show the effectiveness
of a program of routine care integrated with cognitive-motivational interventions (individual and family therapy) over routine psychiatric care alone
for patients who are in the initial phase of schizophrenia. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
European Journal of Psychiatry, 25(2) : 68-80
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
Penn, D. L., Uzenoff,
S. R., Perkins, D., Mueser, K. T., Hamer, R., Waldheter, E., Saade, S., Cook, L.
The Graduated Recovery Intervention Program
(GRIP) is a new individual cognitive-behavioral therapy program designed to facilitate functional recovery in people who have experienced an initial
episode of psychosis. The purposes of this study were to evaluate the feasibility and tolerability of the GRIP intervention, and to compare the
effectiveness of GRIP versus treatment as usual (TAU) for improving specific clinical and psychosocial outcomes. Forty-six individuals with first
episode psychosis were randomized to GRIP. +. TAU or TAU alone. Primary outcomes focused on social and role functioning, and quality of life.
Secondary outcomes included psychotic symptoms, depression, substance use, social support, attitudes toward medications, well-being, and
hospitalizations. The results indicate that GRIP was well-tolerated, as evidenced by good attendance and low drop-out rates, and well-received (based
on positive feedback from participants). Although the majority of mixed model analyses were not statistically significant, examination of within-
group changes and effect sizes suggests an advantage for GRIP over TAU in improving functional outcomes. These advantages and the fact that the GRIP
intervention demonstrated feasibility and tolerability suggest that this intervention is worthy of further investigation. (copyright) 2010 Elsevier
B.V.
Schizophrenia
Research, 125(2-3) : 247-256
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Volavka, Jan, Czobor, Pal, Derks, Eske M., Bitter, Istvan, Libiger, Jan, Fleischhacker, W. Wolfgang
Objective: To compare the effects of haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on hostility in first-episode
schizophrenia, schizoaffective disorder, or schizophreniform disorder. Method: We used the data acquired in the European First-Episode Schizophrenia
Trial, an open, randomized trial (conducted in 14 countries) comparing 5 antipsychotic drugs in 498 patients aged 18–40 years with first-episode
schizophrenia, schizoaffective disorder, or schizophreniform disorder. DSM-IV diagnostic criteria were used. Patients were assessed between December
23, 2002 and January 14, 2006. Most subjects joined the study as inpatients and then continued with follow-ups in outpatient clinic visits. The
Positive and Negative Syndrome Scale (PANSS) was administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. We analyzed the
scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility (a score > 1) at baseline. We hypothesized (1) that
the treatments would differ in their efficacy for hostility and (2) that olanzapine would be superior to haloperidol. Our primary statistical
analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time. Secondary analysis addressed the
question of whether the effects on hostility found in the primary analysis were specific to this item. All our analyses were post hoc. Results: The
primary analysis of hostility indicated an effect of differences between treatments (F[sub]4,889[/sub] = 4.02, P = .0031). Post hoc treatment-group
contrasts for hostility change showed that, at months 1 and 3, olanzapine was significantly superior (P < .05) to haloperidol, quetiapine, and
amisulpride in reducing hostility. Secondary analyses demonstrated that these results were at least partly specific to hostility. Conclusions: Both
hypotheses were supported. Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia,
schizoaffective disorder, and schizophreniform disorder. This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects
and propensity to cause weight gain. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Clinical Psychiatry, 72(7) : 955-
961
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Vinogradov, S., Fisher, M., Loewy, R. L., Lee, A., Moua, K., Pham, L., Niendam, T. A., Daniel Ragland, J., Carter, C. S.
Background: The cognitive deficits that characterize patients with established schizophrenia are present even before
illness onset and typically worsen as the individual progresses into the first episode of psychosis. Moreover, the severity of the initial deficits
predicts functional outcome several years later. Cognitive dysfunction thus should be a primary target for aggressive early intervention in young
recent-onset populations. Methods: We applied neuroplasticity-based cognitive training to 50 young individuals within 5 years of onset of their first
psychotic episode (mean age of 21 years). We performed a 2-site randomized controlled trial of 40 hours of cognitive training vs. 40 hours of
commercial computer games, delivered over 8 weeks. We examined MATRICS-recommended neurocognitive outcome measures, symptoms, and role functioning.
Results: Subjects in the auditory training group demonstrated significant improvements in global cognition (P = .03), verbal learning and memory (P =
.02), and problemsolving (P = .05), as compared with computer games control subjects, and gains in speed of processing approaching trend level (P =
.13). There were no significant differences in symptoms or functional outcome measures in this short time period. Conclusion: Neuroplasticity-based
cognitive training represents a highly promising treatment approach to target the cogni- tive dysfunction in early psychosis. Future studies must
investigate whether it improves long-term outcome and community functioning, and how best to integrate it into critical psychosocial interventions
such as supported education and supported employment.
Schizophrenia Bulletin, 37 : 325-
326
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Morse, Megan, Procter,
Nicholas
Aims and objectives: The aim of this paper is to examine high-level
evidence in early intervention in psychosis and scope the potential role of the mental health nurse-practitioner in the treatment of management of
early psychosis. Background: Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long-term
disability. As specialised early intervention in psychosis is emerging, the nurse-practitioner role in mental health is also gaining momentum. The
background literature highlights several critical synergies between nurse-practitioners’ scope of practice and needs of patients with early
psychosis. Design: Literature review. Method: Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was
limited to articles published between 1988–2009. Eligible studies were limited to systematic reviews and randomised controlled trials. Results: Two
systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse-
practitioner role in early psychosis. Conclusions: Specific interventions require further research but there is emerging evidence that specialised
intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental
health nurse-practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social
inclusion and social connectedness. Relevance to clinical practice: Mental health nurse-practitioners have the potential to provide specialist
support to meet the needs of this complex group. Central to this is an ability to build an evidence-base around the treatment and management of
people with early psychosis and deliver effective education and leadership across clinical, inter-professional and organisational domains. The paper
concludes by positing a set of recommendations for nurse-practitioners in the field of early psychosis in the Australian mental health setting.
(PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Clinical Nursing, 20(19-20) : 2702-
2711
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement
Stauffer, Virginia L., Case, Michael, Kinon, Bruce J., Conley, Robert, Ascher-Svanum, Haya, Kollack-
Walker, Sara, Kane, John, McEvoy, Joseph, Lieberman, Jeffrey
Early response to antipsychotic
medication has been shown to accurately predict later response to continued use of the same treatment in patients with chronic schizophrenia. This
study examines whether this predictive pattern exists for patients with first-episode psychosis. We used a data-driven threshold for early response
of ≥ 26.2% improvement from baseline on the Positive and Negative Syndrome Scale (PANSS[sub]0–6[/sub]) Total score to determine whether response
at Week 2 of treatment may predict response at Week 12 in a randomized, double-blind trial of olanzapine versus haloperidol for treatment of patients
with first-episode psychosis (N = 225). Later response was defined as a ≥ 40% and ≥ 50% improvement in PANSS Total[sub]0–6[/sub] score and as
remission. At Week 2, 43% (97/225) of patients were identified as early responders. At a threshold for later response of ‚â• 50% improvement in
PANSS0–6 Total score, early non-response most strongly predicted later non-response, demonstrating high specificity (74%) and high negative
predictive value (80%). As had been seen in the treatment of patients with chronic schizophrenia, early non-response was a robust predictor of
subsequent non-response in the treatment of patients with first-episode psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
(journal abstract)
Psychiatry Research, 187(1-2) : 42-48
- 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)
Subotnik, K. L., Ventura, J., Gretchen-Doorly, D., Luo, J. S., Casaus, L.
R., Hellemann, G. S., Victoria, A., Nuechterlein, K. H.
Background: Short acting oral antipsychotic medication is
more commonly used than long-acting injectable forms, but the effectiveness of oral medications is hampered by poor adherence. Methods: We are
comparing the clinical efficacy of the long-acting injectable formulation of risperidone (RLAI) to the oral form in a 12-month randomized controlled
trial in recent- onset schizophrenia patients. This is a preliminary report from a sample of first-episode schizophrenia patients (Sample 4) of the
Developmental Processes in Schizophrenic Disorders Project (PI: Keith Nuechterlein, Ph.D.), conducted at the UCLA Aftercare Research Program. The
enrollment target is 110. Interim analyses were conducted with 61 recent-onset schizophrenia patients who were randomized to injectable vs. oral
risperidone. Results: To date, only 1 patient has refused to continue treatment at the time of randomization to RLAI, and 1 other discontinued after
only 2 injections. There were notable clinical advantages of risperidone long-acting injectable (RLAI). The rate of psychotic relapse was lower (7%
vs. 31%), time without relapse was longer (means of 350 vs. 300 days, P = .013), and the rate of early discontinuation of treatment for any reason
was significantly lower (17% vs. 41%, P = .04) for the RLAI group compared with the oral risperidone group. Over the initial 6 months of treatment
for 49 patients who completed 6 months or longer of the protocol, the RLAI group had reductions in Brief Psychiatric Rating Scale (BPRS) symptoms of
Unusual Thought Content (P = .03), Conceptual Disorganization (P=.05), Hostility (P =. 02), and Emotional Withdrawal (P = .04), and increased Motor
Retardation (P = .03), relative to the oral risperidone patient group. Each patient's adherence was rated on a 1-5 scale based on timeliness of
injections for RLAI, and pill counts, patient reports, plasma levels, and psychiatrist judgments for oral medication. Adherence with oral risperidone
did not differ prior to randomization, but adherence was much better for injectable compared with oral medication during the randomized treatment (P
< .001). Medication adherence significantly predicted psychotic relapse (P = .017). Medication adherence was significantly associated with
improvement on a number of symptoms on the BPRS over the initial 6 months. Conclusion: If these findings are confirmed in the full sample, they will
support the use of RLAI in the early course of schizophrenia.
Schizophrenia
Bulletin, 37 : 323
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)