Disorders - Psychosis Disorders
Gafoor, Rafael, Nitsch, Dorothea, McCrone, Paul, Craig, Tom K. J., Garety, Philippa A., Power, Paddy, McGuire, Philip
Background: Aims: Method: Results: Conclusions: Early specialised care may improve short-term outcome in
first-episode non-affective psychosis, but it is unclear if these benefits endure.To assess the long-term effect of early intervention in
psychosis.Individuals with first-episode psychosis were randomised to specialised care or care as usual (trial number: ISRCTN73679874). Outcome after
5 years was assessed by case-note review.There were no significant differences in the admission rate (coefficient 0.096, 95% CI -0.550 to 0.742, P =
0.770) or the mean number of bed days (coefficient 6.344, 95% CI -46 to 58.7, P = 0.810).These findings that specialist intervention did not markedly
improved outcome at 5 years accord with those from a larger OPUS study. The sample size of this study was small and these results should be
generalised with caution. More research is needed.
British Journal of Psychiatry, 196(5) : 372-376
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Josiassen, Richard C., Shaughnessy, Rita A., Filymer, Dawn M., Donohue, Ann Marie, Kacso, Margit, Finkel, Naomi, Curtis, Jessica, Audino, Brett, Skuban, Nina
Objective:
Method: Results: Conclusions: The objective was to compare short-term effectiveness of aripiprazole with three other second-generation antipsychotics
(SGAs) in the treatment of first-episode psychosis.In a naturalistic, 'single-blind' design, 60 subjects experiencing their first psychotic episode
were treated for 8 weeks with aripiprazole (n = 19), risperidone (n = 16), olanzapine (n = 14) or quetiapine (n = 11). Medication and dosing
decisions were made by treating psychiatrists, constrained to once-a-day dosing, low initial doses and no clozapine. Weekly ratings were obtained
using the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Rating Scale and Barnes Akathasia Rating Scale. Weight and vital signs were
also collected weekly.The group presented with severe psychotic symptoms (mean baseline PANSS total score of 105.2), which were reduced rapidly (P <
0.0005). The between-group and group by time interaction terms were non-significant. Similar reductions were seen across all PANSS sub-scales. At
Week 1 the mean PANSS Activation Scale score was reduced more with olanzapine than in the other groups (P < 0.002). Few instances of extrapyramidal
symptoms occurred; all were sporadic and did not require treatment. Group body weight increased by 7.3% over the study. Vital signs remained
unchanged.Early intervention with low doses of four SGAs led to rapid symptom reduction in first-episode psychotic patients with severe
psychopathology. Although no clear medication advantages were observed in the short term, longer duration studies with larger samples will be
required for determining efficacy, rates of compliance, relapse prevention and diminished incidence of extrapyramidal signs and symptoms.
Early Intervention in Psychiatry, 4(1) : 57-
63
- Year: 2010
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Findling, Robert L., Johnson, Jacqueline L., McClellan, Jon, Frazier, Jean
A., Vitiello, Benedetto, Hamer, Robert M., Lieberman, Jeffrey A., Ritz, Louise, McNamara, Nora K., Lingler, Jacqui, Hlastala, Stefanie, Pierson, Leslie, Puglia, Madeline, Maloney, Ann E., Kaufman, Emily Michael, Noyes, Nancy, Sikich, Linmarie
Objective: Method: Results: Conclusions: To examine the long-term safety and efficacy of three antipsychotics in early-onset schizophrenia
spectrum disorders.Patients (8 to 19 years old) who had improved during an 8-week, randomized, double-blind acute trial of olanzapine, risperidone,
or molindone (plus benztropine) were eligible to continue on the same medication for up to 44 additional weeks under double-blind conditions.
Adjunctive medications were allowed according to defined algorithms. Standardized symptom, safety, and functional assessments were conducted every 4
weeks.Of the 116 youths randomized in the acute trial, 54 entered maintenance treatment (molindone, n = 20; olanzapine, n = 13; risperidone, n = 21).
Fourteen (26%) completed 44 weeks of treatment. Adverse effects (n = 15), inadequate efficacy (n = 14), or study nonadherence (n = 8) were the most
common reasons for discontinuation. The three treatment arms did not significantly differ in symptom decrease or time to discontinuation. Akathisia
was more common with molindone and elevated prolactin concentrations more common with risperidone. Although weight gain and metabolic adverse events
had occurred more often with olanzapine and risperidone during the acute trial, no significant between-drug differences emerged in most of these
parameters during maintenance treatment.Only 12% of youths with early-onset schizophrenia spectrum disorders continued on their originally randomized
treatment at 52 weeks. No agent demonstrated superior efficacy, and all were associated with side effects, including weight gain. Improved treatments
are needed for early-onset schizophrenia spectrum disorders. Clinical trial registry information-Treatment of Schizophrenia and Related Disorders in
Children and Adolescents; URL: http://www.clinicaltrials.gov, unique identifier: NCT00053703.\r2010 American Academy of Child and Adolescent
Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(6) : 583-
594
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kelly, Christopher, Hadjinicolaou, Andreas V., Holt, Clare, Agius, Mark, Zaman, Rashid
Introduction: Results: Discussion: Conclusion:
there are now many existing studies which assess the treatments available for 'at risk mental states', as patients who are believed to be in the
prodromal phase of psychotic illness are referred to. However, concerns regarding side effects of possible treatments remain. We here conduct a
meta-analysis of the studies available up to October 2010. The aim of this study is to decide what would be the best treatment for 'at high risk
patients'.all the available studies examining potential treatments during the prodromal phase of psychotic illness were collected. They all showed
comparable efficacy, which reached statistical significance, excluding the one study using olanzapine, which in fact 'tended towards
significance'.treatments appear promising but a balance needs to be kept between adverse events and effectiveness of preventing psychosis.it is
necessary to search further for treatments in order to identify effective treatments with fewer adverse side effects in this phase of psychotic
illness.
Psychiatria Danubina, 22 Suppl 1 : S56-S62
- Year: 2010
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Guo, Xiaofeng, Zhai, Jinguo, Liu, Zhening, Fang, Maosheng, Wang, Bo, Wang, Chuanyue, Hu, Bin, et-al
Context: Objective: Design: Setting: Participants: Main Outcome Measures: Results: Conclusion: Trial Registration:
Antipsychotic drugs are limited in their ability to improve the overall outcome of schizophrenia. Adding psychosocial treatment may produce greater
improvement in functional outcome than does medication treatment alone.To evaluate the effectiveness of antipsychotic medication alone vs combined
with psychosocial intervention on outcomes of early-stage schizophrenia.Randomized controlled trial.Ten clinical sites in China.Clinical sample of
1268 patients with early-stage schizophrenia treated from January 1, 2005, through October 31, 2007. Intervention Patients were randomly assigned to
receive antipsychotic medication treatment only or antipsychotic medication plus 12 months of psychosocial intervention consisting of
psychoeducation, family intervention, skills training, and cognitive behavior therapy administered during 48 group sessions.The rate of treatment
discontinuation or change due to any cause, relapse or remission, and assessments of insight, treatment adherence, quality of life, and social
functioning.The rates of treatment discontinuation or change due to any cause were 32.8% in the combined treatment group and 46.8% in the
medication-alone group. Comparisons with medication treatment alone showed lower risk of any-cause discontinuation with combined treatment (hazard
ratio, 0.62; 95% confidence interval, 0.52-0.74; P < .001) and lower risk of relapse with combined treatment (0.57; 0.44-0.74; P < .001). The
combined treatment group exhibited greater improvement in insight (P < .001), social functioning (P = .002), activities of daily living (P < .001),
and 4 domains of quality of life as measured by the Medical Outcomes Study 36-Item Short Form Health Survey (all P < or = .02). Furthermore, a
significantly higher proportion of patients receiving combined treatment obtained employment or accessed education (P = .001).Compared with those
receiving medication only, patients with early-stage schizophrenia receiving medication and psychosocial intervention have a lower rate of treatment
discontinuation or change, a lower risk of relapse, and improved insight, quality of life, and social functioning.clinicaltrials.gov Identifier:
NCT00654576.
Archives of
General Psychiatry, 67(9) : 895-904
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Psychoeducation, Skills training
Eack, Shaun M., Greenwald, Deborah P., Hogarty, Susan S., Keshavan, Matcheri S.
Cognitive rehabilitation
is an effective intervention for addressing cognitive impairments in patients with schizophrenia. Previous research has shown that the early
application of Cognitive Enhancement Therapy (CET) can improve neurocognitive and social-cognitive deficits in the early course of the disorder, and
ultimately reduce the substantial functional disability that these patients experience. However, the lasting effects of CET on functional outcome in
early course schizophrenia patients remain unknown. In this study, 58 patients in the early course of schizophrenia or schizoaffective disorder
treated with 2 years of either CET or an Enriched Supportive Therapy (EST) control were followed-up 1 year after the completion of treatment to
examine the durability of CET effects on functional outcome. At one-year post-treatment, a high (72%) retention rate was observed in both treatments.
Results from intent-to-treat analyses employing linear mixed-effects models indicated that CET effects on functional outcome were broadly maintained
one-year post-treatment, and that patients receiving CET continued to demonstrate highly significant differential functional benefits compared to
patients treated with EST. These findings support the durability of CET effects on functional outcome in the early course of schizophrenia, and point
to the potential of cognitive rehabilitation to have a lasting impact on the early trajectory of the disorder.\r(c) 2010 Elsevier B.V. All rights
reserved.
Schizophrenia Research, 120(1-
3) : 210-216
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Supportive
therapy
Crossley, Nicolas A., Constante, Miguel, McGuire, Philip, Power,
Paddy
Background: Aims: Method: Results: Conclusions: There is an ongoing debate about the use of atypical antipsychotics as a first-line
treatment for first-episode psychosis.To examine the evidence base for this recommendation.Meta-analyses of randomised controlled trials in the early
phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were
identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.Fifteen randomised controlled
trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation
rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = -0.1, 95% CI -0.2 to 0.02). Participants
on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more
extrapyramidal side-effects (SMD = -0.4, 95% CI -0.5 to -0.2).There was no evidence for differences in efficacy between atypical and typical
antipsychotics, but there was a clear difference in the side-effect profile.
British Journal of Psychiatry, 196(6) : 434-
439
- Year: 2010
- 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)
Buchanan, Robert W., Kreyenbuhl, Julie, Kelly, Deanna L., Noel, Jason M., Boggs, Douglas L., Fischer, Bernard A., Himelhoch, Seth, Fang, Beverly, Peterson, Eunice, Aquino, Patrick R., Keller, William
In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team
psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological
treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified
outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment
recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or
outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of
evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the
Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to
recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice
of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge,
including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom
domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of
co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.
Schizophrenia Bulletin, 36(1) : 71-93
- Year: 2010
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any)
Bird, Victoria, Premkumar, Preethi, Kendall, Tim, Whittington, Craig, Mitchell, Jonathan, Kuipers, Elizabeth
Background: Aims: Method: Results: Conclusions: Early intervention services for psychosis aim to
detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.To evaluate the effectiveness of
early intervention services, cognitive-behavioural therapy (CBT) and family intervention in early psychosis.Systematic review and meta-analysis of
randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.Early intervention services
reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention
reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.For
people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family
intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its
component treatments for people with early and established psychosis need further research.
British Journal of Psychiatry, 197 : 350-
356
- Year: 2010
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Catts, Stanley V., O'Toole, Brian
I., Carr, Vaughan J., Lewin, Terry, Neil, Amanda, Harris, Meredith G., Frost, Aaron D. J., Crissman, Belinda R., Eadie, Kathy, Evans,
Russell W.
The literature that is relevant to evaluation of treatment
effectiveness is large, scattered and difficult to assemble for appraisal. This scoping review first develops a conceptual framework to help organize
the field, and second, uses the framework to appraise early psychosis intervention (EPI) studies. Literature searches were used to identify
representative study designs, which were then sorted according to evaluation approach. The groupings provided a conceptual framework upon which a map
of the field could be drawn. Key words were cross-checked against definitions in dictionaries of scientific terms and the National Library of
Medicine Medical Subject Headings (MeSH) browser. Using the final list of key words as search terms, the EPI evaluation literature was appraised.
Experimental studies could be grouped into two classes: efficacy and effectiveness randomized controlled trials. Non-experimental studies could be
subgrouped into at least four overlapping categories: clinical epidemiological; health service evaluations; quality assurance studies; and, quasi-
experimental assessments of treatment effects. Applying this framework to appraise EPI studies indicated promising evidence for the effectiveness of
EPI irrespective of study design type, and a clearer picture of where future evaluation efforts should be focused. Reliance on clinical trials alone
will restrict the type of information that can inform clinical practice. There is convergent evidence for the benefits of specialized EPI service
functions across a range of study designs. Greater investment in health services research and quality assurance approaches in evaluating EPI
effectiveness should be made, which will involve scaling up of study sizes and development of an EPI programme fidelity rating template. The degree
of complexity of the evaluation field suggests that greater focus on research methodology in the training of Australasian psychiatrists is urgently
needed.
Australian & New Zealand Journal of Psychiatry, 44(3) : 195-
219
- Year: 2010
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Chen, E. Y., Hui, C. L., Lam, M. M., Chiu, C. P., Law, C. W., Chung, D. W., Tso, S., Pang, E. P., Chan, K. T., Wong, Y. C., Mo, F. Y., Chan, K. P., Yao, T.
J., Hung, S.
F., Honer, W. G.
OBJECTIVE: To study rates of relapse in
remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance
treatment. DESIGN: 12 month randomised, double blind, placebo controlled trial. SETTING: Early psychosis outpatient clinics in Hong Kong.
PARTICIPANTS: 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and
July 2006 and had no positive symptoms of psychosis. INTERVENTIONS: Patients received either maintenance treatment with quetiapine (400 mg/day) or
placebo and were followed up for the next 12 months or until a relapse occurred. MAIN OUTCOME MEASURE: Relapse assessed monthly and defined as re-
emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to
predefined thresholds. RESULTS: 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse
at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although
quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group
(18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; chi(2)=3.20, df=1; P=0.07). CONCLUSION:
In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance
treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year. Trial registration
Clinical trials NCT00334035.
British
Journal of Psychiatry, 341 : c4024
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Medication dose
reduction/discontinuation
Amminger, G. Paul, Schafer, Miriam R., Papageorgiou,
Konstantinos, Klier, Claudia M., Cotton, Sue M., Harrigan, Susan M., Mackinnon, Andrew, McGorry, Patrick D., Berger, Gregor E.
Context: Objective: Design: Setting: Participants:
Interventions: Main Outcome Measures: Results: Conclusions: The use of antipsychotic medication for the prevention of psychotic disorders is
controversial. Long-chain omega-3 (omega-3) polyunsaturated fatty acids (PUFAs) may be beneficial in a range of psychiatric conditions, including
schizophrenia. Given that omega-3 PUFAs are generally beneficial to health and without clinically relevant adverse effects, their preventive use in
psychosis merits investigation.To determine whether omega-3 PUFAs reduce the rate of progression to first-episode psychotic disorder in adolescents
and young adults aged 13 to 25 years with subthreshold psychosis.Randomized, double-blind, placebo-controlled trial conducted between 2004 and
2007.Psychosis detection unit of a large public hospital in Vienna, Austria.Eighty-one individuals at ultra-high risk of psychotic disorder.A 12-week
intervention period of 1.2-g/d omega-3 PUFA or placebo was followed by a 40-week monitoring period; the total study period was 12 months.The primary
outcome measure was transition to psychotic disorder. Secondary outcomes included symptomatic and functional changes. The ratio of omega-6 to omega-3
fatty acids in erythrocytes was used to index pretreatment vs posttreatment fatty acid composition.Seventy-six of 81 participants (93.8%) completed
the intervention. By study's end (12 months), 2 of 41 individuals (4.9%) in the omega-3 group and 11 of 40 (27.5%) in the placebo group had
transitioned to psychotic disorder (P = .007). The difference between the groups in the cumulative risk of progression to full-threshold psychosis
was 22.6% (95% confidence interval, 4.8-40.4). omega-3 Polyunsaturated fatty acids also significantly reduced positive symptoms (P = .01), negative
symptoms (P = .02), and general symptoms (P = .01) and improved functioning (P = .002) compared with placebo. The incidence of adverse effects did
not differ between the treatment groups.Long-chain omega-3 PUFAs reduce the risk of progression to psychotic disorder and may offer a safe and
efficacious strategy for indicated prevention in young people with subthreshold psychotic states. Trial Registration clinicaltrials.gov Identifier:
NCT00396643.
Archives of General Psychiatry, 67(2) : 146-154
- Year: 2010
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)