Disorders - Psychosis Disorders
Nuechterlein, K. H, McEwen, S. C, Ventura, J, Subotnik, K. L, Turner, L. R, Boucher, M, Casaus, L. R, Distler, M. G, Hayata, J. N.
BACKGROUND: Cognitive training (CT) and aerobic exercise both show promising moderate impact on cognition and everyday
functioning in schizophrenia. Aerobic exercise is hypothesized to increase brain-derived neurotrophic factor (BDNF) and thereby synaptic plasticity,
leading to increased learning capacity. Systematic CT should take advantage of increased learning capacity and be more effective when combined with
aerobic exercise.\rMETHODS: We examined the impact of a 6-month program of cognitive training & exercise (CT&E) compared to cognitive training alone
(CT) in 47 first-episode schizophrenia outpatients. All participants were provided the same Posit Science computerized CT, 4 h/week, using BrainHQ
and SocialVille programs. The CT&E group also participated in total body circuit training exercises to enhance aerobic conditioning. Clinic and
home-based exercise were combined for a target of 150 min per week.\rRESULTS: The MATRICS Consensus Cognitive Battery Overall Composite improved
significantly more with CT&E than with CT alone (p = 0.04), particularly in the first 3 months (6.5 v. 2.2 T-score points, p < 0.02). Work/school
functioning improved substantially more with CT&E than with CT alone by 6 months (p < 0.001). BDNF gain tended to predict the amount of cognitive
gain but did not reach significance. The cognitive gain by 3 months predicted the amount of work/school functioning improvement at 6 months. The
amount of exercise completed was strongly associated with the degree of cognitive and work/school functioning improvement.\rCONCLUSIONS: Aerobic
exercise significantly enhances the impact of CT on cognition and functional outcome in first-episode schizophrenia, apparently driven by the amount
of exercise completed.
Psychological medicine, : 1-
11
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive remediation
therapy, Physical activity, exercise
Myin-Germeys, I., Van-Aubel, E., Vaessen, T., Steinhart, H., Klippel, A., Lafit, G., Viechtbauer, W., Batink, T., Van-Winkel, R., Van-Der Gaag, M., Van-
Amelsvoort, T., Marcelis, M., Schirmbeck, F., De-Haan, L., Reininghaus, U.
INTRODUCTION/OBJECTIVE: This study aimed to investigate efficacy of Acceptance
and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in addition to
treatment as usual (TAU) for psychotic distress, in comparison to TAU.\rMETHODS: Individuals aged 15-65 years with clinically established ultra-high
risk or first episode of psychosis were randomly assigned to TAU or ACT-DL+TAU. ACT-DL+TAU consisted of 8 ACT-sessions augmented with an EMI-app. The
primary outcome was psychotic distress assessed with the Comprehensive Assessment scale of At Risk Mental State (CAARMS) at post-intervention and 6-
and 12-month follow-up. Secondary outcomes were functioning, symptom severity, and momentary psychotic distress. We performed multivariate mixed
models according to intent-to-treat principles.\rRESULTS: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148
were randomized to ACT-DL+TAU (n = 71) or TAU (n = 77). One hundred and fifteen (78%) provided primary outcome data at least at one follow-up
assessment. There was no evidence of greater reduction in the primary outcome measure CAARMS distress in ACT-DL+TAU compared to TAU (chi2(3) = 2.36;
p = 0.50). However, out of the tested secondary outcomes, global functioning (chi2(3) = 9.05; p = 0.033), and negative symptoms (chi2(3) = 19.91;
p<0.001) improved in ACT-DL+TAU compared to TAU, as did momentary psychotic distress (chi2(3) = 21.56; p < 0.001).\rCONCLUSIONS: INTERACT did not
support a significant effect of ACT-DL over TAU on the primary outcome measure of psychotic distress as assessed with the CAARMS. Although
significant improvements were found for some secondary outcome measures, further replication studies are needed to confirm the strength and
specificity of these effects.
Psychotherapy &
Psychosomatics, 91(6) : 411-423
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)
Mustafa, S. S., Malla, A., Joober, R., Abadi, S., Latimer, E., Schmitz, N., Jarvis, G. E., Margolese, H. C., Casacalenda, N., Abdel-Baki, A., Iyer, S. N.
Objective: To investigate
whether first-episode psychosis patients receiving extended early intervention had better functional outcomes than those in regular care and to
examine the predictors of functional outcomes. Method(s): This is a randomized controlled single-blind trial of 220 patients randomized after 2 years
of early intervention to receive early intervention or regular care for the subsequent 3 years. Outcomes included cumulative time in functional
recovery during the 3-year trial assessed using the Social and Occupational Functioning Assessment Scale (SOFAS); and employment/education at last
assessment which were, respectively, analyzed using multiple linear regression and logistic regression, accounting for well-known predictors. Linear
mixed and generalized linear models were also used to examine the course of SOFAS and employment/education over the 3-year period. Result(s): The
extended early intervention and regular care groups did not differ on time in functional recovery (mean = 50.17 weeks, SD = 46.62 vs. mean = 46.18
weeks, SD = 51.54); percent employed/in school (60.4% vs. 68.8%) or change in SOFAS or employment/education status over time. SOFAS scores were
stable between years 2 and 5. Individuals with longer periods of total symptom remission experienced significantly longer periods of functional
recovery and were likelier to be employed/in school. Those who had completed high school were nine times likelier to be employed/studying.
Conclusion(s): Most individuals maintained functional gains accrued from 2 years of early intervention with no further improvement whether in
extended early intervention or regular care. There was a gap between symptomatic and functional recovery, and one-third were unemployed/not in school
at year 5. The lack of additional progress even in extended early intervention suggests that specific interventions addressing functional roles need
to be provided beyond the first 2 years of early intervention. Sustaining symptom remission and high-school completion may be additional avenues for
targeting functional recovery. Copyright © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Psychiatrica
Scandinavica, 145(1) : 86-99
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Mueser, K. T., Achtyes, E. D., Gogate, J., Mancevski, B., Kim, E., Starr, H. L.
BACKGROUND: Schizophrenia is
a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve
caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not
been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based
psychoeducation for caregivers on either patient or caregiver outcomes.\rOBJECTIVE: The Family Intervention in Recent-Onset Schizophrenia Treatment
(FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate
the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The
impact of study-provided psychoeducation on caregiver burden is also investigated.\rMETHODS: Eligible patients and their designated caregivers were
randomly assigned to either the study-provided psychoeducation (<=16 sessions of telehealth-based psychoeducation over 6 months) or UC group,
stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or
intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using
mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was
assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey.\rRESULTS: A total of 148 pairs of participants were
enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number of sessions in the
study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in
patient outcomes (rates of TF: 70% vs 67%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health).
However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral
antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future
caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with
enrollment, and caregiver-treatment team coordination may have affected the outcomes of the FIRST study.\rCONCLUSIONS: Key insights from the FIRST
study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members
regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment
team.\rTRIAL REGISTRATION: ClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741.
JMIR Mental Health, 9(4) : e32492
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Skills training
Mohr, P., Masopust, J., Kopecek, M.
Dopamine receptor partial agonists (DRPAs; aripiprazole, brexpiprazole, and cariprazine) constitute a
novel class of antipsychotics. Although they share a similar mechanism of action, DRPAs differ in their pharmacodynamics, pharmacokinetics, drug
interactions, or safety and tolerability. The antipsychotic efficacy of all three drugs was established in several placebo-controlled randomized
trials (RCTs) in schizophrenia, both acute phase and relapse prevention. In addition, each of the DRPA agents has been tested in other psychiatric
disorders, including bipolar disorder or major depression. However, a few studies have examined their comparative clinical efficacy. There are no
head-to-head comparisons between aripiprazole, brexpiprazole, or cariprazine. In two acute schizophrenia RCTs of cariprazine and brexpiprazole,
aripiprazole was used as an indirect comparator to control for study sensitivity. To assess potential differences in the efficacy of DRPAs, we
reviewed data from controlled trials, systematic reviews, and meta-analyses. Our results showed that the acute antipsychotic effects of DRPAs, as
measured by the number needed to treat, are comparable. The three agents were superior to placebo in acute treatment, and cariprazine was found to be
effective in the reduction of primary negative symptoms of schizophrenia. In the therapy of bipolar disorder, aripiprazole and cariprazine showed
antimanic efficacy, cariprazine was also effective in the management of bipolar depression, and aripiprazole was effective for relapse prevention.
The addon administration of aripiprazole or brexpiprazole reduced symptoms of major depression. Aripiprazole can control acute agitation associated
with psychosis or bipolar disorder; brexpiprazole showed the potential to manage agitation in dementia patients. Aripiprazole has also established
evidence of efficacy in children and adolescents and other conditions: OCD, tic disorders, and autism spectrum disorder. Our review of published data
suggests that in terms of clinical efficacy, DRPAs are a heterogeneous group, with each drug possessing its own therapeutic benefits. Copyright ©
2022 Mohr, Masopust and Kopecek.
Frontiers in Psychiatry, 12 (no
pagination) :
- Year: 2022
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Lopez-Morinigo, J-D., Leucht, S., Arango, C.
Early-onset schizophrenia (EOS) - onset before age 18 - is linked with great disease burden and disability. Decision-making for EOS
pharmacological treatment may be challenging due to conflicting information from evidence and guidelines and unidentified care needs may remain
unmet.We searched for systematic reviews, meta-analyses and umbrella reviews of EOS pharmacological treatment published in PubMed over the past 10
years and selected five clinical guidelines from Europe, North-America and Australia. Based on predefined outcomes, we critically compared the
evidence supporting EOS-approved drugs in Europe and/or North-America with guidelines recommendations. We also evaluated the coverage of these
outcomes to identify unmet needs.One systematic review, nine meta-analyses and two umbrella reviews (k=203 trials, N=81,289 participants, including
duplicated samples across selected articles) were retrieved. Evidence supported the efficacy of aripiprazole, clozapine, haloperidol, lurasidone,
molindone, olanzapine, quetiapine, risperidone and paliperidone in EOS, all of which obtained approval for EOS either in Europe and/or in North-
America. Cognition, functioning and quality of life, suicidal behaviour and mortality and services utilisation and cost-effectiveness were poorly
covered/uncovered.Among the antipsychotics approved for EOS, aripiprazole, lurasidone, molindone, risperidone, paliperidone and quetiapine emerged as
efficacious and comparably safe options. Olanzapine is known for a high risk of weight gain and haloperidol for extrapyramidal side-effects.
Treatment-resistant patients should be offered clozapine. Future long-term trials looking at cognition, functioning, quality of life, suicidal
behaviour, mortality, services utilisation and cost-effectiveness are warranted. Closer multi-agency collaboration may bridge the gap between
evidence, guidelines and approved drugs. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Pharmacopsychiatry, 55(5) : 233-245
- Year: 2022
- 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)
Loewy, R., Fisher, M., Ma, S., Carter, C., Ragland, J. D., Niendam, T. A., Stuart, B., Schlosser, D., Amirfathi, F., Yohannes, S., Vinogradov, S.
OBJECTIVE:
Cognitive impairment in schizophrenia predicts functional outcomes and is largely unresponsive to pharmacology or psychotherapy; it is thus a
critical unmet treatment need. This article presents the impact of remotely completed, intensive, targeted auditory training (AT) vs control
condition computer games (CG) in a double-blind randomized trial in young adults with recent-onset schizophrenia.\rMETHOD: Participants (N = 147)
were assessed for cognition, symptoms, and functioning at baseline, post-intervention, and at 6-month follow-up. All participants were provided with
laptop computers and were instructed to complete 40 hours remotely of training or computer games. An intent-to-treat analysis (N = 145) was performed
using linear mixed models with time modeled as a continuous variable. Planned contrasts tested the change from baseline to post-training, baseline to
6-month follow-up, and post-training to 6-month follow-up.\rRESULTS: Global Cognition, which had improved in the AT group relative to the CG group at
post-training, showed durable gains at 6-month follow-up in an omnibus group-by-time interaction test (F(1,179) = 4.80, P = .030), as did Problem-
Solving (F(1,179) = 5.13, P = .025), and Speed of Processing improved at trend level significance (F(1,170) = 3.80, P = .053). Furthermore, the AT
group showed significantly greater improvement than the CG group in positive symptoms (F(1,179) = 4.06, P = .045).\rCONCLUSIONS: These results
provide the first evidence of durable cognitive gains and symptom improvement at follow-up of cognitive training (CT) in early schizophrenia
completed independently and remotely. While functioning did not show significant improvement, these findings suggest that intensive targeted CT of
auditory processing is a promising component of early intervention to promote recovery from psychosis.
, 48(1) : 262-272
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Lian, Lulu, Kim, David D., Procyshyn, Ric M., Fredrikson, Diane H., Cazares, Diana, Honer, William G., Barr, Alasdair M.
Aim: Long-acting injectable antipsychotic drugs (LAIs) are often used as an alternative to oral
antipsychotics (OAPs) in individuals with psychosis who demonstrate poor medication adherence. Previous meta-analyses have found mixed results on the
efficacy of LAIs, compared to OAPs, in patients with psychotic disorders. The objective of this meta-analysis was to compare the effectiveness of
using LAIs versus OAPs in the early stages of psychosis.\rMethods: Major electronic databases were used to search for any studies examining the
comparative effectiveness (i.e., relapse, adherence, hospitalization, and all-cause discontinuation) of any LAIs versus OAPs in early stages of
psychosis. Studies published up to 6 June, 2019 were included and no language restriction was applied. Inclusion criteria were a diagnosis of
schizophrenia or related disorder, where patients were in their first episode or had a duration of illness
Early Intervention in
Psychiatry, 16(6) : 589-599
- Year: 2022
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Other service delivery and improvement
interventions
Leucht,
S., Chaimani, A., Krause, M., Schneider-Thoma, J., Wang, D., Dong, S., Samara, M., Peter, N., Huhn, M., Priller, J., Davis, J. M.
BACKGROUND: As comparatively few trials in subgroups of patients with schizophrenia have been done, clinicians
need to know whether they can rely on the results of randomised controlled trials (RCTs) in the general population of patients with schizophrenia. We
aimed to compare the efficacy and side-effects of antipsychotic drugs in different subgroups.\rMETHODS: In this systematic review and meta-analysis,
we searched reference lists of previous systematic reviews and meta-analyses, the Cochrane Schizophrenia Group's Study-Based Register (from database
inception to April 27, 2020), and PubMed (from April 1, 2020 to June 14, 2021). We excluded studies in patients with stable schizophrenia (ie,
relapse prevention studies), studies with a high risk of bias, and studies from mainland China due to quality concerns concerning allocation and
masking methods. We included single-blind RCTs or better that assessed one or more of 16 second-generation and 18 first-generation antipsychotics in
the general population of patients with schizophrenia or in one or more of the subgroups: children and adolescents (age range as defined in the
original studies), patients with a first episode, patients with predominant or prominent negative symptoms, patients with comorbid substance use,
patients with treatment-resistant schizophrenia, or older patients (age range as defined in the original studies). Two authors independently screened
the results of the search, retrieved full-text articles, and checked the inclusion criteria. Using the Preferred Reporting Items for Systematic
Reviews and Meta-analyses guideline, all parameters were extracted in duplicate. The primary outcome was change in overall symptoms. We compared drug
efficacy between subgroups, by sex, schizoaffective disorder versus schizophrenia, and study origin using random-effects, inverse variance meta-
analyses and random-effects subgroup tests, and meta-regression.\rFINDINGS: We included 537 RCTs with 76 382 participants, 26 627 (34.9%) women, 49
755 (65.1%) men, mean age 37.3 years (range of means 7.9-80.2; ethnicity data not available). 412 RCTs included patients in the general population of
patients with schizophrenia, 42 included patients with treatment-resistant schizophrenia, 25 included children and adolescents, 20 included patients
with their first episode, 20 included patients with predominant or prominent negative symptoms, 13 included patients with comorbid substance use, and
11 included older patients. Of 507 random-effects subgroup tests done, 46 (9%) showed a significant difference (p<0.05) between subgroups, but there
was no clear indication as to which drug should be used in which subgroup.\rINTERPRETATION: The effects of antipsychotics in various patient
subgroups were usually similar to those in the general population of patients with schizophrenia, but comparably few studies contributed to the
subgroups, in particular in terms of side-effects. If the evidence for treatment in a given subgroup is small, guideline makers and clinicians should
consider using the results in the much better studied group of the general population of patients with schizophrenia.\rFUNDING: German Federal
Ministry of Education and Research (Bundesministerium fur Bildung und Forschung; FKZ 01KG1508).
The Lancet. Psychiatry, 9(11) : 884-
893
- Year: 2022
- 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)
Huang, M. W, Gibson, R. C, Jayaram, M. B, Caroff, S.
N.
BACKGROUND: Whilst antipsychotics are the mainstay of treatment for
schizophrenia spectrum disorders, there have been numerous attempts to identify biomarkers that can predict treatment response. One potential marker
may be psychomotor abnormalities, including catatonic symptoms. Early studies suggested that catatonic symptoms predict poor treatment response,
whilst anecdotal reports of rare adverse events have been invoked against antipsychotics. The efficacy and safety of antipsychotics in the treatment
of this subtype of schizophrenia have rarely been studied in randomised controlled trials (RCTs).\rOBJECTIVES: To compare the effects of any single
antipsychotic medication with another antipsychotic or with other pharmacological agents, electroconvulsive therapy (ECT), other non-pharmacological
neuromodulation therapies (e.g. transcranial magnetic stimulation), or placebo for treating positive, negative, and catatonic symptoms in people who
have schizophrenia spectrum disorders with catatonic symptoms.\rSEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register
of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ClinicalTrials.gov, the ISRCTN registry, and WHO ICTRP, on 19
September 2021. There were no language, date, document type, or publication status limitations for inclusion of records in the register. We also
manually searched reference lists from the included studies, and contacted study authors when relevant.\rSELECTION CRITERIA: All RCTs comparing any
single antipsychotic medication with another antipsychotic or with other pharmacological agents, ECT, other non-pharmacological neuromodulation
therapies, or placebo for people who have schizophrenia spectrum disorders with catatonic symptoms.\rDATA COLLECTION AND ANALYSIS: two review authors
independently inspected citations, selected studies, extracted data, and appraised study quality. For binary outcomes, we planned to calculate risk
ratios and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous outcomes, we planned to calculate mean differences
between groups and their 95% CI. We assessed risk of bias for the included studies, and created a summary of findings table; however, we did not
assess the certainty of the evidence using the GRADE approach because there was no quantitative evidence in the included study.\rMAIN RESULTS: Out of
53 identified reports, one RCT including 14 hospitalised adults with schizophrenia and catatonic symptoms met the inclusion criteria of the review.
The study, which was conducted in India and lasted only three weeks, compared risperidone with ECT in people who did not respond to an initial
lorazepam trial. There were no usable data reported on the primary efficacy outcomes of clinically important changes in positive, negative, or
catatonic symptoms. Whilst both study groups improved in catatonia scores on the Bush-Francis Catatonia Rating Scale (BFCRS), the ECT group showed
significantly greater improvement at week 3 endpoint (mean +/- estimated standard deviation; 0.68 +/- 4.58; N = 8) than the risperidone group (6.04
+/- 4.58; N = 6; P = 0.035 of a two-way analysis of variance (ANOVA) for repeated measures originally conducted in the trial). Similarly, both groups
improved on the Positive and Negative Syndrome Scale (PANSS) scores by week 3, but ECT showed significantly greater improvement in positive symptoms
scores compared with risperidone (P = 0.04). However, data on BFCRS scores in the ECT group appeared to be skewed, and mean PANSS scores were not
reported, thereby precluding further analyses of both BFCRS and PANSS data according to the protocol. Although no cases of neuroleptic malignant
syndrome were reported, extrapyramidal symptoms as a primary safety outcome were reported in three cases in the risperidone group. Conversely,
headache (N = 6), memory loss (N = 4), and a prolonged seizure were reported in people receiving ECT. These adverse effects, which were assessed as
specific for antipsychotics and ECT, respectively, were the only adverse effects reported in the study. However, the exact number of participants
with adverse events was not clearly reported in both groups, precluding further analysis. Our results were based only on a single study with a very
small sample size, short duration of treatment, unclear or high risk of bias due to unclear randomisation methods, possible imbalance in baseline
characteristics, skewed data, and selective reporting. Data on outcomes of general functioning, global state, quality of life, and service use, as
well as data on specific phenomenology and duration of catatonic symptoms, were not reported.\rAUTHORS' CONCLUSIONS: We found only one small,
short-term trial suggesting that risperidone may improve catatonic and positive symptoms scale scores amongst people with schizophrenia spectrum
disorders and catatonic symptoms, but that ECT may result in greater improvement in the first three weeks of treatment. Due to small sample size,
methodological shortcomings and brief duration of the study, as well as risk of bias, the evidence from this review is of very low quality. We are
uncertain if these are true effects, limiting any conclusions that can be drawn from the evidence. No cases of neuroleptic malignant syndrome were
reported, but we cannot rule out the risk of this or other rare adverse events in larger population samples. High-quality trials continue to be
necessary to differentiate treatments for people with symptoms of catatonia in schizophrenia spectrum disorders. The lack of consensus on the
psychopathology of catatonia remains a barrier to defining treatments for people with schizophrenia. Better understanding of the efficacy and safety
of antipsychotics may clarify treatment for this unique subtype of schizophrenia.
Cochrane Database of Systematic Reviews, 7 : CD013100
- Year: 2022
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Hei, G, Smith, R. C, Li, R, Ou, J, Song, X, Zheng, Y, He, Y, Arriaza, J, Fahey, J. W, Cornblatt, B, Kang, D, Yang, Y, Huang, J, Wang, X, Cadenhead, K, Zhang, M, Davis,
J. M, Zhao, J, Jin, H, Wu, R.
Objective: Cognitive symptoms are associated with significant dysfunction in schizophrenia. Oxidative stress and inflammation involving
histone deacetylase (HDAC) have been implicated in the pathophysiology of schizophrenia. Sulforaphane has antioxidant properties and is an HDAC
inhibitor. The objective of this study was to determine the efficacy of sulforaphane on cognition dysfunction for patients with schizophrenia.
Method(s): This double-blind randomized 22-week trial of patients with first-episode schizophrenia was conducted in four psychiatric institutions in
China. Patients were randomized to three groups (two doses of sulforaphane vs. placebo) and symptomatic and cognitive assessments were completed at
multiple times. The primary outcome measure was change in the MATRICS Composite score. The secondary outcomes were change in MATRICS Domain scores,
PANSS Total Scores and change in side-effects. Result(s): A total of 172 patients were randomized and 151 patients had at least one follow up
evaluation. There were no significant effects of sulforaphane, on the primary outcome, MATRICS overall composite score. However, on secondary
outcomes, sulforaphane did significantly improve performance scores on MATRICS battery Domains of spatial working memory (F = 5.68, P = 0.004),
reasoning-problem solving (F = 2.82, P = 0.063), and verbal learning (F = 3.56, P = 0.031). There were no effects on PANSS symptom scores.
Sulforaphane was well tolerated. Conclusion(s): Although the primary outcome was not significant, improvement in three domains of the MATRICS
battery, suggests a positive cognitive effect on some cognitive functions, which warrants further clinical trials to further assess whether
sulforaphane may be a useful adjunct for treating some types of cognitive deficits in schizophrenia. Copyright © 2022 The Author(s) 2022. Published
by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.
Schizophrenia Bulletin Open, 3(1) (no
pagination) :
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Vitamins and supplements
Haugen, I, Stubberud, J, Haug, E, McGurk, S. R, Hovik, K. T, Ueland, T, Oie, M.
G.
BACKGROUND: Executive functioning is
essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically
founded, empirically supported, metacognitive strategy training program designed to improve executive functioning.\rMETHODS: A randomized controlled
parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an
early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters
post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on
executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical
symptoms.\rRESULTS: GMT improved self-reported executive functioning, measured with the Behavior Rating Inventory of Executive Function - Adult
version (BRIEF-A), significantly more than treatment as usual. A linear mixed model for repeated measures, including all partial data according to
the principle of intention to treat, showed a significant group x time interaction effect assessed immediately after intervention (post-test) and 6
months after intervention (follow-up), F = 8.40, p .005, r .37. Improvement occurred in both groups in objective executive functioning as measured by
neuropsychological tests, functional capacity, daily life functioning and symptoms of psychosis rated by clinicians. Self-reported clinical symptoms
measured with the Symptoms Check List (SCL-10) improved significantly more after GMT than after treatment as usual, F = 5.78, p .019, r .29. Two
participants withdrew due to strenuous testing and one due to adverse effects.\rCONCLUSIONS: GMT had clinically reliable and lasting effects on
subjective executive function. The intervention is a valuable addition to available treatment with considerable gains at low cost.\rTRIAL
REGISTRATION: Registered at clinicaltrials.gov NCT03048695 09/02/2017.
BMC
Psychiatry, 22(1) : 575
- Year: 2022
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy