Disorders - Psychosis Disorders
Keefe, Richard S., Seidman, Larry J., Christensen, Bruce K., Hamer, Robert M., Sharma, Tonmoy, Sitskoorn,
Margriet M., Rock, Stephanie L., Woolson, Sandra, Tohen, Mauricio, Tollefson, Gary D., Sanger, Todd M., Lieberman,
Jeffrey A.
Background: Neurocognitive deficits are severe in first-episode psychosis.
Methods: Patients (N = 263) with first-episode psychosis (schizophrenia, schizoaffective, or schizophreniform disorders) were randomly assigned to
double-blind treatment with olanzapine (mean 11.30 mg/day) or haloperidol (mean 4.87 mg/day) for 104 weeks. A neurocognitive battery was administered
at baseline (n = 246) and 12 (n = 167), 24 (n = 126), 52 (n = 89), and 104 (n = 46) weeks during treatment. Weighted principal component and
unweighted composite scores were derived from individual tests. Results: Both treatment groups demonstrated significant improvement on both composite
scores. On the basis of the weighted composite score, olanzapine had greater improvement than haloperidol only at 12 (p = .014) and 24 (p = .029)
weeks. For the unweighted composite, olanzapine had significantly better improvement compared with haloperidol only at week 12 (p = .044). At week 12
only, olanzapine improved performance on the Digit Symbol and Continuous Performance Test significantly more than haloperidol. Conclusions: Both
antipsychotic agents appeared to improve neurocognitive functioning among first-episode psychosis patients with schizophrenia. A significantly
greater benefit in terms of neurocognitive improvement was found with olanzapine than with haloperidol at weeks 12 and 24. (PsycINFO Database Record
(c) 2007 APA, all rights reserved) (journal abstract).
Biological Psychiatry, 59(2) : 97-
105
- Year: 2006
- 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)
Edwards, J., Elkins, K., Hinton, M., Harrigan, S. M., Donovan, K., Athanasopoulos, O., McGorry, P. D.
OBJECTIVE: To evaluate a cannabis-focused intervention (cannabis and
psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). METHOD: Consecutive
admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A
single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). There were no
significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. RESULTS: There were no
significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both
groups over time. CONCLUSION: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort.
Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.
Acta Psychiatrica
Scandinavica, 114(2) : 109-17
- Year: 2006
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions
Armenteros, Jorge L., Davies, Mark
BACKGROUND: To develop an evidence base
for using antipsychotic medications for schizophrenia in children and adolescents. METHOD: Data sources were identified in PsychINFO (1872-2003),
MEDLINE (1966-2003), and articles in reference lists. Study selection criteria: (1) treatment with antipsychotics; (2) ages were between 5 and 18
years; (3) sample diagnosed with schizophrenia; (4) prospective design; (5) rating instruments used. Fifteen studies met inclusion criteria and were
rated. Study quality was independently rated. RESULTS: Average response rate among 8 studies employing atypicals was 55.7% compared to 72.3% among 13
studies employing typicals. The difference was statistically different at the trend level (z = 1.65, P < 0.10). The effect size on a continuous
measure was 0.36 in favor of typicals. When study quality was included in the model, the effect of medication type remained unchanged. Average weight
gain in patients treated with typicals was 1.4 Kg. compared to 4.5 Kg for those treated with atypicals. Sedation was more common among those on
atypicals. The rate of extrapyramidal side effects was similar among the two groups CONCLUSIONS: Antipsychotic medications seem effective for
schizophrenia treatment in children and adolescents. Typicals appear to be more effective and cause less weight gain than atypicals. However, more
rigorous clinical trials are necessary. [References: 36]
European Child &
Adolescent Psychiatry, 15(3) : 141-8
- Year: 2006
- 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)
Crespo-Facorro, B., Perez-Iglesias, R., Ramirez-Bonilla, M.,
Martinez-Garcia, O., LLorca, J., & Vazquez-Barquero, J.
Objective: Randomized controlled drug trials have demonstrated that antipsychotic medication is effective to rapidly improve
psychotic symptomatology in first-episode psychosis. However, these results may not be generalizable to routine clinical practice. We evaluated the
effectiveness, tolerability, and safety of olanzapine, risperidone, and haloperidol in individuals with first-episode nonaffective psychosis who are
representative of clinical practice and who are treated in routine clinical settings.\rMethod: 172 patients participated in a practical clinical
trial and were randomly assigned to haloperidol (N = 56), risperidone (N = 61), and olanzapine (N = 55). The mean modal daily doses were 5.4 mg/day
for haloperidol, 4 mg/day for risperidone, and 15.3 mg/day for olanzapine; 98.3% of subjects were drug naive at baseline. Data from clinical measures
of treatment response and tolerability and safety data from the 6-week acute phase of a large epidemiologic and longitudinal (February 2001 to
February 2005) intervention program of first-episode psychosis (schizophrenia spectrum disorders, DSM-IV criteria) are reported.\rResults: All 3
treatments showed similar effectiveness in reducing the severity of general, negative, and positive symptomatology after 6 weeks of treatment, as
reported by mean change in total Clinical Global Impressions-Severity of Illness scale, Brief Psychiatric Rating Scale (BPRS), Scale for the
Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms scores between baseline and 6 weeks. The proportion of study
subjects responding, defined as 40% or greater BPRS total score improvement from baseline, was 57.1% (N = 32 of 56) haloperidol, 52.5% (N = 32 of 61)
risperidone, and 63.6% (N = 35 of 55) olanzapine, with no statistical differences among groups. The frequency of extrapyramidal symptoms (chi(2) =
24.519; p < .001) and concomitant anticholinergic medication use (chi(2) = 57.842; p < .0001) was greater with haloperidol than olanzapine or
risperidone. Olanzapine-treated patients had significantly more weight gain compared with the haloperidol and risperidone groups (P < .001).
\rConclusion: Relatively low doses of haloperidol, risperidone, and olanzapine are equally effective for the acute treatment of first-episode
nonaffective psychosis under usual conditions of real clinical practice.
Journal of Clinical Psychiatry, 67(10) : 1511-1521
- Year: 2006
- 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)
Bola, J. R.
This study investigates
the question of whether short periods of medication-free research in early episode schizophrenia result in demonstrable long-term harm to human
subjects. A meta-analysis of published quasi-experimental and random assignment studies that had a majority of first-or second-episode schizophrenia
spectrum subjects, at least 1 initially unmedicated group, and a minimum of 1-year results was conducted. Only 6 studies, with 623 subjects, met
inclusion criteria. The initially unmedicated groups showed a small, statistically nonsignificant long-term advantage (r = -0.09). Incorporating only
random assignment studies into a composite effect size produced a similar near-zero result (r = 0.01). Good-quality evidence is inadequate to support
a conclusion of long-term harm resulting from short-term postponement of medication in early episode schizophrenia research. A categorical
prohibition against such research should be reconsidered. copyright The Author 2005. Published by Oxford University Press on behalf of the Maryland
Psychiatric Research Center. All rights reserved.
Schizophrenia Bulletin., 32(2) : 288-296
- Year: 2006
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Medication dose
reduction/discontinuation
Jackson, Henry, McGorry, Patrick, Edwards, Jane, Hulbert,
Carol, Henry, Lisa, Harrigan, Susy, Dudgeon, Paul, Francey, Shona, Maude, Dana, Cocks, John, Killackey, Eoin, Power, Paddy
OBJECTIVES: Cognitively oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and
preventing or alleviating secondary morbidity in the wake of the first psychotic episode. The present study reports on the outcomes of a controlled
trial comparing two conditions: COPE versus No-COPE. METHOD: Ninety-one people participated in the trial which was analysed by intention-to-treat,
including 12 people who were assigned to COPE but refused to participate. Assessments were conducted at pre-treatment, mid-treatment and post-
treatment. Hospital readmission data were obtained through a Psychiatric Case Register. The study was conducted in a front-line public mental health
service, the Early Psychosis Prevention and Intervention Centre (EPPIC). Clients in both COPE and No-COPE were provided with full access to the
complete range of EPPIC services. RESULTS: There were no significant differences between the two conditions on the nine primary outcome variables.
Hospital readmissions were assessed for each client at yearly intervals up to 4 years following the completion of treatment and again there were no
significant between-group differences. CONCLUSIONS: The study indicated that there was no significant advantage to COPE over and above routine care
at EPPIC.
Psychological Medicine, 35(9) : 1295-
306
- Year: 2005
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Duggan, L., Fenton, M., Rathbone, J., Dardennes, R., El-Dosoky, A., Indran, S.
Background: Olanzapine is an atypical antipsychotic reported to be effective without producing disabling extrapyramidal
adverse effects associated with older, typical antipsychotic drugs.Objectives: To determine the clinical effects and safety of olanzapine compared
with placebo, typical and other atypical antipsychotic drugs for schizophrenia and schizophreniform psychoses.Search methods: We updated the first
search [Biological Abstracts (1980-1999), The Cochrane Library (Issue 2, 1999), EMBASE (1980-1999), MEDLINE (1966-1999), PsycLIT (1974-1999) and The
Cochrane Schizophrenia Group's Register (October 2000)] in October 2004 using the Cochrane Schizophrenia's Group's register of trials. We also
searched references of all included studies for further trials, and contacted relevant pharmaceutical companies and authors.Selection criteria: We
included all randomised clinical trials comparing olanzapine with placebo or any antipsychotic treatment for people with schizophrenia or
schizophreniform psychoses.Data collection and analysis: We independently extracted data and, for homogeneous dichotomous data, calculated the random
effects relative risk (RR), the 95% confidence intervals (CI) and the number needed to treat (NNT) on an intention-to-treat basis. For continuous
data we calculated weighted mean differences.Main results: Fifty five trials are included (total n>10000 people with schizophrenia). Attrition from
olanzapine versus placebo studies was >50% by six weeks, leaving interpretation of results problematic. Olanzapine appeared superior to placebo at
six weeks for the outcome of 'no important clinical response' (any dose, 2 RCTs n=418, RR 0.88 CI 0.8 to 0.1, NNT 8 CI 5 to 27). Although dizziness
and dry mouth were reported more frequently in the olanzapine-treated group, this did not reach statistical significance. The olanzapine group gained
more weight.When compared with typical antipsychotic drugs, data from several small trials are incomplete. With high attrition in both groups (14
RCTs, n=3344, 38% attrition by six weeks, RR 0.81 CI 0.65 to 1.02) the assumptions included in all data are considerable. For the short term outcome
of 'no important clinical response', olanzapine seems as effective as typical antipsychotics (4 RCTs, n=2778, RR 0.90 CI 0.76 to 1.06). People
allocated olanzapine experienced fewer extrapyramidal adverse effects than those given typical antipsychotics. Weight change data for the short term
are not statistically significant but results between three to 12 months suggest a clinically important average gain of four kilograms for people
given olanzapine (4 RCTs, n=186, WMD 4.62, CI 0.6 to 8.64).Twenty three percent of people in trials of olanzapine and other atypical drugs left by
eight weeks; 48% by three to12 months (11 RCTs, n=1847, RR 0.91 CI 0.82 to 1.00). There is little to choose between the atypicals, although
olanzapine may cause fewer extrapyramidal adverse effects than other drugs in this category. Olanzapine produces more weight gain than other
atypicals with some differences reaching conventional levels of statistical significance (1 RCT, n=980, RR gain at 2 years 1.73 CI 1.49 to 2.00, NNH
5 CI 4 to 7). There are very few data for people with first episode illness (1 RCT, duration 6 weeks, n=42). For people with treatment-resistant
illness there were no clear differences between olanzapine and clozapine (4 RCTs, n=457).Authors' conclusions: The large proportion of participants
leaving studies early in these trials makes it difficult to draw firm conclusions on olanzapine's clinical effects. For people with schizophrenia it
may offer antipsychotic efficacy with fewer extrapyramidal adverse effects than typical drugs, but more weight gain. There is a need for further
large, long-term randomised trials with more comprehensive data.
Cochrane Database of Systematic
Reviews, (2) : CD001359
- Year: 2005
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Penn, David L., Waldheter, Evan J., Perkins, Diana O., Mueser, Kim T., Lieberman, Jeffrey A.
OBJECTIVE: This
article reviews research on psychosocial treatment for first-episode psychosis. METHOD: PsycINFO and MEDLINE were systematically searched for studies
that evaluated psychosocial interventions for first-episode psychosis. RESULTS: Comprehensive (i.e., multielement) treatment approaches show promise
in reducing symptoms and hospital readmissions, as well as improving functional outcomes, although few rigorously controlled trials have been
conducted. Individual cognitive behavior therapy has shown modest efficacy in reducing symptoms, assisting individuals in adjusting to their illness,
and improving subjective quality of life, but it has shown minimal efficacy in reducing relapse. Some controlled research supports the benefits of
family interventions, while less controlled research has evaluated group interventions. CONCLUSIONS: Adjunctive psychosocial interventions early in
psychosis may be beneficial across a variety of domains and can assist with symptomatic and functional recovery. More randomized, controlled trials
are needed to evaluate the effectiveness of these interventions, particularly for multielement, group, and family treatments. [References: 100]
American Journal of
Psychiatry, 162(12) : 2220-32
- Year: 2005
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any)
Schooler, Nina, Rabinowitz, Jonathan, Davidson, Michael, Emsley, Robin, Harvey,
Philip D., Kopala, Lili, McGorry, Patrick D., VanHove, Ilse, Eerdekens, Marielle, Swyzen,
Wim, DeSmedt, Goedele, EarlyPsychosisGlobalWorkingGroup
OBJECTIVE: The first episode of psychotic
illness is a key intervention point. The initial experience with medication can affect willingness to accept treatment. Further, relapse prevention
is a treatment cornerstone during the first years of illness because active psychotic illness may affect lifetime outcomes. Thus, initial treatment
of active symptoms and subsequent relapse prevention are central goals of pharmacotherapy. This study compared long-term effectiveness of risperidone
versus haloperidol in first-episode psychosis patients. METHOD: First-episode psychosis patients (N=555, mean age=25.4 years) participated in a
double-blind, randomized, controlled flexible-dose trial that compared risperidone (mean modal dose=3.3 mg) and haloperidol (mean modal dose=2.9 mg).
The median treatment length was 206 days (maximum=1,514). RESULTS: Positive and Negative Syndrome Scale scores and Clinical Global Impression ratings
improved significantly relative to baseline, with no significant differences between groups. Three-quarters of the patients achieved initial clinical
improvement, defined as >20% reduction in total Positive and Negative Syndrome Scale score. However, among those who achieved clinical improvement,
42% of the risperidone group experienced a relapse compared with 55% of the haloperidol group. The median time to relapse was 466 days for
risperidone-treated subjects and 205 days for those given haloperidol. These differences were statistically significant based on Kaplan-Meier
survival analysis. Adverse effects distinguished the treatments: there were significantly more extrapyramidal signs and symptoms and adjunctive
medication use in the haloperidol group and greater prolactin elevation in the risperidone group. There was less weight gain with haloperidol
initially but no significant differences between groups at endpoint. CONCLUSIONS: Relatively low doses of antipsychotic drugs lead to significant
symptom amelioration in the majority of first-episode psychosis patients. In the long term, risperidone prevents relapse in more patients and for a
longer time and also induces less abnormal movements than haloperidol.
American Journal of Psychiatry, 162(5) : 947-53
- Year: 2005
- 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)
Rosenbaum, B., Valbak, K., Harder, S., Knudsen, P., , Koster, A., Lajer, M., Lindhardt, A., Winther, G., Petersen, L., Jorgensen, P., Nordentoft, M., Andreasen, A.
H.
Background: First-episode psychosis intervention
may improve the course and outcome of schizophrenic disorders. Aims: To describe the Danish National Schizophrenia Project and to measure the outcome
of two different forms of intervention after 1 year, compared with standard treatment. Method: A prospective, longitudinal, multicentre investigation
included 562 patients, consecutively referred over a 2-year period, with a first episode of psychosis. Patients were allocated to supportive
psychodynamic psychotherapy as a supplement to treatment as usual, an integrated, assertive, psychosocial and educational treatment programme or
treatment as usual. Results: There was a non-significant tendency towards greater improvement in social functioning in the integrated treatment group
and the supportive psychodynamic psychotherapy group compared with the treatment as usual group. Significance was reached for some measures when the
confounding effect of drug and alcohol misuse was included. Conclusions: Integrated treatment and supportive psychodynamic psychotherapy in addition
to treatment as usual may improve outcome after 1 year of treatment for people with first-episode psychosis, compared with treatment as usual
alone.
British Journal of
Psychiatry., 186 : 394-399
- Year: 2005
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Ueland, T., Rund, B. R.
OBJECTIVE: To investigate the long-term effects of a cognitive remediation programme for adolescents
with early onset psychosis. METHOD: Twenty-five subjects (cognitive remediation, n=14; control, n=11) were assessed on cognitive, clinical and
psychosocial measures 1 year after discharge. All patients had received a psychoeducational programme, while the experimental group received the
addition of a 30-h cognitive remediation programme. RESULTS: A significant overall improvement for eight of 10 cognitive and three of four outcome
measures was found. After controlling for IQ, there was a differential improvement in early visual information processing (P<0.05) in favour of the
remediation group. No other between-group differences were found. CONCLUSION: The remediation programme may have a favourable long-term effect for
early visual information processing. Improved cognitive functioning in both groups may be caused by beneficial elements in the psychoeducational
programme. Because the study may be underpowered, the results should be interpreted with caution. Copyright (c) Blackwell Munksgaard 2005
Acta Psychiatrica Scandinavica, 111(3) : 193-201
- Year: 2005
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Strakowski, Stephen M., Johnson, Jacqueline L., DelBello, Melissa P., Hamer, Robert M., Green, Alan I., Tohen, Mauricio, Lieberman, Jeffrey A., Glick, Ira, Patel, Jayendra K.
Objectives: Schizophrenia
causes significant impairments of quality of life. As treatment approaches have advanced, more attention has been given to re-integrating patients
into their psychosocial environments, rather than simply monitoring psychotic symptoms. The development of the second-generation antipsychotics
raised hope that these medications would provide better quality of life improvement than conventional antipsychotics. This improvement is
particularly relevant early in the course of schizophrenia. Methods: To address these considerations, improvements in measures of general health and
social function (determined using the SF-36) were assessed in 195 patients with first-episode schizophrenia for up to one year following
randomization to either olanzapine or haloperidol in a double blind clinical trial. We hypothesized that olanzapine would demonstrate better
improvement on these measures than haloperidol. In order to test this hypothesis, we used a repeated measure model with SF-36 scores as the outcome,
and treatment group, time, time2, time-by-treatment group interaction, and time2-by-treatment group interaction as fixed effects. Results: Both
treatments demonstrated similar changes on the SF-36. Independent of treatment, patients demonstrated significant improvements in most of the SF-36
subscales, which approached normative scores by the end of one year of treatment. Forty-six of 100 olanzapine-treated patients and 37 of 95
haloperidol-treated patients completed the one year of this study (p < .4). Conclusions: These results suggest an important initial treatment goal
for patients with new onset schizophrenic disorders, namely that they can expect to recover significant quality of life and social function at least
initially in treatment. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).
Schizophrenia Research, 78(2-3) : 161-
169
- Year: 2005
- 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)