Disorders - Psychosis Disorders
Ueland, Torill,
Objective: To examine if a cognitive remediation program could be a positive supplement to a psychoeducational
treatment program for adolescents with early onset psychosis. Method: Twenty-six subjects, randomly assigned to cognitive remediation (n = 14) or
control group (n = 12), were assessed on cognitive, clinical, psychosocial and behavioural measures. Results: No significant between-group
differences in pre- and posttreatment scores were found. This may be due to low statistical power. Exploratory within-group analyses showed that the
training group improved on five of the 10 cognitive, and three of the five functioning outcome measures, while the control group improved on three of
the cognitive, and one functioning outcome variable. Conclusion: Based on these results we cannot conclude that the addition of this cognitive
remediation program, yields better results than psychoeducation alone. However, within-group analyses indicate that on specific cognitive functions,
as well as on some functioning outcome measures, the remediation program may have a positive effect. (PsycINFO Database Record (c) 2007 APA, all
rights reserved) (journal abstract).
Acta Psychiatrica Scandinavica, 109(1) : 70-74
- Year: 2004
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Tarrier, Nicholas, Lewis, Shon, Haddock, Gillian, Bentall, Richard, Drake, Richard, Kinderman, Peter, Kingdon, David, Siddle, Ronald, Everitt, Julie, Leadley, Karen, Benn, Andy, Grazebrook, Katy, Haley,
Cliff, Akhtar, Shahid, Davies, Linda, Palmer, Steve, Dunn, Graham,
BACKGROUND: The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with
schizophrenia of recent onset showed that it speeded recovery. AIMS: To test the hypothesis that CBT in addition to treatment as usual (TAU) during
the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period. METHOD: This was an 18-month follow-up of a
multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised
for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-
hospitalisation. RESULTS: There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no
group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in
the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not
explain group differences. CONCLUSIONS: Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.
British Journal of Psychiatry, 184 : 231-
9
- Year: 2004
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Morrison, Anthony P., French, Paul, Walford, Lara, Lewis, Shon W., Kilcommons, Aoiffe, Green, Joanne, Parker, Sophie, Bentall, Richard P.
Background: Advances in the ability to identify people at high risk of developing
psychosis have generated interest in the possibility of preventing psychosis. Aims: To evaluate the efficacy of cognitive therapy for the prevention
of transition to psychosis. Method: A randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultrahigh risk
of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months.
Results: Logistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined
on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic
medication and of meeting criteria for a DSM-IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also
significantly improved positive symptoms of psychosis in this population over the 12-month period Conclusions: Cognitive therapy appears to be an
acceptable and efficacious intervention for people at high risk of developing psychosis. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
(journal abstract).
British Journal of
Psychiatry, 185(4) : 291-297
- Year: 2004
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Green, Alan I., Tohen, Mauricio F., Hamer, Robert M., Strakowski, Stephen M., Lieberman, Jeffrey A., Glick, Ira, Clark, W. Scott, HgdhResearchGroup
BACKGROUND: Co-occurring substance use
disorders, mostly involving alcohol, cannabis or cocaine, occur commonly in patients with schizophrenia and are associated with increased morbidity
and mortality. Available but limited data suggest that substance use disorders (especially cannabis use disorders) may also be common in first-
episode patients and appear linked to a poor outcome in these patients. Strategies to curtail substance use form an important dimension of the
treatment program for both first-episode and chronic patients. We report on rates of co-occurring substance use disorders in patients within their
first episode of schizophrenia-related psychosis from a multicenter, international treatment trial of olanzapine vs. haloperidol. METHODS: The study
involved 262 patients (of 263 who were randomized and who returned for a post-randomization evaluation) within their first episode of psychosis
(schizophrenia, schizoaffective disorder or schizophreniform disorder) recruited from 14 academic medical centers in North America and Western
Europe. Patients with a history of substance dependence within 1 month prior to entry were excluded. RESULTS: Of this sample, 97 (37%) had a lifetime
diagnosis of substance use disorder (SUD); of these 74 (28% of the total) had a lifetime cannabis use disorder (CUD) and 54 (21%) had a lifetime
diagnosis of alcohol use disorder (AUD). Patients with SUD were more likely to be men. Those with CUD had a lower age of onset than those without.
Patients with SUD had more positive symptoms and fewer negative symptoms than those without SUD, and they had a longer duration of untreated
psychosis. The 12-week response data indicated that 27% of patients with SUD were responders compared to 35% of those without SUD. Patients with AUD
were less likely to respond to olanzapine than those without AUD. DISCUSSION: These data suggest that first-episode patients are quite likely to have
comorbid substance use disorders, and that the presence of these disorders may negatively influence response to antipsychotic medications, both
typical and atypical antipsychotics, over the first 12 weeks of treatment.
Schizophrenia Research, 66(2-3) : 125-35
- Year: 2004
- 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)
Keefe, Richard S., Seidman, Larry J., Christensen, Bruce K., Hamer,
Robert M., Sharma, Tonmoy, Sitskoorn, Margriet M., Lewine, Richard R., Yurgelun-Todd, Deborah A., Gur, Ruben C., Tohen, Mauricio, Tollefson, Gary D., Sanger, Todd M., Lieberman, Jeffrey A.
Objective: The effect of antipsychotic
medication on neurocognitive function remains controversial, especially since most previous work has compared the effects of novel antipsychotic
medications with those of high doses of conventional medications. This study compares the neurocognitive effects of olanzapine and low doses of
haloperidol in patients with first-episode psychosis. Method: Patients with a first episode of schizophrenia, schizoaffective disorder, or
schizophreniform disorder (N=167) were randomly assigned to double-blind treatment with olanzapine (mean modal dose= 9.63 mg/day) or haloperidol
(mean modal dose=4.60 mg/day) for the 12-week acute phase of a 2-year study. The patients were assessed with a battery of neurocognitive tests at
baseline and 12 weeks after beginning treatment. Results: An unweighted neurocognitive composite score, composed of measures of verbal fluency, motor
functions, working memory, verbal memory, and vigilance, improved significantly with both haloperidol and olanzapine treatment (effect sizes of 0.20
and 0.36, respectively, no significant difference between groups). A weighted composite score developed from a principal-component analysis of the
same measures improved to a significantly greater degree with olanzapine, compared with haloperidol. Anticholinergic use, extrapyramidal symptoms,
and estimated IQ had little effect on the statistical differentiation of the medications, although duration of illness had a modest effect. The
correlations of cognitive improvement with changes in clinical characteristics and with side effects of treatment were significant for patients who
received haloperidol but not for patients who received olanzapine. Conclusions: Olanzapine has a beneficial effect on neurocognitive function in
patients with a first episode of psychosis. However, in a comparison of the effects of olanzapine and low doses of haloperidol, the difference in
benefit is small. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract).
American Journal of
Psychiatry, 161(6) : 985-995
- Year: 2004
- 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)
Kavanagh, David J., Young, Ross, White, Angela, Saunders, John B., Wallis,
Jeff, Shockley, Natalie, Jenner, Linda, et-al
Substance misuse is common in early psychosis, and impacts
negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for
substance misuse in early psychosis (Start Over and Survive: SOS), comparing it with Standard Care (SC). Twenty-five in-patients aged 18-35 years
with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed
at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational
interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more
SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41)
declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement
and potential confounds.
Drug & Alcohol Review, 23(2) : 151-
5
- Year: 2004
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Hafner, H., Maurer, K., Ruhrmann, S., Bechdolf, A., Klosterkotter, J., Wagner, M., Maier, W., Bottlender,
R., Moller, H.
J., Gaebel, W., Wolwer, W.
As
effective and practical approaches to primary and universal prevention of psychosis are lacking, intervention efforts are targeted at the early
stages of schizophrenia to prevent (by way of secondary prevention) or postpone psychosis onset, reduce severity of illness or at least ameliorate
the social consequences involved. Early intervention requires early detection and early recognition (diagnosis) of persons at risk and early
prediction of psychosis. Within the German Research Network on Schizophrenia (GRNS) awareness programmes are being carried out in several German
cities, and these efforts are already improving utilisation of early-recognition and early-prediction services by at risk persons. The empirical
basis of developing a two-step early-recognition inventory and strategies of application will be discussed. This instrument is supplemented by a set
of cognitive tests, prospectively validated in the GRNS. Results from preliminary analysis of data covering a two-year period demonstrate that the
inventory and the cognitive tests are readily accepted. When used for screening in non-specialist settings and at the next level, i. e. at early-
recognition centres, they seem to permit identification of at-risk persons. Early intervention is being tested 1) in a randomised controlled multi-
centre trial consisting of a specially developed cognitive-behavioural therapy in the early (prepsychotic) prodromal state and 2) on additional
treatment with appropriate doses of amisulpride in the late prodromal (early psychotic) state. Preliminary data from Study 1 covering 16.3 months
show significantly fewer transitions to psychosis and from Study 2 reduced positive and negative symptoms and improved global functioning compared
with controls who had received normal clinical treatment. As a result, both the early-recognition inventory plus cognitive tests and the two therapy
strategies are feasible. We hope that the favourable trend indicated by the preliminary data will be confirmed in the final analysis planned for 2005
and the objective of implementing effective and practical secondary prevention of psychosis and its consequences will be attained.
European Archives of Psychiatry & Clinical Neuroscience., 254(2) : 117-
128
- Year: 2004
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Li, T. Y., Li, Y. Y., Wu, T. C., Yan,
W. Y., Chen, Y. H., An,
Y., Lu, C. Y., Zhu, H. L., Jiang, C. X.
Aim: To investigate the influence of early intervention on the quality of life
(QOL) in first-episode schizophrenic patients. Methods: Totally 97 patients with first episode schizophrenia were randomly divided into study group(n
= 49) and control group(n = 48). Patients in the study group received drug treatment and psychological and social interventions, while patients in
the control group received drug treatment only. All the patients were evaluated with the positive and negative symptoms scale (PANSS) and WHO Quality
of Life Survey (WHOQOL-100) before treatment and 1 year after discharge. Results: One year after discharge, the negative rating scale of PANSS in the
study group was improved obviously better than that in the control group (9.04 +/- 1.80 vs 13.20 +/- 1.90), with significant difference(t = 11.24, P
< 0.01), and QOL was remarkably enhanced except mental support, significantly different from before treatment (t = 3.85 - 26.41, P < 0.01. In the
control group, physiological field, independent field and mental support were not greatly improved(t = 7.70, 6.45, 0.64, P > 0.05). Conclusion: Early
intervention is good for the improvement of the QOL in first-episode schizophrenic patients. Copyright © 2008 Elsevier B. V., Amsterdam. All Rights
Reserved.
Zhongguo
Linchuang Kangfu, 8(18) : 3464-5
- Year: 2004
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Lieberman, Jeffrey A., Tollefson, Gary, Tohen, Mauricio, Green, Alan I., Gur, Raquel E., Kahn, Rene, McEvoy, Joseph, Perkins, Diana, Sharma, Tonmoy, Zipursky,
Robert, Wei, Hank, Hamer, Robert M., HgdhStudyGroup
OBJECTIVE: Few long-term studies have compared the efficacy and safety of typical and atypical antipsychotic medications
directly in patients with a first episode of psychosis who met the criteria for schizophrenia or a related psychotic disorder. This study compared
the acute and long-term effectiveness of haloperidol with that of olanzapine in patients with first-episode psychosis in a large, controlled clinical
trial. METHOD: Patients with first-episode psychosis (N=263) were randomly assigned under double-blind conditions to receive haloperidol or
olanzapine and were followed for up to 104 weeks. Domains measured included psychopathology, psychosocial variables, neurocognitive functioning, and
brain morphology and metabolism. This report presents data from clinical measures of treatment response and safety data from the 12-week acute
treatment phase. RESULTS: Haloperidol and olanzapine were associated with substantial and comparable baseline-to-endpoint reductions in symptom
severity, which did not differ significantly in last-observation-carried-forward analyses. However, in a mixed-model analysis, olanzapine-treated
subjects had significantly greater decreases in symptom severity as measured by the Positive and Negative Syndrome Scale total score and negative and
general scales and by the Montgomery-Asberg Depression Rating Scale but not as measured by the Positive and Negative Syndrome Scale positive scale
and by the Clinical Global Impression severity rating. Olanzapine-treated patients experienced a lower rate of treatment-emergent parkinsonism and
akathisia but had significantly more weight gain, compared with the haloperidol-treated patients. Overall, significantly more olanzapine-treated
subjects than haloperidol-treated subjects completed the 12-week acute phase of the study (67% versus 54%). CONCLUSIONS: As expected on the basis of
previous studies, both olanzapine and haloperidol were effective in the acute reduction of psychopathological symptoms in this group of patients with
first-episode psychosis. However, olanzapine had several relative advantages in therapeutic response. Although the nature of adverse events differed
between the two agents, retention in the study was greater with olanzapine. Retention in treatment is important in this patient population, given
their risk of relapse. Longer-term results are needed to determine whether treatment with atypical antipsychotics results in superior outcomes for a
first episode of schizophrenia.
American Journal of Psychiatry, 160(8) : 1396-404
- Year: 2003
- 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)
McEvoy, J., Lieberman, J. A., Perkins, D., Hamer, R. M., Sharma, T., Zipursky, R., Kahn, R., Gur, R., Centorrino,
F., Glick, I.
The aim of this study was to compare, in a large and well-controlled clinical trial, the acute and long-
term effectiveness of haloperidol and olanzapine in first episode schizophrenia and schizoaffective dis- order patients. 262 first-episode subjects
were randomly assigned under double-blind conditions to haloperidol or olanzapine and fol- lowed for up to 104 weeks. Domains measured included
treatment continuation and adherence, psychopathology, psychosocial meas- ures, neurocognitive function, brain morphology and metabolism. Both
haloperidol and olanzapine were associated with substantial and comparable reductions in symptom severity. Olanzapine treated subjects showed
significantly greater symptom decreases in mixed model analysis, lower rates of treatment-emergent Parkinsonism and akathisia and greater weight
gain. Treatment discontinuation rates were high overall with only 47 patients remaining in the study by 2 years. Retention was greater with
olanzapine. Beginning by week 6, there were more dropouts with haloperidol than olanzapine, and this difference in dropout rates widened over the
course of the study with 12% of haloperidol subjects and 24% of olanzapine subjects staying in the study at two years. The psychopathology and safety
results of through 104 weeks will be presented and discussed.
Schizophrenia
Research, 60 : 313
- Year: 2003
- 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)
Hamann, J., Kissling, W., Leucht, S., Rummel-Kluge, C.
BACKGROUND: The new generation antipsychotics are associated with a lower risk of adverse effects compared with drugs such as
haloperidol. Many treatment guidelines recommend the use of new generation ('atypical') antipsychotic drugs for people with a first episode of
schizophrenia. OBJECTIVES: To examine the effects of the new generation antipsychotics for people with a first episode of schizophrenia or
schizophrenia-like psychoses. SEARCH STRATEGY: The reviewers searched the Cochrane Schizophrenia Group's register (March 2002) and the included and
excluded studies tables of relevant Cochrane reviews, references of all relevant studies, contacted industry and authors of relevant studies to
identify further trials. SELECTION CRITERIA: Randomised clinical trials comparing new generation antipsychotics (amisulpride, clozapine, olanzapine,
quetiapine, risperidone, sulpiride, ziprasidone, zotepine) with conventional antipsychotics for people with a first episode of schizophrenia or
schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by three reviewers,
papers ordered, re-inspected and quality assessed. We independently extracted data but excluded them if loss to follow up was greater than 50%. For
homogeneous dichotomous data, we calculated the relative risk (RR), the 95% confidence interval (CI) and, where appropriate, the number needed to
treat (NNT), on an intention-to-treat basis. For continuous data, reviewers calculated weighted mean differences (WMD). MAIN RESULTS: We include two
short-term studies (total n=266), one of which was a report of a sub-group of a larger study. One compared risperidone with an average of 6 mg/day
haloperidol and the other olanzapine with an average of 11 mg/day haloperidol. Compared with olanzapine, significantly more people receiving
haloperidol left the study early (n=83, 1 RCT, RR 0.43 CI 0.3 to 0.7, NNH 3 CI 2 to 8). This was not so for the risperidone versus haloperidol
comparison (n=183, 1 RCT, RR=0.7 CI 0.4 to 1.1). In terms of global effects, studies reported no differences between risperidone and haloperidol
(n=183, RR not much improved 1.0 CI 0.6 to 1.5), and olanzapine and the same control (n=83, RR needing at least one dose of benzodiazepine 0.8 CI 0.5
to 1.1). More people allocated to olanzapine had clinically significant improvement in mental state compared with those given haloperidol (n=83, RR
no 'clinically significant improvement' 0.45 CI 0.3 to 0.7, NNH 3 CI 2 to 6). In the risperidone study, however, no such difference was apparent
(n=183, RR 'no clinically significant improvement in mental state' 0.85 CI 0.6 to 1.2). Significantly more people given haloperidol (4-16mg)
experienced at least one adverse event when compared with risperidone (4-16mg) (n=183, RR 0.9 CI 0.8 to 0.98, NNH 8 CI 4 to 50). Use of
anticholinergic medication for extrapyramidal adverse events was less prevalent for people allocated either olanzapine (n=83, RR 0.3 CI 0.2 to 0.7,
NNH 4 CI 2 to 14) or risperidone (n=183, RR 0.7 CI 0.5 to 0.9, NNH 4 CI 3 to 9) compared with those given haloperidol.There are no data at all on
outcomes such as compliance, cost, social and cognitive functioning, relapse, rehospitalisation, or quality of life. There are no medium to long-term
data. Eight ongoing studies may provide more information. REVIEWER'S CONCLUSIONS: The results of this review are inconclusive. Whether the use of
new generation antipsychotics really makes the treatment less off putting and enhances long-term compliance is unclear. Pragmatic, well-designed and
reported long-term trials would be useful to answer this question. [References: 107]
Cochrane Database of Systematic
Reviews, (4) : CD004410
- Year: 2003
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
DeHaan, L., VanBruggen, M., Lavalaye, J., Booij, J., Dingemans, P. M. A. J., Linszen, D.,
Objective: The authors tested the hypothesis
that a dopamine D2 receptor occupancy level between 60% and 70% in patients with recent-onset schizophrenia would result in optimal
subjective experience. In addition, they sought preliminary evidence on whether subjective experience is better with low-dose olanzapine than with
low-dose haloperidol. Method: Subjects (N=24) who met DSM-IV criteria for schizophrenia were randomly assigned to 6 weeks of double-blind treatment
with either olanzapine, 7.5 mg/day, or haloperidol, 2.5 mg/day. Subjective experience, psychopathology, and extrapyramidal symptoms were assessed at
baseline and at endpoint. After 6 weeks, D2 receptor occupancy was assessed with [123I]iodobenzamide single photon emission
computed tomography. Results: The two study groups were similar at baseline. After 6 weeks, patients receiving olanzapine had a significantly lower
mean dopamine D2 receptor occupancy (51.0%, range=36%-67%) than those given haloperidol (65.5%, range= 45%-75%). Receptor occupancy
between 60% and 70% was associated with optimal subjective experience, and subjective experience improved significantly in the haloperidol group.
Conclusions: A level of D2 receptor occupancy between 60% and 70% is optimal for subjective experience of patients with recent-onset
schizophrenia. Substantial interindividual variation in D2 receptor occupancy was seen at fixed low-dose levels of olanzapine and
haloperidol. Olanzapine, 7.5 mg/day, showed no superior subjective response over haloperidol, 2.5 mg/day. Olanzapine may need to be dosed higher than
7.5 mg/day for most patients with recent-onset schizophrenia, and haloperidol needs to be individually titrated in the very low dose range to reach
optimal occupancy.
American Journal of Psychiatry., 160(2) : 303-
309
- Year: 2003
- 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)