Disorders - psychosis disorders
Kumra, S., Frazier, J. A., Jacobsen, L. K., McKenna, K., Gordon, C. T., Lenane, M. C., Hamburger, S. D., Smith, A. K., Albus, K. E., Alaghband-Rad, J., Rapoport, J.
L.
BACKGROUND: Childhood-onset schizophrenia
is a rare but severe form of the disorder that is often treatment-refractory. In this study, the efficacy and adverse effects of clozapine and
haloperidol were compared for children and adolescents with early-onset schizophrenia. METHODS: Twenty-one patients (mean [+/-SD] age, 14.0 +/- 2.3
years) with onset of Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition-defined schizophrenia that began by age 12 years
and who had been nonresponsive to typical neuroleptics participated in the study. Patients were randomized to a 6-week double-blind parallel
comparison of clozapine (mean [+/-SD] final dose, 176 +/- 149 mg/d), or haloperidol, (16 +/- 8 mg/d). RESULTS: Clozapine was superior to haloperidol
on all measures of psychosis (P = .04-.002). Positive and negative symptoms of schizophrenia improved. However, neutropenia and seizures were major
concerns. To date, one third of the group has discontinued using clozapine. CONCLUSIONS: Clozapine has striking superiority for positive and negative
symptoms in treatment-refractory childhood-onset schizophrenia. However, due to possibly increased toxic effects in this pediatric population, close
monitoring for adverse events is essential.
Archives of General Psychiatry, 53(12) : 1090-7
- Year: 1996
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Linszen, D., Dingemans, P., VanDerDoes, J. W., Nugter, A., Scholte, P., Lenior, R., Goldstein, M. J.
The effect of in-patient and individual orientated psychosocial intervention
(IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a
group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention
programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-
patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates
during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate.
Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation
for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may
increase stress in low EE families, thus affecting relapse in their children.
Psychological Medicine, 26(2) : 333-
42
- Year: 1996
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Lambert, T., Keks, N., McGrath, J., Catts, S., Hustig, H., Vaddadi, K., Burrows, G., Varghese, F., George, T., Kerr, K., Johnson, G., Burnett, P., Zorbas, A., Hill, C., Copolov, D.
Remoxipride, a substituted benzamide, is a selective D2 antagonist
with an atypical neuroleptic profile. Previous studies have demonstrated its antipsychotic efficacy against haloperidol and, more recently,
thioridazine. Of the 144 patients enrolled in the Australian remoxipride-thioridazine comparative trial, 28 presented for their first episode of
schizophrenia and/or had no previous neuroleptic treatment. These patients form the subject of this paper. The study found that in persons presenting
for their first admission for schizophrenia, remoxipride showed equal antipsychotic efficacy compared to thioridazine. Treatments were comparable in
terms of generating few extrapyramidal symptoms but thioridazine caused more significant general side-effects. Patients are more likely to be
compliant with remoxipride due to its tolerability. Despite remoxipride being withdrawn from the market due to a suggested association with aplastic
anaemia, this class of substituted benzamides warrants further examination as a treatment agent for first and subsequent episodic psychosis.
Human
Psychopharmacology., 10(6) : 455-460
- Year: 1995
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Rund, B. R., Moe,
L., Sollien, T., Fjell, A., Borchgrevink, T., Hallert, M., Naess, P. O.
The outcome of a psychoeducational treatment programme for very early- onset schizophrenics was compared with a
standard reference treatment. The study sample consisted of 12 patients in each group. Clinical outcome was assessed by relapses during the 2-year
treatment period and changes in psychosocial functioning as measured by the Global Assessment Scale. A cost- effectiveness analysis was also carried
out. The results indicated that the most effective programme measured by relapse was also the cheapest the psychoeducational programme. Patients with
poor premorbid psychosocial functioning benefit most from this treatment. Decisive with respect to how effective the programme can be is the
cooperativeness of patients' parents and their ability to change their emotional attitudes toward the patient.
Acta Psychiatrica Scandinavica., 89(3) : 211-
218
- Year: 1994
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Zhang, M., Wang, M., Li, J., Phillips,
M. R.
At the time of discharge from
their first stay in psychiatric hospital, 78 male schizophrenic patients were randomly assigned to a family intervention (experimental) group or a
'standard care' control group and were followed for the next 18 months. The family intervention consisted of both group and individual counselling
sessions every 1-3 months that focused on education about the illness and on methods of dealing with the patient. There was a significantly lower
rate of hospital readmission in the family intervention group than in the control group (15.4% versus 53.8%, chi 2 = 12.75, P < 0.01), and the mean
hospital-free period for those who were readmitted was significantly longer in the experimental group than in the control group (245 days versus 130
days, t = 2.91, P < 0.01). Moreover, the clinical status and overall level of functioning in patients who were not readmitted were significantly
better in experimental subjects than in control subjects. Stratified analysis showed that family intervention and regular use of medication had
independent and additive effects on the outcome. During the 18 months after the index discharge patients who did not take medication regularly and
who did not receive family intervention were 7.9 times as likely to be readmitted to hospital as patients who took medication regularly and received
family intervention.
British Journal of Psychiatry, (24) : 96-102
- Year: 1994
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Spencer, E. K., Kafantaris, V., Padron-Gayol, M. V., Rosenberg, C. R., Campbell, M.
This report presents preliminary
findings in an ongoing double-blind, placebo-controlled study of the safety and efficacy of haloperidol in hospitalized schizophrenic children. The
subjects are diagnosed schizophrenic by DSM-III-R criteria and admitted to the Bellevue Hospital Children's Inpatient Psychiatric Unit. The study is
10 weeks in duration and employs a crossover design. After a 2-week placebo baseline period, the subjects enter double-blind treatment for 8 weeks,
by random assignment receiving either haloperidol for 4 weeks followed by placebo for 4 weeks, or alternatively, placebo for 4 weeks followed by
haloperidol for 4 weeks. Dosage, regulated individually, ranges from 0.5 to 10.0 mg/day. To date, of an anticipated 20 subjects, 12 have completed
the study. These children, 9 boys and 3 girls, were ages 5.5 to 11.75 years upon study entry. Haloperidol was superior to placebo for reduction of
target symptoms with optimal haloperidol dose of 0.5 to 3.5 mg/day (0.02-0.12 mg/kg/day).
Psychopharmacology
Bulletin, 28(2) : 183-6
- Year: 1992
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation)
McCreadie, R. G., Wiles, D., Grant, S., Crockett, G. T., Mahmood, Z., Livingston, M. G., Watt, J. A., Greene, J. G., Kershaw,
P. W., Todd, N. A.
Of 49 schizophrenic patients followed up 2 years
after their first admission to hospital, 37% were well, 47% had been readmitted to hospital at some time over the 2 years, and 38% showed
schizophrenic symptoms at follow-up. A poor outcome at 2 years was associated with male sex, poor outcome after the first 5 weeks of the first
admission, negative schizophrenic symptoms on first admission, and a diagnosis of definite or probable schizophrenia using the Feighner criteria.
Only 23% were in employment. A small double-blind discontinuation study of maintenance antipsychotic medication during the second year found more
relapses in those switched to placebo medication. Repeat psychometric assessment at 2 years confirmed modest improvements found at 12 months; that
is, there was no evidence of intellectual decline. Relatives showed no more psychosocial distress than that found in a normal community sample; what
distress there was correlated with patients' schizophrenic symptoms.
Acta Psychiatrica Scandinavica, 80(6) : 597-
602
- Year: 1989
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation)
Kane, John M., Rifkin, A, Quitkin, F, Nayak, D, Ramos-Lorenzi, J
28 patients (mean age 21.5 yrs) who had recently recovered from an acute-onset, 1st episode schizophrenic illness were randomly given
fluphenazine hydrochloride, decanoate, or placebo for a 1-yr period. Seven of 17 Ss receiving placebo experienced a psychotic relapse, whereas none
of 11 drug-treated Ss experienced a relapse. 18 of the 26 Ss available for follow-up (mean interval 3.5 yrs) experienced a 2nd psychotic relapse
either during the study or afterward, and 50% of the original sample experienced a 3rd episode. (20 ref) (PsycINFO Database Record (c) 2007 APA, all
rights reserved).
Archives of General Psychiatry, 39(1) : 70-
73
- Year: 1982
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation)