Disorders - psychosis disorders
Wijnen, B. F. M., Pos, K., Velthorst, E., Schirmbeck, F., Chan, H. Y., de-Haan, L., van-der-Gaag, M., Evers, S. M. A. A., Smit, F.
Background In schizophrenia spectrum disorders, negative symptoms
(e.g. social withdrawal) may persist after initial treatment with antipsychotics, much affecting the quality of life (QOL) of patients. This health-
economic study evaluated if a dedicated form of cognitive behaviour therapy for social activation (CBTsa) would reduce negative symptoms and improve
QOL in an economically sustainable way. Methods A health-economic evaluation was conducted alongside a single-blind randomised controlled trial in
two parallel groups: guideline congruent treatment as usual (TAU; n = 50) versus TAU augmented with adjunct CBTsa (n = 49). Outcomes were PANSS
negative symptom severity and EQ-5D quality adjusted life years (QALYs) gained. The health-economic evaluation was conducted both from the societal
and the health sector perspective. Results Both conditions showed improvement in the respective outcomes over the follow-up period of six months, but
QALY gains were significantly higher in the CBTsa condition compared to the TAU condition. Treatment response rate (i.e. >= 5-point decrease on the
PANSS) was not significantly different. However, the add-on CBT intervention was associated with higher costs. This did not support the idea that
CBTsa is a cost-effective adjunct. Various sensitivity analyses attested to the robustness of these findings. Conclusions In the Dutch context where
TAU for psychosis is guideline congruent and well implemented there appears no added value for adjunct CBTsa. In other settings where the treatment
for the schizophrenia spectrum disorders solely relies on antipsychotics, add-on CBTsa may lead to clinically superior outcomes, but it should still
be evaluated if adjunct CBTsa therapy is a cost-effective alternative. Copyright © 2018 Wijnen et al. This is an open access article distributed
under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
PLoS ONE, 13 (11) (no pagination)(e0206236) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Heinssen, R.
The
Recovery After an Initial Schizophrenia Episode initiative evaluated the feasibility, effectiveness, and scalability of a multi-element, team-based
approach to first episode psychosis care in the United States. The Early Treatment Program comparative effectiveness trial (RAISE-ETP) enrolled 404
participants from 34 community centers in 21 states; clinics were randomly assigned to provide specialized early intervention services (NAVIGATE; N =
17) or usual community care (N = 17). The median duration of untreated psychosis (DUP) among participants was 74 weeks. After 24 months, NAVIGATE
recipients experienced greater improvements in quality of life, psychopathology, and involvement in work or school compared with patients in
community care. In addition, NAVIGATE was more cost-effective than typical treatment. Median DUP was a significant moderator of treatment effects on
quality of life and overall symptoms, but not on employment or school attendance. Patients with shorter DUP derived substantially more benefit from
NAVIGATE compared to those with longer DUP, and participants in community care. For NAVIGATE patients with DUP <74 weeks, average annual treatment
costs were 15 percent lower compared to the annual cost of typical care. Together these findings underscore the importance of complementary
approaches for improving FEP outcomes. In 2013, the National Institute of Mental Health launched research initiatives to test feasible strategies for
reducing DUP and achieving rapid referral of persons with FEP to specialized treatment programs. The focus, methods, and preliminary findings from 10
funded projects will be presented, along with implications for reducing DUP in ~200 specialized early intervention clinics now established in the
United States.
Early Intervention in
Psychiatry, 12 (Supplement 1) : 22
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Murru, A., Carpiniello, B.
The first psychotic episode is classically viewed as a critical period which management is important in determining the long-term outcome
of the schizophrenia (SCZ). For this reason, the duration of untreated illness (DUI), defined as the interval between the onset of the psychiatric
disorder and the administration of the first pharmacological treatment, is a clinical variable that has been increasingly investigated due to its
potentially modifiable nature and its value as a predictor of outcome. DUI is poorly applicable and highly unreliable in psychosis. The present
critical review examines the impact of DUI and its more operative definition of \"duration of untreated psychosis\" (DUP) in the course and outcome
of SCZ, focusing on its epidemiologic, clinical, prognostic factors. Length of DUP has been identified as positively related to a worst treatment
response, symptom control and overall functional outcome in SCZ. Negative symptoms appear to be prominently related to longer DUP. Neuroimaging
correlates of DUP have not been clearly outlined: few of the studies considering first-episode patients and DUP showed structural abnormalities. A
low proportion of significant associations were found mostly in cerebellum and occipital lobe of patients with longer DUP. Also, evidence of an
inverse correlation between cognitive alterations and DUP is not conclusive. DUI and DUP are multidimensional constructs that imply both intrinsic,
illness related (e.g. subtle symptoms at onset) and extrinsic factors (e.g. access to mental health services), so that from its study sprouted in the
last decades First-Episode Units, aimed at providing secondary prevention in SCZ such as providing a timely diagnosis and treatment to patients
experiencing their first psychotic episode. Early intervention seems to ensure a shortened DUP, especially for people presenting with brief limited
intermittent psychotic symptoms, and, ultimately, ensure a more favorable prognosis for patients affected by SCZ. Copyright © 2016 Elsevier Ireland
Ltd
Neuroscience
Letters, 669 : 59-67
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Marchira, C. R., Suprianto, I., Subandi, M. A., Del-Vecchio-
Good, M. J., Good, B. J.
Psychoeducation of persons living with psychotic illness and their family caregivers is a long-standing and effective means of
providing information and support that benefits both families and those living with illness. However, cultural adaptation of psychoeducation and
integration into routine care in settings with very low mental health resources is rare. Purpose(s): This presentation aims to describe outcomes of
an investigation of the effectiveness of a culturally-adapted, brief interactive psychoeducation intervention for family caregivers in Java, and to
study the feasibility of integrating such interventions into routine mental health services provided by primary health care providers. Method(s): An
experimental study was conducted with pre-test and post-test assessments with 100 persons living with first episode psychotic illness and their
family caregivers. Families were randomly assigned to intervention and control groups, and psychiatric residents were trained to administer 4 weekly
interactive psychoeducation sessions with modules adapted for the local cultural setting. When the intervention was found to be feasible and
effective, a program was developed to train staff in three primary health centers to provide a similar intervention for individuals and families
registered with the primary health care center. Finding(s): The initial intervention was found to be feasible and effective, particularly in
increasing Knowledge of Schizophrenia of family members and reducing rehospitalization. Training of primary health care workers was found to be
feasible and effective. Conclusion(s): Adapting psychoeducation for individuals with psychotic illness and family caregivers is feasible and can be
integrated into primary health services in low resource settings.
Early Intervention in Psychiatry, 12 (Supplement
1) : 28
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Ahuir, M., Cabezas, A., Minano, M. J., Algora, M. J., Estrada, F., Sole, M. et al.
Metacognitive training (MCT) improves cognitive biases in psychosis. We aimed to
explore whether the effectiveness of the combination of psychoeducation and MCT group treatments on cognitive biases differed if the combination was
started by psychoeducation or by MCT. Fourty-nine stable patients with a recent-onset psychosis were randomized to two different sequences: MCT
+psychoeducation vs psychoeducation+MCT. Cognitive biases, psychopathology symptoms, insight and functioning were assessed. Cognitive biases and
depressive symptoms improved with both group interventions, without differential effects between both sequences. Our study suggests that MCT and
psychoeducation are useful in improving cognitive biases and depressive symptoms in recent-onset psychosis.
Psychiatry Research, 270 : 720-
723
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Psychoeducation
Landa, Y., Mueser, K., Jacobs, M., Jespersen, R., Wyka, K., Swiderski, C., Cahalan, C., Gossrau, J. J., Doss, A., Reyna, V., Silbersweig, D.
To decrease the severity of symptoms and functional impairment in
youth at high risk of developing psychosis we have established a comprehensive Group and Family-based Cognitive Behavioral Therapy Program (GF-CBT).
GF-CBT, which is grounded in theory and research on information processing in delusions, decision making, memory and behavioral change, teaches youth
at-risk strategies for reducing biased information processing in order to prevent the formation of delusional beliefs. Families learn CBT techniques
to support, encourage and maintain use of these skills at home. Two mixed methods studies were completed: a pilot open trial to evaluate the
program's feasibility and a pilot randomized controlled trial to evaluate its efficacy, as compared to symptom monitoring, over a 2-year follow-up.
Nineteen youth ages 12-25 and 20 family members participated. Results support the feasibility and preliminary efficacy of GF-CBT, as evidenced by
high levels of program satisfaction and significant remission rates among GF-CBT participants, with the majority no longer meeting ARMS criteria
post-CBT, and maintaining recovery at the follow-up. At post-treatment GF-CBT group showed greater decreases in positive and negative symptoms
(CAARMS) as well as improvements in functioning (SOFAS). The difference between groups increased over time. As part of the SAMHSA funded project to
improve outcomes for as many as 2,000 youth and their families affected by, or at risk of, early onset psychosis in the State of Missouri, GF-CBT has
been implemented in 3 DMH clinics. GF-CBT state-wide implantation, including clinician training and \"Train-the-Trainer\" procedures to allow
sustainability of the intervention will be discussed.
Early Intervention in Psychiatry, 12 (Supplement 1) : 183
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Schlosser, D. A., Campellone, T. R., Truong, B., Etter, K., Vergani, S., Komaiko, K., Vinogradov, S.
The onset of schizophrenia occurs during a period critical for development of social
relationships and functional independence. As such, interventions that target the early course of illness have the potential to stave off functional
decline and restore functioning to pre-illness levels. In this entirely remote study, people with recent-onset schizophrenia spectrum disorders
(SSDs) participated in a 12-week randomized controlled trial to determine the efficacy of PRIME (personalized real-time intervention for motivational
enhancement), a mobile-based digital health intervention designed to improve motivation and quality of life.
Schizophrenia Bulletin, 44(5) : 1010-
1020
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Wu, R. Q., Lin, C. G., Zhang, W., Lin, X. D., Chen, X. S., Chen, C., Zhang, L. J., Huang, Z. Y., Chen, G. D., Xu, D. L., Lin, Z. G., Zhang, M. D.
Background: Risperidone and paliperidone have been the mainstay
treatment for schizophrenia and their potential role in neuroprotection could be associated with brain-derived neurotrophic factor (BDNF) and N400
(an event-related brain potential component). So far, different effects on both BDNF and N400 were reported in relation to various antipsychotic
treatments. However, few studies have been conducted on the mechanism of risperidone and paliperidone on BDNF and N400. This study aimed to compare
the effects of risperidone and paliperidone on BDNF and the N400 component of the event-related brain potential in patients with first-episode
schizophrenia.\rMethods: Ninety-eight patients with first-episode schizophrenia were randomly divided into the risperidone and paliperidone groups
and treated with risperidone and paliperidone, respectively, for 12 weeks. Serum BDNF level, the latency, and amplitude of the N400 event-related
potential before and after the treatment and Positive and Negative Syndrome Scale (PANSS) scores were compared between the two groups.\rResults: A
total of 94 patients were included in the final analysis (47 patients in each group). After the treatment, the serum BDNF levels in both groups
increased (all P < 0.01), while no significant difference in serum BDNF level was found between the groups before and after the treatment (all P >
0.05). After the treatment, N400 amplitudes were increased (from 4.73 +/- 2.86 muv and 4.51 +/- 4.63 muv to 5.35 +/- 4.18 muv and 5.52 +/- 3.08 muv,
respectively) under congruent condition in both risperidone and paliperidone groups (all P < 0.01). Under incongruent conditions, the N400 latencies
were shortened in the paliperidone group (from 424.13 +/- 110.42 ms to 4.7.41 +/- 154.59 ms, P < 0.05), and the N400 amplitudes were increased in the
risperidone group (from 5.80 +/- 3.50 muv to 7.17 +/- 5.51 muv, P < 0.01). After treatment, the total PANSS score in both groups decreased
significantly (all P < 0.01), but the difference between the groups was not significant (P > 0.05). A negative correlation between the reduction rate
of the PANSS score and the increase in serum BDNF level after the treatment was found in the paliperidone group but not in the risperidone group.
\rConclusions: Both risperidone and paliperidone could increase the serum BDNF levels in patients with first-episode schizophrenia and improve their
cognitive function (N400 latency and amplitude), but their antipsychotic mechanisms might differ.
Chinese Medical Journal, 131(19) : 2297-
2301
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kuzman, M. R., Kuharic,
D. B., Kekin, I., Makaric, P., Madzarac, Z., Makar, A. K., et al.
Background: Antipsychotic-induced weight gain and metabolic abnormalities are one of the major challenges in the
treatment of psychosis, contributing to the morbidity, mortality and treatment non-adherence. Different approaches were used to counteract these side
effects but showed only limited or short-term effects. This study aims to analyse the effects of a long-term multimodal treatment program for first
episode psychosis on antipsychotic-induced metabolic changes. Method(s): We enrolled 71 patients with first episode psychosis treated at the Zagreb
University Hospital Centre from 2016 until 2018. Participants were assigned to one of the two groups: day hospital program vs. treatment as usual
(TAU). Outcomes were: body weight, blood glucose, lipids and cholesterol, psychopathology and global level of functioning during the 18-months
follow-up. Result(s): Although the TAU group gained more weight and had higher increase of blood glucose, while the day hospital group had a higher
increase in total cholesterol at 18th month follow-up, after the adjustment for age, gender and baseline measures, the type of treatment was not
significantly associated with any of the primary outcome measures. Patients' psychopathology measures significantly decreased and their functional
level significantly increased at month 18th in both groups. Conclusion(s): While both types of treatment were effective in reducing psychopathology
and restoring the patients' level of functioning, both were relatively ineffective in counteracting antipsychotic-induced metabolic abnormalities
and antipsychotic-induced weight gain. Copyright © 2018 Rojnic Kuzman, Bosnjak Kuharic, Kekin, Makaric, Madzarac, Koricancic Makar, Kudlek Mikulic,
Bajic, Bistrovic, Bonacin and Vogrinc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC
BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and
that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is
permitted which does not comply with these terms.
Frontiers in Psychiatry, 9 (OCT) (no
pagination)(00488) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Erickson, D., Whitehurst, D., Roes, M., Digiacomo, A.
Purpose: Although the Individual Placement and Support (IPS) strategy has
achieved 'gold standard' status for enhancing employment among older clients in the later stages of mental illness, the nature and timing of its
contributions to younger clients in the early stages of illness is less understood. This randomized controlled trial assesses the effectiveness of
the IPS model of employment support in a population-based sample of early-psychosis clients. Method(s): We have recruited 109 clients from the Fraser
Health Early Psychosis program; 55 clients received one year of IPS support and 54 received 'treatment as usual' (TAU). A variety of employment,
clinical, and service-use outcomes were assessed at 6- and 12-months; this presentation describes employment outcomes. Result(s): Over 12 months,
clients who received IPS in addition to TAU more often worked (80%) than did those receiving TAU alone (60%; chi-square = 4.50, p = .03). However,
there was no significant difference in the number of days worked (58.7 days in IPS, versus 46.4 in TAU; p = .33). Conclusion(s): When EPI clients are
ready to look for work many are successful, compared to clients in later stages of illness. In our early psychosis clients, IPS increased the
likelihood of getting work, but did not significantly affect job tenure. Further analyses will assess the nature and timing of differential
employment outcomes attributable to IPS.
Early
Intervention in Psychiatry, 12 (Supplement 1) : 209
- Year: 2018
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions
Devoe, D., Farris, M. S., Townes, P., Addington, J.
Objective: The primary objective of this systematic
review and metaanalysis was to summarize the impact of all treatments on transition to psychosis in high risk samples. Method(s): PsycINFO, Embase,
CINAHL, EBM, and MEDLINE were searched from inception to May 2017 using keywords psychosis, risk, and treatment with no language restrictions. The
following data was extracted: study characteristics (e.g., sample size), participant characteristics (e.g., mean age), and clinical outcome data
(e.g., number and percent transited for each intervention group at each time-point and transition assessment employed). Data were analyzed using
randomeffects pairwise meta-analysis, and secondly, multivariate network meta-analyses (NMA), and reported as risk ratios (RR). Result(s): A total of
38 independent studies met the inclusion criteria. In pairwise meta-analyses, CBT studies were associated with a significant reduction in transition
compared to controls at 12-month and 18-month follow-up (RR = 0.57; 95% CI, 0.35 to 0.93; I2 = 7%; P = 0.02 versus RR = 0.54; 95% CI, 0.32
to 0.92; I2 = 0%; P = 0.02). In the NMA, integrated psychological therapy, CBT, supportive therapy, family therapy, needs-based
interventions, omega-3, risperidone plus CBT, ziprasidone, and olanzapine were not significantly more effective at reducing transition at 6- and 12-
months relative to any other intervention. Conclusion(s): This systematic review and meta-analysis demonstrated a reduced risk for transition
favoring CBT at 12- and 18-months. No interventions were significantly more effective at reducing transition compared to all other interventions in
the NMA.
Early Intervention in Psychiatry, 12 (Supplement
1) : 173
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any)
Thompson, A., Winsper, C., Marwaha, S., Haynes, J., Alvarez-Jimenez, M., Hetrick, S., Realpe, A., Vail, L., Dawson, S., Sullivan, S. A.
Background
Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis
(FEP) is an important area of practice.Method A systematic review and meta-analysis. Prospective experimental studies including a parallel control
group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following
remission in FEP.Results Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290)
compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies
with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients
excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis.Conclusions There is a
higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples.
The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies.Declaration of interest A.T. has
received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted
investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has
received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended
meetings supported by Sunovion Pharmaceuticals. Copyright © The Royal College of Psychiatrists 2018.
BJPsych
Open, 4(4) : 215-225
- Year: 2018
- 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), Medication dose
reduction/discontinuation