Disorders - psychosis disorders
Choi, L., Corcoran, C., Fiszdon, J., Stevens, M., Javitt, D., Deasy, M., Haber, L., Dewberry, M., Pearlson,
G.
Objective: Among individuals at clinical high risk (CHR) for psychosis, processing speed (PS) has been related to social and
role functioning regardless of conversion to schizophrenia. This information processing dysfunction is a gateway to broader behavioral deficits such
as difficulty executing social behaviors. We examined the feasibility of improving information processing relevant to social situations in CHR,
including its sustainability at 2-month follow-up, and its association with concurrent social function. Method: This was a double-blind RCT in which
62 CHR participants were randomized to Processing Speed Training (PST) or an active control matched for training format and the same dose and
duration of treatment. PST is a tablet-based program that uses pupillometry-based neurofeedback to continually adjust training parameters for an
optimal neurocognitive load and to improve visual scanning efficiency by inhibiting selection of nonessential targets and discriminating figure-
ground details. Results: The PST group showed faster motoric and nonmotoric PS at post training and 2-month follow-up. At 2 month follow-up, the PST
group reported better overall social adjustment. Changes in PS from baseline to 2 months were correlated with overall social adjustment and social
avoidance in the entire sample. Conclusions and Implications for Practice: This is the first study to test focal neurofeedback-based cognitive
training for PS deficits in the putatively prodromal phase of schizophrenia to address associated social morbidity. Targeting PS appears to be a
promising pathway to decreasing comorbidity and mitigating a risk factor for psychosis. (PsycINFO Database Record (c) 2017 APA, all rights
reserved)
Psychiatric Rehabilitation Journal, 40(1) : 33-
42
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Behan, C., Masterson, S., Clarke, M.
Aim: Although early intervention in psychosis is an accepted
policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this
model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside the
specialist stand-alone centre. Methods: A systematic search following the PRISMA guidelines was undertaken in Medline, PsycInfo, Embase and the
Cochrane trials register. The search was limited to articles in English from 1990 to end of January 2016. Inclusion criteria for the review comprised
comparative evaluations of services delivering early intervention in psychosis outside the specialist model. Exclusion criteria included prodromal
services, descriptions of services without reference to a comparator and standalone specialist services evaluated in comparison to treatment as
usual. Results: There were 637 unique citations. Twenty-eight papers were reviewed at second-stage screening. The majority were excluded as they
compared specialist early intervention with treatment as usual, did not evaluate the first episode or had no comparator. Seven peer-reviewed
publications and two conference papers fulfilled criteria evaluating models of delivering early intervention other than the specialist model.
Conclusions: There is a spaucity of evidence evaluating models other than specialist models in early intervention. Published studies are
heterogeneous in design and outcome. Although there have been two recent trials evaluating integrated early intervention in comparison with treatment
as usual, it remains unclear whether reported improved outcomes of specialist centres apply to other models. (PsycINFO Database Record (c) 2017 APA,
all rights reserved)
Early Intervention in Psychiatry, 11(1) : 3-
13
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Firth, J., Carney, R., French,
P., Elliott, R., Yung, A.
Background: Exercise has previously been
shown to reduce symptoms of schizophrenia in long-term patients, along with improving their physical health and cognitive functioning. However, the
effects of exercise in frst-episode psychosis (FEP) have not been widely investigated. Methods: Twenty-eight people with FEP participated in 10 weeks
of supervised exercise twice weekly, using activities tailored to their own choice. Participant engagement was measured, and various aspects of
physical health, mental health, and cognitive functioning were assessed. Participants were assessed at baseline, 10 weeks, and then 6 months after
the supervised intervention, and compared to a group of patients with FEP who did not receive an exercise intervention. Results: Over the 10-week
intervention, participants achieved 107 minutes (mean average) of moderate-to-vigorous exercise per week. Furthermore, at 10 weeks (ie, immediately
postintervention), there were improvements in total symptoms, negative symptoms, waist circumference, verbal memory, social cognition, and social
functioning (all P <.05). After 6 months, 55% of participants had continued to exercise. Psychiatric assessments at the 6-month follow-up showed that
positive and negative symptoms were still signifcantly lower than preintervention scores. However, post hoc analyses revealed that only those who had
maintained regular exercise over the 6 months had continued to show signifcantly reduced symptoms, whereas those who had ceased exercising had
regressed to baseline scores. Previously observed benefts of exercise for social functioning were also maintained at the follow-up, although
improvements in waist circumference and cognition were lost. Conclusion: Future research should aim to establish sustainable methods for maintaining
regular exercise and explore the effectiveness of \"step-down\" support following supervised interventions in order to improve physical health
outcomes and facilitate psychosocial recovery in FEP.
Schizophrenia Bulletin, 43(Suppl
1) : S199
- Year: 2017
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Correll, C., Kohegyi, E., Zhao,
C., Baker, R., McQuade, R., Salzman, Phyllis M. Sanchez, R., Nyilas, M., Carson, W.
Objective: To evaluate the efficacy, safety, and tolerability of aripiprazole, a dopamine D2 receptor partial agonist, as
maintenance treatment in adolescent outpatients with schizophrenia. Method: This was a multicenter, double-blind, placebo-controlled, randomized
withdrawal design trial. Participants 13 to 17 years of age with a diagnosis of schizophrenia (DSM-IV-TR) were first cross-titrated from their other
oral antipsychotic(s) (4-6 weeks), then stabilized (7-21 weeks) on oral aripiprazole 10 to 30 mg/d, and finally randomized 2:1 to continuation of
oral aripiprazole or to placebo in a double-blind maintenance phase (<= 52 weeks). The primary endpoint was time from randomization to exacerbation
of psychotic symptoms/impending relapse. Safety and tolerability were assessed. Results: Of 201 enrolled participants, 146 were randomized to
aripiprazole (n = 98) or placebo (n = 48) in the double-blind maintenance phase. Treatment with aripiprazole was associated with a significantly
longer time to exacerbation of psychotic symptoms/impending relapse compared with placebo (hazard ratio, 0.46 [95% CI = 0.24-0.88]; p = .016).
Aripiprazole was associated with lower rates of serious treatment-emergent adverse events (TEAEs) versus placebo (3.1% versus 12.5%; p = .059) and
severe TEAEs (2.0% versus 10.4%; p = .039). The rate of discontinuation due to TEAEs was lower with aripiprazole versus placebo (20.4% versus 39.6%,
p = .014; number-needed-to-harm = 5.1). The incidences of extrapyramidal symptoms, weight gain, and somnolence were similar or lower with
aripiprazole than with placebo, and no TEAEs related to elevated serum prolactin were reported. Based on Tanner staging, 27.6% of participants
treated with aripiprazole and 16.7% of those who received placebo progressed one or two stages from baseline. Conclusion: Aripiprazole was observed
to be safe and effective for the maintenance treatment of adolescents with schizophrenia. (PsycINFO Database Record (c) 2017 APA, all rights
reserved)
Journal of the American Academy of Child & Adolescent Psychiatry, 56(9) : 784-
792
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Fowler, D., Hodgekins, J., French, P., Marshall, M., Freemantle, N., McCrone, P., Everard, L., Lavis, A., Jones, P. B., Amos, T., Singh, S., Sharma, V., Birchwood, M.
Background:
Provision of early intervention services has increased the rate of social recovery in patients with first-episode psychosis; however, many
individuals have continuing severe and persistent problems with social functioning. We aimed to assess the efficacy of early intervention services
augmented with social recovery therapy in patients with first-episode psychosis. The primary hypothesis was that social recovery therapy plus early
intervention services would lead to improvements in social recovery. Methods: We did this single-blind, phase 2, randomised controlled trial
(SUPEREDEN3) at four specialist early intervention services in the UK. We included participants who were aged 16-35 years, had non-affective
psychosis, had been clients of early intervention services for 12-30 months, and had persistent and severe social disability, defined as engagement
in less than 30 h per week of structured activity. Participants were randomly assigned (1:1), via computer-generated randomisation with permuted
blocks (sizes of four to six), to receive social recovery therapy plus early intervention services or early intervention services alone.
Randomisation was stratified by sex and recruitment centre (Norfolk, Birmingham, Lancashire, and Sussex). By necessity, participants were not masked
to group allocation, but allocation was concealed from outcome assessors. The primary outcome was time spent in structured activity at 9 months, as
measured by the Time Use Survey. Analysis was by intention to treat. This trial is registered with ISRCTN, number ISRCTN61621571. Findings: Between
Oct 1, 2012, and June 20, 2014, we randomly assigned 155 participants to receive social recovery therapy plus early intervention services (n=76) or
early intervention services alone (n=79); the intention-to-treat population comprised 154 patients. At 9 months, 143 (93%) participants had data for
the primary outcome. Social recovery therapy plus early intervention services was associated with an increase in structured activity of 8.1 h (95% CI
2.5-13.6; p=0.0050) compared with early intervention services alone. No adverse events were deemed attributable to study therapy. Interpretation: Our
findings show a clinically important benefit of enhanced social recovery on structured activity in patients with first-episode psychosis who received
social recovery therapy plus early intervention services. Social recovery therapy might be useful in improving functional outcomes in people with
first-episode psychosis, particularly in individuals not motivated to engage in existing psychosocial interventions targeting functioning, or who
have comorbid difficulties preventing them from doing so. Funding: National Institute for Health Research. Copyright © 2017 The Author(s). Published
by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Lancet Psychiatry, 5 : 41-50
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Fowler, D., Hodgekins, J., French, P.
Background: Social Recovery Therapy (SRT)
is a cognitive behavioural therapy which targets young people with early psychosis who have complex problems associated with severe social
disability. This paper provides a narrative overview of current evidence for SRT and reports new data on a 2. year follow-up of participants
recruited into the Improving Social Recovery in Early Psychosis (ISREP) trial. Method: In the ISREP study 50 participants (86%) were followed up at
2. years, 15. months post treatment. The primary outcome was engagement in paid work, assessed using the Time Use Survey. Engagement in education and
voluntary work were also assessed. In addition, the Positive and Negative Syndrome Scales (PANSS) and the Beck Hopelessness Scale (BHS) were
administered. Results: 25% of individuals with non-affective psychosis in the treatment group had engaged in paid work at some point in the year
following the end of therapy, compared with none of the control group. Data from the PANSS and BHS suggested no worsening of symptoms and an
indication that gains in hope were maintained over the 15. month period following the end of therapy. Conclusion: Social Recovery Therapy is a
promising psychological intervention which may improve social recovery in individuals with early psychosis. The new data reported in this paper shows
evidence of gains in engagement in paid employment outcomes that persisted 15. months beyond the period of active intervention. Copyright © 2017
Elsevier B.V.
Schizophrenia
Research, :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Claxton, M., Onwumere, J., Fornells-Ambrojo, M.
Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in
people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia.
However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-
analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches
(using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles
published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health
Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which
was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of
treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp
target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused
criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of
treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an
effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key
therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.
(PsycINFO Database Record (c) 2017 APA, all rights reserved)
Frontiers in
Psychology, 8 : 371
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Devoe, D., Peterson, A., Addington, J.
Objective: Youth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which
have been reported (Figure Presented) to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative
symptoms remain inadequate. There has been an increased interest in negative symptom treatments, but a comprehensive assessment of intervention
studies to date is lacking. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative
symptom outcomes in youth at CHR for psychosis. Methods: The authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December
2016. Studies were selected if they included any intervention that reported changes in negative symptoms in youth at CHR for psychosis. Treatment
comparisons were evaluated using both pairwise and Bayesian network meta-analyses. Due to the differences in negative symptom scales the effect sizes
were calculated as Hedges g and reported as the standardized mean difference (SMD). Results: Of 3027 citations, 32 studies met our inclusion
criteria, including a total of 2,463 CHR participants. N-methyl-D-aspartatereceptor (NMDAR) modulators (glycine and D-serine) were associated with a
significant reduction in negative symptoms compared to placebo (SMD, -0.61; 95% CI -1.17 to -0.05; I2 = 0%, P = 0.03) and in the network meta-
analysis NMDAR modulators emerged more effective than antipsychotics, omega-3, and psychological treatments (see Fig. 2). Conclusion: This systematic
review and meta-analyses demonstrated a moderate effect size between NMDAR modulator interventions and the subsequent reduction in negative symptoms
compared to all other treatments.
European Archives of Psychiatry and Clinical Neuroscience, 267(1 (Suppl
1)) : S46-S47
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Glenthoj, L. B., Hjorthoj, C., Kristensen, T. D., Davidson, C. A., Nordentoft, M.
Cognitive deficits are prominent
features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be
the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study
systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases
MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were
peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were
identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out
of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and
processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the
domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect
the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state
of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive
remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on
multiple outcomes. Copyright © 2017 The Author(s).
npj Schizophrenia, 3(20) :
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Lambert, M., Schottle, D., Ruppelt, F., Rohenkohl, A., Sengutta, M., Luedecke, D., Nawara, L., Galling, B., Falk, A., Wittmann, L., Niehaus, V., Sarikaya, G., Rietschel, L., Gagern, C., Schulte-Markwort, M., Unger, H., Ott, S., Romer, G., Daubmann, A., Wegscheider, K., Correll, C., , Schimmelmann,
B., Wiedemann, K., Bock, T., Gallinat, J., Karow, A.
Objective: The objective of the study was to
investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early
psychosis compared to standard care (SC). Methods: ACCESS III is a prospective non-randomized historical control design 1-year study examining the
efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of >= 6 months combined symptomatic and
functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and
satisfaction with care. Results: In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted
by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted nonremission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated
a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and
GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). Conclusions: EDIC
lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC,
offering psychotherapeutic interventions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Acta Psychiatrica Scandinavica, 136(2) : 188-
200
- Year: 2017
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Case management, Other service delivery and improvement
interventions
Killackey, E., Cotton, S., Allott, K.
Background: Employment and education are highly desired goals of young
people with psychosis, however most people with psychosis do not complete education and fail to transition to employment. This study investigated the
use of Individual Placement and Support (IPS) supported employment and education to address this problem. Methods: A RCT was conducted comparing IPS
to treatment as usual (TAU) which in Australia is access to external government funded employ-ment providers. Participants were 146 young people with
frst episode psychosis. Their average age was 20.4 years, and 30.8% were female. Assessments were conducted at baseline, 6 months (end of IPS
intervention), 12 months, and 18 months. Results: There was a signifcant interaction between treatment group and time with respect to employment
outcomes, OR = 0.88, 95% CI of the OR =0.78-0.99, Wald z =-2.16, P =.031, even after controlling for baseline employment status. As is demonstrated,
the greatest difference between IPS and TAU was observed at 6 months, the predicted probability of employment for IPS was 0.67 and TAU was 0.49. The
predicted probabilities of employment in the IPS group declined over time with the TAU group at 18 months being more likely to be employed than the
IPS group although this difference was not signifcant. A similar pattern was observed for edu-cation. There was a signifcant interaction for
education, OR = 0.86 95% CI of the OR = 0.77-0.98, Wald z =-2.37, P =.018, even after controlling for baseline studying status. Conclusion: This
study lent support to the idea that IPS can be benefcial for achieving employment and education outcomes among young people with psychosis. However,
the durability of this signifcant beneft reduces over time.
Schizophrenia Bulletin, 43(Suppl 1) : S50-
S51
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational
interventions
Kreinin, A., Bawakny, N., Ritsner, M. S.
Purpose: This study aimed to examine the effect of
add-on treatment with the neurosteroid pregnenolone (PREG) on neurocognitive dysfunctions of patients with recent-onset schizophrenia (SZ) and
schizoaffective disorder (SA). Method: Sixty out- and inpatients that met DSM-IV criteria for SZ/SA were randomized to an 8-week, double-blind,
randomized, placebo-controlled, 2-center trial. Participants received either pregnenolone (50 mg/d) or placebo added on to antipsychotic medications.
Computerized Cambridge Automated Neuropsychological Test Battery measures were administered at baseline and after 4 and 8 weeks of treatment. ANOVA
and paired t- or z-tests were applied to examine between- and within-group differences over time. Results: Compared to placebo, adjunctive PREG
significantly reduced the deficits in visual attention measured with the Matching to Sample Visual Search task (p=0.002), with moderate effect sizes
(d=0.42). In addition, a significant improvement was observed from baseline to end-of-study with respect to the visual (p=0.008) and sustained
attention (Rapid Visual Information Processing, p=0.038) deficits, and executive functions (Stockings of Cambridge, p=0.049; Spatial Working Memory,
p<0.001) among patients receiving PREG but not among those receiving placebo (all p's>0.05). This beneficial effect of PREG was independent of the
type of antipsychotic agents, gender, age, education, and illness duration. Conclusions: Pregnenolone augmentation demonstrated significant
amelioration of the visual attention deficit in recent-onset SZ/SA. Long-term, large-scale studies are required to obtain greater statistical
significance and more confident clinical generalization.
Clinical Schizophrenia and Related Psychoses, 10(4) : 201-
210
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions