Disorders - psychosis disorders
San, L., Arranz, B., Perez, V., Safont, G., Corripio,
I., Ramirez, N., Duenas, R., Alvarez, E.
The aim of this study was to compare the
12-month effectiveness of several second-generation antipsychotic drugs, with that of haloperidol in never-treated patients with first-episode
psychosis. In total, 114 patients without life time exposure to any psychotropic medication were randomized to haloperidol, olanzapine, risperidone,
quetiapine or ziprasidone. Primary outcome was time to all-cause discontinuation. Secondary outcomes included discontinuation rates and symptom
change as measured by the Positive and Negative Syndrome Scale (PANSS). The overall discontinuation rate 64%. At 12 months, the proportion of
patients discontinuing treatment was 40.0% for olanzapine, 56.5% for quetiapine, 64.0% for risperidone, 80.0% for ziprasidone and 85.7% for
haloperidol. Mean time to antipsychotic discontinuation was higher in patients randomized to second-generation antipsychotics than in those taking
haloperidol. Significantly lower discontinuation was noted in patients on olanzapine than on haloperidol, or ziprasidone. Our results suggest that
olanzapine might lead to longer treatment continuation in treatment naive FEP patients than haloperidol and, possibly ziprasidone. Global
psychopathology was significantly less reduced by haloperidol than with each individual SGA in this earliest phase of treatment. (copyright) 2012
Elsevier Ireland Ltd.
Psychiatry Research, 200(2-3) : 693-701
- Year: 2012
- 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)
Thomas, S. P., Nandhra, H. S., Singh, S. P.
Objective: To
review the evidence base for the efficacy and tolerability of antipsychotic medication for the treatment of the first episode of schizophrenia. Data
Source: MEDLINE databases were searched for published articles in English over the last 25 years, from January 1986 to January 2011, on choice of
antipsychotic treatment for the first episode of schizophrenia, with an emphasis on efficacy and tolerability of antipsychotic drugs in the acute
phase of psychotic illness. Study Selection: The keywords antipsychotic drugs and schizophrenia were used in combination with drug treatment,
pharmacologic treatment, efficacy, and tolerability in addition to atypical antipsychotics, first-generation antipsychotics, second-generation
antipsychotics, first-episode psychosis, and acute psychotic episode. Data Synthesis: At present, there is no convincing evidence to guide clinicians
in choosing a single first-line antipsychotic that is effective in treating the positive and negative symptoms of the first episode of schizophrenia.
Even though second-generation antipsychotic drugs offer potential benefits in terms of less extrapyramidal side effects and some benefits in treating
negative, affective, and cognitive symptoms, these drugs are not without their own side effects. Conclusions: With the introduction of a number of
second-generation antipsychotic drugs there have been significant advances in antipsychotic drug treatment over the last decade. Despite these
advances, there are still a number of limitations in continued use of some antipsychotic medications due to their efficacy and tolerability issues in
the acute and early maintenance phases of psychosis. Active research in this area would provide more promising results of improved efficacy and
tolerability of antipsychotic medication. (copyright) 2012 Physicians Postgraduate Press, Inc.
Primary Care Companion to the Journal of Clinical
Psychiatry, 14(1) :
- Year: 2012
- 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)
Rosenbaum, B., Harder, S., Knudsen, P., Koster, A., Lajer, M., Lindhardt, A., Valbak, K., Winther, G.
During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome
studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project
(DNS) compared psychodynamic psychotherapy for psychosis with standard treatment in patients with a first-episode schizophrenia spectrum disorder.
The study was designed as a prospective, comparative, longitudinal multi-site investigation of consecutively referred patients who were included
during two years. The patients were treated with either manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment
as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale
(PANSS) and the Global Assessment of Functioning scale (GAF). The study included 269 consecutively admitted patients, age 18-35, of whom 79% remained
in the study after two years. The intervention group improved significantly on measures of both PANSS and GAF scores, with large effect sizes at two
years follow-up after inclusion. Further, improvement on GAFfunction (p = 0.000) and GAFsymptom (p = 0.010) significantly favored SPP in combination
with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for
patients with schizophrenic first-episode psychoses. (copyright) 2012 Washington School of Psychiatry.
Psychiatry, 75(4) : 331-341
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Srihari, V., Phutane, V., Breitborde, N., Tek, C., Woods, S.
Objective: To determine the
effectiveness and costs of an early intervention service (STEP) based in an urban U.S. community mental health center. Methods: This randomized
controlled trial enrolled 'first-episode psychosis' patients within 5 years of illness onset and with less than 12 weeks of antipsychotic exposure.
120 participants were referred mostly from area inpatient psychiatric units and emergency rooms and randomized to either STEP care or referral to
community providers (TAU). Main outcomes included hospital utilization (primary), ability to work or attend age-appropriate schooling on a part-time
basis ('vocational engagement'), and cost of care. Cost-effectiveness analysis relied on assessing costrelated events from administrative datasets
and structured assessments and multiplying these events by estimated mean unit costs. Results: Over the first year, STEP care resulted in a
significant reduction in inpatient utilization (67%) compared to the TAU group (43%) and significant improvement in levels of vocational engagement
(31%) compared to TAU (12%). The cost of the outpatient EI service was easily offset by reduced inpatient utilization. Conclusions: This trial
demonstrates the feasibility and cost-effectiveness of an EI service implemented in the U.S. public sector. Data from this study will be critical in
informing both service reform and health policy targeting serious mental illness in this country.
Early Intervention in Psychiatry, 6 : 106
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Urben, S., Pihet, S., Jaugey, L., Halfon, O., Holzer, L.
Objective: To investigate short-term outcomes of a computer-assisted cognitive remediation (CACR) for adolescents with psychotic
disorders or at high risk for psychosis. Method: Cognitive abilities and clinical status were assessed at baseline (N = 32) and at 6-month follow-up
(N = 22) after enrolment in either a CACR (treatment group) or a computer games (control group) program (8 weeks). Results: With regard to the
cognitive abilities, no amelioration was found in the control group while, in the CACR group, significant improvements in inhibition (p = 0.040) and
reasoning (p = 0.005) were observed. Furthermore, symptom severity decreased significantly in the control group (p = 0.046) and marginally in the
CACR group (p = 0.088). Improvements in cognitive abilities were not associated with symptoms' amelioration. Finally, increase in reasoning
abilities was related to the median effective work time in sessions of CACR (R = 0.64, p = 0.024). Conclusion: At follow-up, enhanced cognitive
abilities (reasoning and inhibition), which are necessary for executing higher-order goals or adapting behaviour to the ever-changing environment,
were reported in adolescents participants of the CACR. Thus, further studies are needed to confirm and extend these interesting results. (copyright)
2012 John Wiley & Sons A/S.
Acta
Neuropsychiatrica, 24(6) : 328-335
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Valencia, Marcelo, Juarez, Francisco, Ortega, Hector
This study describes an integrated treatment
approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment
conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: N = 39) or
to medication alone (control group: N = 34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed
according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to
58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental
group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group.;
Schizophrenia Research & Treatment, 2012 : 962371-
962371
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
VanDerGaag, M., Nieman, D. H., Rietdijk,
J., Dragt, S., Ising, H. K., Klaassen, R. M. C., Koeter, M., Cuijpers, P., Wunderink, L., Linszen, D. H.
Background: Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains
inconclusive. Objective: A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT]
for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects. Methods: A total of
201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a
comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months. Results: In the CBTuhr condition, 10 patients
transitioned to psychosis compared with 22 in the TAU condition ((chi) (1) 5.575, P . 03). The number needed to treat (NNT) was 9 (95% confidence
interval [CI]: 4.7-89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7
(95% CI: 3.7-71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency ((chi) (1) 3.338, P
. 06). Conclusions: Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the
transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis. (copyright) The Author 2012.
Schizophrenia Bulletin, 38(6) : 1180-
1188
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Weiden, Peter
J., Schooler, Nina R., Weedon, Jeremy C., Elmouchtari, Abdel, Sunakawa-McMillan, Ayako
Background: Because long-acting injectable (LAI) antipsychotics are largely reserved for persistently ill patients, little is known
about the use of LAIs early in the course of illness for first-episode outpatients.; Method: A prospective, open-label, randomized controlled trial
was conducted in which outpatients with first-episode DSM-IV schizophreniform disorder, schizophrenia, or schizoaffective disorder were enrolled from
December 2004 to March 2007. Participants were randomly assigned at a 2:1 ratio to a recommendation of changing to LAI risperidone microspheres
(RLAI) (n = 26) or continuing oral antipsychotic treatment (n = 11) for up to 104 weeks. Primary outcomes were time until initial nonadherence
(medication gap of = 14 days) and medication attitudes as assessed with the Rating of Medication Influences scale. Patients randomly assigned to an
RLAI recommendation could decline the recommendation, so analysis defined treatment groups by intent-to-treat and as-actually-treated.; Results:
Eighty-one percent of patients (30/37) stopped medication within 104 weeks. There was a trend toward an initial adherence benefit favoring RLAI
acceptors at 12 weeks (P = .058), but no significant difference between RLAI and oral antipsychotic treatment in time to initial nonadherence during
the overall study (P = .188). Medication attitudes did not differ between groups.; Conclusions: Acceptance of RLAI was associated with an initial
adherence benefit that was not sustained over time. Early introduction of LAI therapy did not adversely affect adherence attitudes. The small size of
the study and low power limit interpretation, but the few patients who remained adherent into a second year were all receiving RLAI. Nonadherence was
almost universal in our first-episode cohort, but nonadherence was more easily detected among first-episode patients treated with LAI therapy than it
was with oral antipsychotics.; Trial Registration: ClinicalTrials.gov identifier: NCT00220714.; © Copyright 2012 Physicians Postgraduate Press,
Inc.
Journal of Clinical Psychiatry, 73(9) : 1224-
1233
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Riedel, Michael, Mayr,
Andreas, Seemuller, Florian, Maier, Wolfgang, Klingberg, Stefan, Heuser,
Isabella, Klosterkötter, Joachim, Gastpar, Markus, Schmitt, Andrea, Sauer, Heinrich, Schneider, Frank, Gaebel, Wolfgang, Jager, Markus, Moller, Hans-Jurgen, Schennach-Wolff, Rebecca
Objective: To evaluate depressive
symptoms regarding their association with the acute outcome in first-episode schizophrenia comparing risperidone and haloperidol.; Method: A total of
274 patients were analysed within a double-blind randomized controlled trial and treated with risperidone or haloperidol. The patients were grouped
according to their baseline HAMD-21 total score in a \"depressed\" (HAMD-21 =16) or \"non-depressed\" (HAMD-21 <16) patient subgroup. PANSS,
HAMD-21, GAF, SOFAS and AIMS ratings were performed. Early response was defined as an initial 20% reduction of the PANSS total score from admission
to week 2, response as an at least 50% reduction of the PANSS total score from admission to discharge and remission according to the consensus
criteria.; Results: A total of 124 patients were classified as depressive at baseline with 22 patients still being depressive at discharge. The
depressed and non-depressed patients did not significantly differ regarding the treatment with risperidone and haloperidol (P = 0.2270). The
depressive patients suffered from significantly more suicidal tendencies (P = 0.0165), had significantly less insight into their illness (P = 0.0152)
and featured significantly worse functioning (P = 0.0066). Patients with depressive symptoms achieved remission significantly less often than non-
depressed patients.; Conclusion: The importance of a specific and adequate treatment of depressive symptoms is highlighted.;
World Journal of Biological Psychiatry, 13(1) : 30-
38
- Year: 2012
- 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)
Piskulic, D., Barbato, M., Addington, J.
Background: Deficits in cognition often precede the onset of full-blown psychosis, making cognition an
excellent treatment target. The primary aim of the project is to reduce cognitive deterioration and improve cognition among youths at CHR using
cognitive remediation and to test the efficacy of the PositScience Brain Fitness (BF) auditory training program in improving cognition of individuals
at clinical high risk of psychosis (CHR). Methods: This is a longitudinal, randomized controlled pilot trial of cognitive remediation in 36 CHR
persons. Participants are randomised to 40 hours of either the BF or a control treatment consisting of video games (VG). The primary outcome is
cognitive function, which is assessed using the MATRICS consensus cognitive battery. The secondary outcome is social and role functioning. All
assessments are performed at baseline, post treatment and 12 months after baseline. Results: A preliminary data analysis on 12 CHR individuals
suggests that for the participants in the treatment group (n = 6), there was a non signifi- cant trend for improvements on tests of working memory (M
= 44.8, SD = 10.17) and reasoning and problem solving (M = 50.6, SD = 8.75) at the completion of treatment compared to baseline (M = 39.3, SD = 16.44
and M = 44.6, SD = 14.10, respectively). More detailed data will be available at the time of this presentation. Discussion: The PositScience auditory
training program appears to be a feasible treatment option in youth at CHR of psychosis. Preliminary data suggests that this may be an effective
treatment of cognitive dysfunction in the putatively prodromal stage of psychosis.
Early Intervention in Psychiatry, 6 : 89
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Morrison, Anthony P., French, Paul, Stewart, Suzanne L. K., Birchwood, Max, Fowler, David, Gumley, Andrew I., Jones, Peter B., Bentall, Richard
P., Lewis, Shon W., Murray, Graham K., Patterson, Paul, Brunet, Kat, Conroy, Jennie, Parker, Sophie, Reilly, Tony, Byrne, Rory, Davies, Linda M., Dunn,
Graham
Objective: To determine whether
cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at
risk for serious conditions such as schizophrenia.; Design: Multisite single blind randomised controlled trial.; Setting: Diverse services at five UK
sites.; Participants: 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy
plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of
24 months.; Intervention: Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring
of mental state only.; Main Outcome Measures: Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which
provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included
emotional dysfunction and quality of life.; Results: Transition to psychosis based on intention to treat was analysed using discrete time survival
models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups
(proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes,
were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did
not differ (estimated difference at 12 months -3.00, 95% confidence interval -6.95 to 0.94) but their severity was significantly reduced in the group
assigned to cognitive therapy (estimated between group effect size at 12 months -3.67, -6.71 to -0.64, P=0.018).; Conclusions: Cognitive therapy plus
monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young
people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state
concept.; Trial Registration: Current Controlled Trials ISRCTN56283883.;
BMJ, 344 : e2233-e2233
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Seida, J. C., Schouten, J. R., Boylan, K., Newton,
A. S., Mousavi, S. S., Beaith, A., Vandermeer, B., Dryden, D. M., Carrey, N.
BACKGROUND AND OBJECTIVE: Despite increasing on-label and
offlabel use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and
safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged (less-
than or equal to)24 years with psychiatric and behavioral conditions. METHODS: We searched 10 databases from January 1987 to February 2011, gray
literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the
evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted metaanalyses when appropriate.
RESULTS: Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All
comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength
of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone.
Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and
disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and
tics (Tourette syndrome). CONCLUSIONS: This is the first comprehensive review comparing the effectiveness and safety across the range of
antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a
better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed. Copyright (copyright) 2012 by the American
Academy of Pediatrics.
Pediatrics, 129(3) : e771-
e784
- Year: 2012
- Problem: Bipolar Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)