Disorders - psychosis disorders
Argyriou, E., Petroggona, M., Charitaki, S., Belivanaki, M., Giannakopoulos, G., Kolaitis, G.
Background: Aripiprazole is an atypical antipsychotic
that was approved, relatively recently, for use in adolescents with schizophrenia. Objective: The aim was to discuss efficacy and tolerability issues
of aripiprazole in adolescents suffering from schizophrenia. Method: A Medline search identified only three studies and one post hoc analysis for one
of them, concerning the use of aripiprazole in adolescents with schizophrenia. Finally, one of the studies was excluded because of the small number
of cases treated with aripiprazole. Results: Based on the clinical evidence, including data from two short-terms clinical trials and one post-hoc
analysis of one of the abovementioned studies, aripiprazole seemed generally safe and well tolerated in children and adolescents. Aripiprazole at
doses of 10 to 30 mg/day was more efficacious in ameliorating the symptoms (including hostility) of schizophrenia than was placebo. It was associated
with low number and mild-to-moderate intensity of adverse events, and with no clinically relevant findings in ECGs, vital signs, and clinical
laboratory tests. The most common adverse events were extrapyramidal disorder, somnolence, and tremor. Also aripiprazole is unlikely to be associated
with hyperprolactinemia and clinically significant weight gain. Conclusion: Scant information exists to evaluate the use of aripiprazole in early-
onset schizophrenia, due to the lack of published studies. The initial encouraging results provide further support and point out the necessity for
systematic research on the efficacy and tolerability of aripiprazole in pediatric patients suffering from schizophrenia. (copyright) 2012 Bentham
Science Publishers.
Current
Psychopharmacology, 1(2) : 117-121
- Year: 2012
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Bechdolf,
A., Wagner, M., Ruhrmann, S., Harrigan, S., Putzfeld, V., Pukrop, R., Brockhaus-Dumke, A., Berning, J., Janssen, B., Decker, P., Bottlender, R., Maurer, K., Moller, H.
J., Gaebel, W., Hafner,
H., Maier, W., Klosterkotter, J.
Background: Young people with self-
experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which
most of the disability and neurobiological deficits of schizophrenia have not yet occurred. Aims: To investigate the effects of an integrated
psychological intervention (IPI), combining individual cognitive-behavioural therapy, group skills training, cognitive remediation and multifamily
psychoeducation, on the prevention of psychosis in the EIPS. Method: A randomised controlled, multicentre, parallel group trial of 12 months of IPI
v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up.
Results: A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive
counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P =
0.019). Conclusions: Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people
in an EIPS. Declaration of interest: None.
British Journal of Psychiatry, 200(1) : 22-
29
- 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), Cognitive remediation
therapy, Psychoeducation, Skills training, Supportive
therapy
Chaudhry, Imran
B., Hallak, Jaime, Husain, Nusrat, Minhas,
Fareed, Stirling, John, Richardson, Paul, Dursun, Serdar, Dunn, Graham, Deakin, Bill
The onset and early course of schizophrenia is
associated with subtle loss of grey matter which may be responsible for the evolution and persistence of symptoms such as apathy, emotional blunting,
and social withdrawal. Such 'negative' symptoms are unaffected by current antipsychotic therapies. There is evidence that the antibiotic
minocycline has neuroprotective properties. We investigated whether the addition of minocycline to treatment as usual (TAU) for 1 year in early
psychosis would reduce negative symptoms compared with placebo. In total, 144 participants within 5 years of first onset in Brazil and Pakistan were
randomised to receive TAU plus placebo or minocycline. The primary outcome measures were the negative and positive syndrome ratings using the
Positive and Negative Syndrome Scale. Some 94 patients completed the trial. The mean improvement in negative symptoms for the minocycline group was
9.2 and in the placebo group 4.7, an adjusted difference of 3.53 (s.e. 1.01) 95% CI: 1.55, 5.51; p < 0.001 in the intention-to-treat population.
The effect was present in both countries. The addition of minocycline to TAU early in the course of schizophrenia predominantly improves negative
symptoms. Whether this is mediated by neuroprotective, anti-inflammatory or others actions is under investigation.;
Journal of Psychopharmacology, 26(9) : 1185-
1193
- Year: 2012
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Ando, S., Nishida, A., Koike, S., Yamasaki, S., Ishikura, S., Aono, E., Harima,
H., Wakeshima, T., Asukai, N., Okazaki, Y.
Background: First
episode psychosis is easy to relapse during the five years since onset. Disengagement was suggested to be an important factor for exacerbation of
psychiatric symptoms. The objectives of this study were: 1) to examine whether the early intervention program prevents disengagement from treatment,
2) to investigate the effectiveness of the early intervention program for psychosis in Japan. Method: This study is a retrospective comparative
cohort study based on medical records to investigate the effectiveness of a specialized early intervention program for patients with psychosis. Study
setting was the outpatient unit in Tokyo Metropolitan Matsuzawa Hospital. The early intervention program included cognitive behavioral therapeutic
(CBT) approaches, psycho-educational approaches, family interventions, and pharmacological therapy in accordance with the guidelines for early
psychosis. The patients in the control group received treatment as usual. Both groups were followed up for twelve months. Outcome measurement
included disengagement from treatment, re-admission, and use of typical antipsychotics. Result: Disengagement rate was lower in the intervention
group than in the control group. Although there was no statistical significant difference in re-admission rate and use of typical antipsychotics,
both rates were lower in the intervention group. Conclusion: This study showed the effectiveness of the specialized treatment program in prevention
of disengagement from treatment.
Early Intervention in Psychiatry, 6 : 95
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Barrio, P., Hidalgo, D., Garcia, M., Batalla, A., Castellvi, P., Pons, A., Parellada, E.
Introduction: Long-acting
injectable antipsychotics in early-onset schizophrenia improve treatment adherence, and this may lead to decreased rates of hospital admission,
better rates of clinical remission and better psychosocial adjustment. Objectives: To compare clinical remission rates, number of hospital
readmissions and personal and social functioning after two years between patients with early-onset schizophrenia (EOS;(less-than or equal to) 2
years), either in treatment with long-acting injectable risperidone (LAIR) or oral antipsychotics (OA). Methods: This is a case-control study
comparing patients with EOS who initiated LAIR between 2004-2008 (n=26 cases) with a control group with EOS matched for age and sex (n=26 controls)
treated with OA. The PANSS was administered at baseline; after two years the PANSS, the Personal and Social Functioning Scale (PSP) and the Andreasen
remission criteria were administered. Results: The PANSS score comparison at baseline showed no significant differences between LAIR and OA groups
(79.9 vs. 88.5, respectively; CI 95%: -21.6, 4.3; p=0.185). There were statistical significant differences after two years of treatment in the PANSS
scores (47.7 vs. 66.2, respectively; CI 95%: -27.2, -9.8; p< 0.001), the PSP scores (72.4 vs. 59.7, respectively; CI 95%: 4.9, 20.7; p=0.002) and the
clinical remission rates (65.4% vs. 38.5, respectively; p=0.05). Although no statistically significant, there were differences between hospital
readmission rates (19,5% vs. 42.3%, respectively). Conclusions: Despite case-control studies limitations, data suggest that treatment with LAIR
instead of OA in EOS might improve clinical, remission and social functioning rates. This improved effectiveness might be due to a greater treatment
adherence achieved with LAIR.
European
Psychiatry, 27 :
- Year: 2012
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Frazier, J. A., Giuliano, A. J., Johnson, J. L., Yakutis,
L., Youngstrom, E. A., Breiger, D., Sikich, L., Findling, R. L., McClellan, J., Hamer, R. M., Vitiello, B., Lieberman, J. A., Hooper, S.
R.
OBJECTIVE: To assess neurocognitive outcomes following antipsychotic intervention in youth enrolled in
the National Institute of Mental Health (NIMH)-funded Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS). METHOD: Neurocognitive
functioning of youth (ages 8 to 19 years) with schizophrenia or schizoaffective disorder was evaluated in a four-site, randomized, double-blind
clinical trial comparing molindone, olanzapine, and risperidone. The primary outcomes were overall group change from baseline in neurocognitive
composite and six domain scores after 8 weeks and continued treatment up to 52 weeks. Age and sex were included as covariates in all analyses.
RESULTS: Of 116 TEOSS participants, 77 (66%) had post-baseline neurocognitive data. No significant differences emerged in the neurocognitive outcomes
of the three medication groups. Therefore, the three treatment groups were combined into one group to assess overall neurocognitive outcomes.
Significant modest improvements were observed in the composite score and in three of six domain scores in the acute phase, and in four of six domain
scores in the combined acute and maintenance phases. Partial correlation analyses revealed very few relationships among Positive and Negative
Syndrome Scale (PANSS) baseline or change scores and neurocognition change scores. CONCLUSIONS: Antipsychotic intervention in youth with early-onset
schizophrenia spectrum disorders (EOSS) led to modest improvement in measures of neurocognitive function. The changes in cognition were largely
unrelated to baseline symptoms or symptom change. Small treatment effect sizes, easily accounted for by practice effects, highlight the critical need
for the development of more efficacious interventions for the enduring neurocognitive deficits seen in EOSS. Clinical trial registry information-
Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS); http://www.clinicaltrials.gov; NCT00053703. Copyright © 2012 American Academy of
Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child and Adolescent Psychiatry, 51(5) : 496-
505
- Year: 2012
- 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)
Chen, E. Y. H., Tang, J. Y., Hui, C. L., Chiu, C. P., Lam, M. M., Law, C. W., Yew, C. W., Wong, G.
H., Chung, D. W., Tso, S., Chan, K. P., Yip, K. C., Hung, S. F., Honer, W. G.
Aim: Although phase-specific early
intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in
non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early
intervention in first-episode psychosis. Method: In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who
received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior
to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal
behaviour and service utilization from clinical records. Results: Patients in the early intervention group had longer full-time employment or study
(P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P=0.001), fewer suicides
(P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group
experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72).
Conclusions: The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with
respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate
of relapse. (copyright) 2011 Blackwell Publishing Asia Pty Ltd.
Early Intervention in
Psychiatry, 5(4) : 315-323
- Year: 2011
- Problem: Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm), Suicide or self-harm with comorbid mental disorder
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Addington, Jean, Epstein, Irvin, Liu, Lu, French,
Paul, Boydell, Katherine M., Zipursky, Robert B.
Background: Method: Results: Conclusions: There has been increasing interest in
early detection during the prodromal phase of a psychotic disorder. To date a few treatment studies have been published with some promising results
for both pharmacological treatments, using second generation antipsychotics, and psychological interventions, mainly cognitive behavioral therapy.
The purpose of this study was to determine first if cognitive behavioral therapy (CBT) was more effective in reducing the rates of conversion
compared to a supportive therapy and secondly whether those who received CBT had improved symptoms compared to those who received supportive
therapy.Fifty-one individuals at clinical high risk of developing psychosis were randomized to CBT or a supportive therapy for up to 6 months. The
sample was assessed at 6, 12 and 18 months post baseline on attenuated positive symptoms, negative symptoms, depression, anxiety and social
functioning.Conversions to psychosis only occurred in the group who received supportive therapy although the difference was not significant. Both
groups improved in attenuated positive symptoms, depression and anxiety and neither improved in social functioning and negative symptoms. There were
no differences between the two treatment groups. However, the improvement in attenuated positive symptoms was more rapid for the CBT group.There are
limitations of this trial and potential explanations for the lack of differences. However, both the results of this study and the possible
explanations have significant implications for early detection and intervention in the pre-psychotic phase and for designing future treatments.
\rCopyright © 2010 Elsevier B.V. All rights reserved.
Schizophrenia Research, 125(1) : 54-
61
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy
Bonsack, C., Gibellini-Manetti, S., Favrod, J., Montagrin, Y., Besson, J., Bovet, P., Conus, P.
Background: Cannabis use has a negative impact on psychosis. Studies are needed to explore the
efficacy of psychological interventions to reduce cannabis use in psychosis. Our aim is to study the efficacy of a specific motivational intervention
on young cannabis users suffering from psychosis. Methods: Participants (aged less than 35 years) were randomly assigned to treatment as usual (TAU)
alone, or treatment as usual plus motivational intervention (MI + TAU). TAU was comprehensive and included case management, early intervention and
mobile team when needed. Assessments were completed at baseline and at 3, 6 and12 months follow-up. Results: Sixty-two participants (32 TAU and 30 MI
+ TAU) were included in the study. Cannabis use decreased in both groups at follow-up. Participants who received MI in addition to TAU displayed both
a greater reduction in number of joints smoked per week and greater confidence to change cannabis use at 3 and 6 months follow-up, but differences
between groups were nonsignificant at 12 months. Conclusions: MI is well accepted by patients suffering from psychosis and has a short-term impact on
cannabis use when added to standard care. However, the differential effect was not maintained at 1-year follow-up. MI appears to be a useful active
component to reduce cannabis use which should be integrated in routine clinical practice. (copyright) 2011 S. Karger AG, Basel.
Psychotherapy &
Psychosomatics, 80(5) : 287-297
- Year: 2011
- Problem: Psychosis Disorders, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Boonstra, Geartsje, Burger, Huibert, Grobbee, Diederick E., Kahn, R S.
Objective: To assess the effect of withdrawal of antipsychotic treatment on relapse risk in remitted first-episode
schizophrenia patients. Methods: First-episode 1-year stable and remitted outpatients with a schizophrenic disorder were randomly allocated to
continuation of their antipsychotic regimen for at least 6 months (N = 9), or gradual withdrawal (N = 11). Primary outcome was the difference in
cumulative relapse-free survival at 9 months. Results: Recruitment was terminated prematurely on 26 October 2005. The cumulative relapse-free
survival was 88% (SE = 0.12) in the continuation and 18% (SE = 0.12) in the discontinuation group (P = 0.001) at 9 months follow-up. Conclusions:
Discontinuation of antipsychotic medication markedly increases the risk of relapse in stable remitted first-episode schizophrenia patients. In future
studies the topics of safety monitoring and sampling of patients should receive extra attention. (PsycINFO Database Record (c) 2012 APA, all rights
reserved) (journal abstract)
International Journal of Psychiatry in Clinical
Practice, 15(2) : 128-134
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Relapse prevention, First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation), Medication dose
reduction/discontinuation
Bechdolf, A., Tecic, T., Lehmkuhl, G., Walger, P., Mueller, K., Wiedemann, G., Stoesser,
D., Klingberg, S.
Objective: Treatment as usual (TAU) supplemented by cognitivebehavioral therapy (CBT)
leads to greater clinical improvement in adult patients with schizophrenia than TAU alone. Until now no cognitive-behavioral therapy for patients
with nullearly onset psychosisnull (EOP, a first episode of psychosis between 14 and 18 years) has been developed. The present project's goal is to
develop a modified cognitive-behavioral treatment (mCBT) for patients with EOP and to evaluate the acceptance, tolerability and efficacy. Methods: 49
patients were screened of which 25 were included in a randomised controlled trial. Thirteen patients were randomised into the intervention group
(mCBT + TAU) and 12 into the control group (TAU). MCBT was delivered in 20 individual sessions (plus five sessions with relatives) over a period of 9
months. Assessments were performed at baseline and monthly during treatment until treatment stopped using the PANSS Positive-Scale, Global
Functioning Scale (GAF) and Quality of Life (MSLQ). Results: The average age was 17.2 years. There were no significant differences between groups
regarding demographic and clinical features at intake. Eighty percent of planned sessions were conducted. At the descriptive level by the end of
treatment more patients in mCBT + TAU were in remission than in TAU (75% vs. 50%). Differences in GAF between groups (62.3 vs. 58.9, P = 0.13) were
in favour of mCBT. MSLQ Scores descriptively revealed advantage for the intervention group (67.4 vs. 61.6, P = 0.18). The effect sizes in the mCBT
group were moderate for GAF (d = 0.35) and MSLQ (d = 0.45). Conclusion: The pilot study has shown that mCBT is feasible, acceptable and tolerable in
adolescents with schizophrenia. The effect sizes for mCBT were moderate in several secondary outcome parameters but no statistically significant
differences between the treatment groups emerged It is likely that due to the small sample size a statistical significant difference could not be
detected.
European Archives of Psychiatry & Clinical
Neuroscience, 261 : S14
- Year: 2011
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Alvarez-Jimenez, Mario, Parker, Alexandra G., Hetrick, Sarah E., McGorry,
Patrick D., Gleeson, John F.
Objective: The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This
study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of
pharmacological and non-pharmacological interventions to prevent relapse in FEP patients. Methods: Systematic review and metaanalysis of RCTs.
Results: Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological
treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients
demonstrated the former to be more effective in preventing relapse (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.31–2.48; P < .001;
number needed to treat [NNT] = 10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse
showed no further benefits compared with specialist FEP programs (OR = 1.95, 95% CI = 0.76–5.00; P = .17), the combination of specific individual
and family intervention targeted at relapse prevention may further improve upon these outcomes (OR54.88, 95% CI = 0.97–24.60; P = .06). Only 3
small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all
individual estimates favored FGAs (OR = 2.82, 95% CI = 0.54–14.75; P = .22). Exploratory analysis involving 1055 FEP patients revealed that relapse
rates were significantly lower with second generation antipsychotics (SGAs) compared with FGAs (OR = 1.47, 95% CI = 1.07–2.01; P < .02; NNT = 10).
Conclusions: Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to
specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the
available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs
antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies
should identify those patients who may not need antipsychotic medication to be able to recover from psychosis. (PsycINFO Database Record (c) 2012
APA, all rights reserved) (journal abstract)
Schizophrenia
Bulletin, 37(3) : 619-630
- Year: 2011
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)