The Impact of Cannabis in the Early Stages of Schizophrenia: A 3-Year Longitudinal Study on Cannabis Influence on Relapse Rates

2017 ◽  
Vol 41 (S1) ◽  
pp. S196-S197
Author(s):  
M. Gomez Revuelta ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
V. Gajardo Galan ◽  
G. Pardo de Santayana Jenaro ◽  
...  
Keyword(s):  
Intervention Program ◽  
Response To Treatment ◽  
Rank Test ◽  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Early Stages ◽  
Increased Risk ◽  
The Impact

IntroductionThe first five years after the onset of a first episode of psychosis (FEP) are crucial for long term outcome. In this period, the risk of relapse is particularly high. Consequences of relapse include an increased risk of neurotoxicity, chronicity, hospitalization, decreased response to treatment, increased economic burden and functional impairment.ObjectivesTo discern the influence of cannabis on relapse as it may contribute to adopt specific measures in patients during early stages of the illness.Material and methodsPAFIP is an early intervention program for patients with a FEP. Between January 2005 and January 2011, 163 patients were recruited for this study. They were followed-up during 3 years at intervals of three months. The sample was divided into three groups: (1) those non-cannabis users neither before the FEP nor during follow-up (nn), (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).ResultsNo statistically significant differences between the three groups were observed but a trend (P = 0.057) towards a more enduring survival in Group 3 (sn). (Kaplan–Meier curve and detailed Log Rank Test results will be included in the final poster).ConclusionsCannabis has a detrimental effect on schizophrenia. The interruption of its use could contribute to improve the outcome of the disease, as the results of our study suggest.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The impact of Cannabis in Schizophrenia: Pafip Three-year Longitudinal Study on Outcome and Functionality After a First Episode of Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S136-S137
Author(s):  
M. Gomez Revuelta ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
M. Fernández Rodríguez ◽  
D. Abejas Díez ◽  
...  
Keyword(s):  
Intervention Program ◽  
Age Of Onset ◽  
Cannabis Use ◽  
First Episode ◽  
Long Term Outcome ◽  
Clinical Prognosis ◽  
Increased Risk ◽  
The Impact

IntroductionThe association between cannabis and psychosis makes crucial the intervention on cannabis use disorder at first episodes of psychosis (FEP), especially among young population. In this group of patients, the harmful potential of cannabis is more evident by its influence on neurodevelopment. However, the nature of the association cannabis-psychosis is not clearly described. It seems to represent a mediating factor for an increased risk of psychosis in healthy and high-risk populations, determining an earlier age of onset and worsening long term outcome.ObjectivesTo assess the impact of cannabis in terms of functional and clinical prognosis in patients recruited after a FEP.Material and methodsPAFIP is an early intervention program for early stages of psychosis. One hundred and sixty-three were included, followed-up at regular intervals of six months for three years with administration of clinical and functional scales (BPRS, SAPS, SANS, CDRS, GAF and Drake). Patients were divided into three groups: (1) those non-users neither before the onset nor during follow-up (nn) PEP, (2) consumers before the FEP and during follow-up (ss) and (3) consumers before the FEP that gave up consumption during follow-up (sn).ResultsNo statistically significant differences were observed in terms of functionality at three-year follow-up endpoint but a trend to a better-preserved functionality in the sn group. The sn group presented lower scores in scales for positive symptoms with respect to the comparison groups.ConclusionsThe interruption in cannabis use may have a beneficial effect on short-term clinical prognosis and functionality on long term.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A critical analysis of recent data on the long-term outcome of antipsychotic treatment

2018 ◽  
Vol 49 (5) ◽  
pp. 750-753 ◽  
Author(s):  
Joanna Moncrieff ◽  
Sandra Steingard
Keyword(s):  
Negative Symptoms ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Level Of Functioning ◽  
Risk Of Death ◽  
Increased Risk

AbstractNew studies of long-term outcomes claim to show that taking antipsychotics on a continuous and indefinite basis is the best approach for people diagnosed with a first episode of psychosis or schizophrenia. A 10-year follow-up of a trial of quetiapine maintenance, for example, found a higher proportion of people with a poor composite outcome in the group initially randomised to placebo. However, most people classified as showing poor outcome were rated as having a mild score on a single psychotic symptom; there were no differences in overall symptoms, positive or negative symptoms or level of functioning. Moreover, 16% of participants did not have a follow-up interview and data from the end of the original trial were used instead. A study using a Finnish database suggested that mortality and readmission were higher in people who did not start long-term antipsychotic treatment or who discontinued it as compared with long-term continuous users. However, the analysis did not control for important confounders and is likely to reflect the fact that people who do not comply with treatment are at higher risk of death due to underlying health risks and behaviours. The analysis showed a slightly higher risk of readmission among non-users of antipsychotics compared with long-term users and a more substantial increased risk among people who discontinued treatment. However, follow-up ceased at the first readmission and therefore eventual, long-term outcome was not assessed. Speed of reduction and whether it was done with or without clinical support were also not distinguished.

Long term outcome of childhood onset headache: A prospective community study

Cephalalgia ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 1159-1166 ◽  
Author(s):  
Matti Sillanpää ◽  
Maiju M Saarinen
Keyword(s):  
Young Adulthood ◽  
Childhood Onset ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Recurrent Headache ◽  
Childhood Migraine ◽  
Early School ◽  
Increased Risk

Purpose To examine prevalence, course, and long-term outcome of childhood migraine and other headaches. Method Using questionnaires, 1185 children were followed for recurrent headaches at ages seven, 14 and 32 years, respectively. Results At age seven years, 4.0% of the 1185 children (girls 3.7%, boys 4.3%) had migraine and 24% (25%/23%) had nonmigrainous headache. In adulthood, 16% (22%/8%) had migraine and 60% (64%/54%) nonmigrainous headache. Childhood migraine persisted into adulthood in 65% of females and 21% of males, and nonmigrainous headache in 62% and 59%, respectively. After childhood, 17% of females and 7% of males started to have episodes of migraine. No recurrent headache during the follow-up was reported by 11% (6%/16%). In a multivariate analysis, compared with no childhood headache, childhood migraine increased the risk of adulthood migraine by 3.36-fold (95% CI 1.94–5.82) and that of nonmigrainous headache by 1.72-fold (1.14–2.60). Discussion and conclusions Headaches are generally as common in preschool girls as boys. From early school years, headaches steadily increase up to young adulthood, but among boys the prevalence levels off after adolescence. About two thirds of children experienced changes in their headache status during a 25-year follow-up. Any kind of recurrent headache at school entry predicts an increased risk of headache in young adulthood. Special attention should be paid to girls and particularly those girls who have recurrent headache when they start school.

scholarly journals Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone

2020 ◽  
Vol 23 (4) ◽  
pp. 217-229 ◽  
Author(s):  
Marcos Gómez-Revuelta ◽  
José María Pelayo-Terán ◽  
María Juncal-Ruiz ◽  
Javier Vázquez-Bourgon ◽  
Paula Suárez-Pinilla ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Dropout Rate ◽  
Treatment Discontinuation ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Open Label ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Treatment Groups

Abstract Background Different effectiveness profiles among antipsychotics may be a key point to optimize treatment in patients suffering a first episode of psychosis to impact on long-term outcome. The aim of this study is to compare the clinical effectiveness of olanzapine, risperidone, haloperidol, aripiprazole, ziprasidone, and quetiapine in the treatment of first episode of psychosis at 3-year follow-up. Method From February 2001 to January 2011, 2 phases of a prospective, randomized, open-label study were undertaken. A total of 376 first-episode drug-naïve patients were randomly assigned to olanzapine (n = 55), risperidone (n = 63), haloperidol (n = 56), aripiprazole (n = 78), ziprasidone (n = 62), or quetiapine (n = 62) and followed up for 3 years. The primary effectiveness measure was all cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy. Results The overall dropout rate at 3 years reached 20.75%. Treatment discontinuation rates were significantly different among treatment groups (olanzapine = 69.09, risperidone = 71.43, aripiprazole = 73.08%, ziprasidone = 79.03%, haloperidol = 89.28%, and quetiapine = 95.53%) (χ2 = 79.86; P = .000). Statistically significant differences in terms of lack of efficacy, adherence, and tolerability were observed among treatment groups along the 3-year follow-up, determining significant differences in time to all-cause discontinuation (log-rank = 92.240; P = .000). Significant differences between treatments were found in the categories of sleepiness/sedation, increased sleep duration, akinesia, weight gain, ejaculatory dysfunction, extrapyramidal-symptoms, and amenorrhea. Conclusions Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first episode of psychosis in terms of effectiveness. Identifying different discontinuation patterns may contribute to optimize treatment selection after first episode of psychosis. ClinicalTrials.gov Identifier: NCT02526030 https://clinicaltrials.gov/show/NCT02526030

Implications of N-terminal pro-B-type natriuretic peptide in patients with three-vessel disease

2019 ◽  
Vol 40 (41) ◽  
pp. 3397-3405 ◽  
Author(s):  
Ce Zhang ◽  
Lin Jiang ◽  
Lianjun Xu ◽  
Jian Tian ◽  
Junhao Liu ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cardiac Death ◽  
Artery Bypass ◽  
Syntax Score ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vessel Disease ◽  
Potential Biomarker ◽  
Increased Risk

Abstract Aims Risk assessment and treatment stratification for three-vessel disease (3VD) remain challenging. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established biomarker for prognostication and treatment in heart failure. The present study aimed to evaluate the prognostic value of NT-proBNP beyond the SYNTAX score II (SSII), and its association with long-term outcome after three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and medical therapy (MT)] in a cohort of patients with 3VD. Methods and results A total of 6597 patients with available baseline NT-proBNP data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was all-cause death. Secondary endpoints included cardiac death and major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke. During a median follow-up of 7.0 years, higher NT-proBNP levels were strongly associated with increased risks of all-cause death, cardiac death, and MACCE (all adjusted P < 0.01). Moreover, NT-proBNP significantly improved discrimination and reclassification of the SSII. Notably, there was a significant interaction between NT-proBNP quartiles and treatment strategies for MACCE (P = 0.004). Revascularization was associated with lower risks of MACCE than MT, except for patients in the lowest quartile wherein no such association was observed. Among patients in the highest quartile, PCI was associated with an increased risk of MACCE compared with CABG (hazard ratio 1.43, 95% confidence interval 1.09–1.87). Conclusion N-terminal pro-BNP is a potential biomarker for risk stratification and therapeutic decision-making in patients with 3VD. Further randomized studies are needed to confirm these findings.

Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa

2019 ◽  
Vol 25 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Susana Andrés-Pepiñá ◽  
Maria Teresa Plana ◽  
Itziar Flamarique ◽  
Sonia Romero ◽  
Roger Borràs ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Control Group ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Increased Risk ◽  
A Current

Objective: To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. Methods: Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. Results: Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3–8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. Conclusion: Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.

The cannabis profile: A high-risk subtype

2017 ◽  
Vol 41 (S1) ◽  
pp. S310-S311
Author(s):  
R. Landera Rodríguez ◽  
M. Gómez Revuelta ◽  
J.L. García Egea ◽  
O. Porta Olivares ◽  
M. Juncal Ruíz ◽  
...  
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Intervention Program ◽  
Age Of Onset ◽  
Psychotic Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cannabis Consumption ◽  
Competing Interest

IntroductionThe first phase following the diagnosis of a first psychotic episode (FEP), is crucial to determine clinical and functional long-term outcome. Cannabis exerts a mediating action on the debut of the disease and determines a poor prognosis.ObjectivesThe description of a specific population profile of increased vulnerability to maintain cannabis use after a FEP could help to identify this high risk subtype of patients and speed up the implementation of specific interventions.Materials and methodsOne hundred and seventy-eight patients were recruited from PAFIP (early intervention program on FEP), obtaining detailed socio-demographic assessment. They were followed-up for a year during which cannabis consumption was assessed by Drake scale every three months. We divided the sample into two groups:– those patients who neither smoked cannabis before the FEP nor during follow-up period (nn);– consumers group: cannabis users before the FEP who kept on smoking during the follow-up period (ss) and those who smoked before the FEP and gave up consumption during follow-up (sn).ResultsStatistically significant differences between groups were observed. The consumers group (ss + sn) had an earlier age of onset, most were male, unemployed, single, prone to loneliness and they were concomitant users of alcohol and tobacco.ConclusionsThe use of cannabis has a detrimental effect on the outcome of schizophrenia. A specific and early intervention could contribute to prognostic improvements. Identifying cannabis consumption subtypes could be useful for this purpose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Impact of Smoking on Clinical Outcomes After First Episode Psychosis: Longer-Term Outcome Findings From the EPPIC 800 Follow-Up Study

2010 ◽  
Vol 6 (3-4) ◽  
pp. 212-234 ◽  
Author(s):  
Michael Berk ◽  
Lisa P. Henry ◽  
Kathryn S. Elkins ◽  
Susy M. Harrigan ◽  
Meredith G. Harris ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
First Episode Psychosis ◽  
First Episode ◽  
Term Outcome ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
The Impact

Factors predicting outcome of G1/2 GEP NET after PRRT with Lu177-octreotate.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14565-e14565 ◽  
Author(s):  
Samer Ezziddin ◽  
Mared Attassi ◽  
Charlotte Jane Yong-Hing ◽  
Amir Sabet ◽  
Hojjat Ahmadzadehfar ◽  
...  
Keyword(s):  
Performance Status ◽  
Stage Iv ◽  
Impact Factors ◽  
Rank Test ◽  
Karnofsky Score ◽  
Ki 67 ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Entire Cohort ◽  
The Impact

e14565 Background: Outcome analyses of G1/2 NEN stage IV after peptide receptor radionuclide therapy (PRRT) are still limited, especially with regard to the impact of the Ki-67 index. This study aims to establish predictors of survival. Methods: Retrospective analysis of 74 consecutive GEP NET patients undergoing PRRT with 177Lu-octreotate. Patients had unresectable metastatic disease and a G1/2 grading (33 pancreatic, 41 non-pancreatic GEP- NET), documented morphologic or clinical progression within < 12 months and/or uncontrolled disease. Response (modified SWOG criteria) was correlated with potential impact factors: origin, function, burden, and uptake of tumor, age, Ki-67-index, Karnofsky score, baseline tumor marker levels. Predictors for survival were analyzed with Kaplan-Meier curves (log-rank test) and multivariate analysis (p<0.05). Results: The response rates were 36.5% PR, 17.6% MR, 35.1% SD, and 10.8% PD for the entire cohort, 54.5% PR, 18.2% MR, 18.2% SD, and 9.1% PD for pancreatic NET, and 22.0% PR, 17.1% MR, 48.8% SD, and 12.2% PD for non-pancreatic GEP-NET. The median progression-free (PFS) and overall (OS) survival was 26 months (95% CI, 18.3 - 33.7) and 55 months (95% CI, 48.8–61.2), respectively. The only factor associated with decreased PFS was a Ki-67 index >10% (p=0.002). For OS, besides the Ki-67 index, a Karnofsky score ≤70% and a baseline NSE of >15 ng/ml independently predicted shorter survival (each p<0.005, HR 3.0 - 3.4). Patients with a Ki-67 index >10% still had a median PFS and OS of 19 and 34 months, respectively. Conclusions: This study confirms the favorable outcome of G1/2 NET after PRRT. Independent predictors of survival are the Ki-67 index, the patient‘s performance status and the baseline NSE level. Nevertheless, patients with a Ki-67 >10% may still benefit from PRRT as demonstrated by the long-term outcome.

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