What Antipsychotic is More Effective? Pafip Three Years Longitudinal Study Comparing Haloperidol, Risperidone, Olanzapine, Quetiapine, Ziprasidone and Aripiprazole

IntroductionEarly stages after a first psychotic episode (FEP) are crucial for the prognosis of the disease. Those patients who drop out of treatment after a FEP show a significant increase in their vulnerability to relapse. Relapses associated a greater risk of neurotoxicity, chronicity, hospitalization, decrease of response to the treatment, increase of burden and functional decline.ObjectivesTo determine what antipsychotic is more effective in the prevention of relapse after a first psychotic episode.Material and methodsPAFIP is an assistance program focused on early intervention in psychosis. Between January 2001 and January 2011, 255 patients were recruited and randomly assigned to treatment with haloperidol (n = 48), olanzapine (n = 41), risperidone (n = 44), quetiapine (n = 34), ziprasidone (n = 38) and aripiprazole (n = 50). We compared the rates of relapse and remission reached by haloperidol, olanzapine, risperidone, aripiprazole, ziprasidone and quetiapine during a 3-year follow-up. All of the patients were antipsychotic naives at the beginning of the treatment.ResultsThere were no statistically significant differences in regard to the rate of clinical remission. Patients assigned to the groups of aripiprazole, olanzapine and risperidone presented a solid trend to a significantly inferior rate of discontinuation for any reason since the beginning of the treatment.ConclusionsThese data point to a greater protection against relapse and a likely better prognosis related to the use of aripiprazole, Olanzapine and risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.100 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S271-S272

Author(s):

S. Malta Vacas ◽

R. Carvalho ◽

M.J. Heitor

Keyword(s):

Great Majority ◽

First Episode ◽

Psychotic Episode ◽

Term Care ◽

First Psychotic Episode ◽

Effective Interventions ◽

Episode Psychosis ◽

Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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First Psychotic Episode and Early Intervention: An Opportunity to Change the Course of the Illness

European Psychiatry ◽

10.1016/s0924-9338(09)71358-6 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

R. Coentre ◽

D. Barrocas ◽

I. Chendo ◽

P. Levy

Keyword(s):

Early Intervention ◽

High Risk ◽

Clinical Effectiveness ◽

Psychotic Episode ◽

List Type ◽

First Psychotic Episode ◽

Effective Care ◽

Two Stages ◽

Early Intervention In Psychosis ◽

Prevention Of Relapse

Aims:Early intervention in psychosis constitutes an important opportunity to change the classic limited outcome associated with the patients who suffer of psychotic disease.Methods:Based on literature review the authors analyse the evidence for early intervention in first psychotic episode.Results:The evidence for the effectiveness of interventions in early psychosis can be considered in two stages:1.first stage before the onset of full symptoms of psychosis, in people with high risk of developing psychosis or in the prodrome phase of the illness;2.second stage includes the therapeutic focus on the period after the first psychotic episode, reducing the duration of untreated psychosis (DUP) and ameliorate the recovery.Preventing psychosis by intervene in the prodrome or in people with high risk of developing psychosis remains ethically contentious because of the non-specificity of the symptoms. by the contrary there is evidence that early and specialised intervention in first psychotic episode improves outcome. Besides the controversy of the relation between long DUP and poor outcome, there is agreement that clinicians should identify and treat psychosis early with a great impact in patients and their family's life. Effective care during first psychotic episode includes proactive engagement and initiation of low doses of antipsychotics and psychosocial treatments, aiming for maximal symptomatic and functional recovery and the prevention of relapse.Conclusion:There is evidence that early intervention in first psychotic episode improve clinical effectiveness over standard care. Further studies are important to make evidence more robust.

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Diagnostic Stability in First Psychotic Episode after 5 years follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2138 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S197-S197

Author(s):

M. Mota-Oliveira ◽

M.J. Peixoto ◽

I. Ferraz ◽

E. Pereira ◽

R. Guedes ◽

...

Keyword(s):

Health Clinic ◽

Admission Diagnosis ◽

Psychotic Episode ◽

Diagnostic Stability ◽

First Psychotic Episode ◽

Not Otherwise Specified ◽

Competing Interest ◽

Drop Outs

IntroductionThe diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.Aims and objectivesThe aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).MethodologyA retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.ResultsWe included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.ConclusionsThe diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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P.7.d.002 Longitudinal study of neurotrophic factors in children and adolescents with a first psychotic episode

European Neuropsychopharmacology ◽

10.1016/s0924-977x(07)70898-2 ◽

2007 ◽

Vol 17 ◽

pp. S576-S577

Author(s):

E. Del Moral ◽

A. Palomino ◽

C. Matute ◽

J. Palomo ◽

S. ´ Alvarez de Eulate ◽

...

Keyword(s):

Longitudinal Study ◽

Children And Adolescents ◽

Neurotrophic Factors ◽

Psychotic Episode ◽

First Psychotic Episode

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First Psychotic Episode and Predictors of Bipolar Disorder Progression

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1903 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S117-S117

Author(s):

N. Halouani ◽

K. Yaich ◽

F. Guermazi ◽

R. Ennaoui ◽

S. Chouayekh ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychotic Disorders ◽

Demographic Data ◽

Psychotic Episode ◽

Acute Psychosis ◽

Evolutionary Potential ◽

Prodromal Phase ◽

Bipolar Mood Disorder ◽

First Psychotic Episode ◽

Competing Interest

IntroductionMany studies on the identification and early treatment of psychotic disorders have focussed less on a solution to the issue of the evolution of an acute psychosis.ObjectiveTo identify some predictive elements of an evolution to bipolar disorder during a first psychotic episode.MethodsWe proceed with a retrospective study concerning 55 patients having developed a first psychotic episode and admitted in the psychiatry B department during the period extending between January 2010 and December 2015. Data were collected on a predetermined questionnaire exploring the following items (socio-demographic data, personal and psychiatric family antecedent, prodromes and psychotic episode symptomatology).ResultsOur sample was composed by 55 patients divided into 74% (n = 41) men and 26% (n = 14) women with a mean age of 26.5 ± 6.27 years. The evolution to a bipolar mood disorder concerned 22% of patients. The prodromal phase was always present. Prodromes correlated with progression to bipolar disorder are: thymic symptoms 44.1% of patients (P = 0.001), modification of volition 42.9% (P = 0.05), anger/irritability 66.7% (P = 0.032) and sadness 83.3% of patients (P = 0.05). Psychotic episode's symptoms correlated with the evolution towards a bipolar disorder corresponded to thymic symptoms. The latter was present in 44.1% of patients (P = 0.01).ConclusionThrough our study, we were able to identify some factors positively correlated with a progression towards bipolarity during a first psychotic disorder. So it would be important to monitor closely and to educate our patients and their families about the evolutionary potential of a first psychotic episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The cannabis profile: A high-risk subtype

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.212 ◽

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.

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is the Brief Psychotic Disorder a Distinct Nosologic Entity?: A Longitudinal Study of 80 Patients

European Psychiatry ◽

10.1016/s0924-9338(09)71421-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

L. Rodriguez Incio ◽

I. Grande Fullana ◽

V. Sánchez Gistau ◽

M. Bernardo Arroyo ◽

E. Parellada Rodón

Keyword(s):

Longitudinal Study ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Psychiatric Inpatient ◽

Psychotic Episode ◽

Inpatient Service ◽

Brief Psychotic Disorder ◽

Dsm Iv ◽

Nosologic Entity

Introduction:The DSM-IV-TR category “brief psychotic disorder” includes different concepts that have been defined before like bouffée délirante, cycloid psychosis and “acute and transient psychosis” in the last ICD-10. Limited prospective studies have been done, and they all show a marked diagnostic instability during follow-up. According to that, its independent nosologic entity is still uncertain.Aims:To determine the diagnostic stability of the brief psychotic disorders as well as their distinct clinical features.Method:Observational, retrospective, longitudinal study of 80 consecutive patients admitted at the acute psychiatric inpatient service of a general hospital between 2000 and 2006. at discharge, all of them fulfilled diagnostic criteria for “brief psychotic disorder” according to DSM-IV. Demographic and psychopathological data were analysed.Results:Mean age (SD) was 31.3 (9.5), most of them women (63%). the most frequent previous stressor was related to labour, while up to 45% didn't report any. 51% had no psychiatric family history. 15 (19%) patients previously had a brief psychotic episode. Psychopathological disturbances identified were: thought disorder 69%, anxiety 66.6%, insomnia 57.7%, suspiciousness 53.5%, rapidly changing delusions 53.3% (paranoid contents 75.3%), perplexity 46.5%, auditory hallucinations 45.1%, mood lability 36.6%, elation 23.9%, depressed mood 22.5% and irritability 12.7%. in the 24 month follow-up, 32.5% changed diagnosis to schizophrenia, 3"9% to schizoaffective, 10% to bipolar disorder and 16.9% achieved clinical remission. 28.5% were lost to follow-up.Conclusion:“Brief psychotic disorder” category is still uncertain and more data may be necessary to clarify if it should remain as a distinct nosologic entity.

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From ADHD to psychosis… executive functions and time

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1252 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S353-S353

Author(s):

C.D.M. Isabel

Keyword(s):

Executive Functions ◽

Psychotic Disorders ◽

Stressful Life Event ◽

Auditory Hallucination ◽

First Episode ◽

Psychotic Episode ◽

Positive Symptoms ◽

Memory Work ◽

First Psychotic Episode ◽

Competing Interest

IntroductionCognitive impairment is present from the early stages of psychotic disorders. Alterations are found mainly in areas of attention, memory work and executive functions. During adolescence, ADHD patients often suffer from secondary disorders to lack of efficient procurement processes information by the poor development of executive functions.ObjectiveEvaluation of a patient whose diagnosis of ADD evolve to acute psychotic episode.MethodReview by clinical and psychometric tests developments in executive functions disorders.ResultsTwelve years old patient who comes to the hospital since 2012, was initially diagnosed with literacy difficulties and low academic performance, after MFF-20 speaks of Learning Disabilities. It presents lack of motivation, apathy, difficulty in scheduling and organization and adherence to schedules, so they diagnosed ADD. It is given treatment with methylphenidate and atomoxetine, presenting erratic path.After a year without treatment and the presence of a major stressful life event, at 17, has a first episode, consisting in mutiste attitude, phenomena of self-referenciality, experiences of control, enforcement and dissemination of ideas and auditory hallucination imperative type.ConclusionsThe presence of emocional dysregulation and alterations in the executive functions atribuyen to ADD, in this case, were premorbid symtomatology of a first psychotic episode. The presence of positive symptoms allows to clarify the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment efficacy with paliperidone palmitate in patients after the first psychotic episode

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1995 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S539-S540

Author(s):

S. Galiano Rus ◽

A. Soler Iborte ◽

S. García Marín

Keyword(s):

Evolutionary Process ◽

Monitoring And Evaluation ◽

Paliperidone Palmitate ◽

Average Score ◽

Psychotic Episode ◽

Hospital Unit ◽

First Psychotic Episode ◽

Competing Interest ◽

Clinically Significant ◽

Mental Health Hospital

ObjectivesTo evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.Materials and methodsTwo-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.ResultsAverage scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.ConclusionThe results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The relevance of Paraphrenia: Case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1235 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S699-S699

Author(s):

M. Peixoto ◽

M.M. Oliveira ◽

M. Bragança

Keyword(s):

Case Report ◽

Psychotic Episode ◽

Psychiatric Ward ◽

Cognitive Deterioration ◽

Medical Work ◽

First Psychotic Episode ◽

Not Otherwise Specified ◽

Personality Changes ◽

Competing Interest ◽

Disorganized Speech

IntroductionParaphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.Objectives/aimsTo report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.MethodsCase report and systematic review of the literature.ResultsWe report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.ConclusionsThe diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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