COGNITIVE IMPAIRMENT AND RESPONSE TO LOW‐DOSE DEPOT CONVENTIONAL ANTIPSYCHOTIC IN A SOUTH AFRICAN COHORT OF SUBJECTS WITH FIRST‐EPISODE PSYCHOSIS

Background. Co-morbidity between substance abuse and psy- chotic disorders is high. Few studies have examined therelationship between first-episode psychosis and substance abuse. Several questions emerge from this common relationship and many of them remain unanswered.Objectives. To determine the effect of substance abuse on psychosis in terms of onset, duration, severity of symptoms, use of medication and outcome.Method. Thirty - three subjects with first-episode psychosis, as well as primary caregivers, were interviewed re g a rding substance abuse and its relation to illness. Thirty-six control subjects were also interv i e w e d .Results. Twenty-seven per cent of subjects abused substances in the 3 months before onset of illness, and 77.8% of the abusers w e re male. Subjects in the first-episode psychosis group were m o re likely to choose cannabis as their substance of abuse than c o n t rols. They also started abusing substances at a younger age than controls. Subjects with first-episode psychosis who abused substances presented at an earlier age than non-abusers. Substances affected symptoms at baseline presentation .Conclusions. Substance abuse has a significant impact on first- onset psychosis as far as age of onset and symptom severity are c o n c e rned. Subjects with an underlying vulnerability to psychosis seem to start abusing substances at an earlier age than the general population. Males are more likely to abuse substances than females.

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Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis: A Randomized, Double-Blind Trial of Olanzapine Versus Haloperidol

American Journal of Psychiatry ◽

10.1176/appi.ajp.160.8.1396 ◽

2003 ◽

Vol 160 (8) ◽

pp. 1396-1404 ◽

Cited By ~ 265

Author(s):

Jeffrey A. Lieberman ◽

Gary Tollefson ◽

Mauricio Tohen ◽

Alan I. Green ◽

Raquel E. Gur ◽

...

Keyword(s):

Antipsychotic Drugs ◽

First Episode Psychosis ◽

First Episode ◽

Double Blind Trial ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

Double Blind ◽

Blind Trial ◽

Conventional Antipsychotic ◽

Episode Psychosis

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PRIMER EPISODIO PSICÓTICO Y EL CONSUMO DE CANNABIS: ¿CUÁL ES EL IMPACTO EN LA COGNICIÓN?

10.17579/sepd2021o020 ◽

2021 ◽

Author(s):

Maria João Gonçalves ◽

Rita André ◽

Joana Romão ◽

Rodrigo Saraiva ◽

Gabriela Andrade ◽

...

Keyword(s):

Cognitive Impairment ◽

First Episode Psychosis ◽

Cannabis Use ◽

First Episode ◽

Episode Psychosis

1.Objetivos: La prevalencia del trastorno por uso de cannabis (TUC) es <10% en la población general, llegando a 27,1% en la esquizofrenia. El 64% de personas con primer episodio psicótico (PEP) consumen cannabis, el 30% de los cuales presentan TUC. Los pacientes con diagnosis de PEP tienen mayor probabilidad de presentar consumo de cannabis de alta potencia (THC > 10%). Los déficits cognitivos en pacientes con esquizofrenia (con o sin consumo de cannabis) son determinantes para su funcionamiento, y parecen estar presentes desde el PEP. Revisar el conocimiento actual acerca de la asociación entre TUC y los déficits cognitivos en personas con PEP. 2.Material y métodos: Selección de artículos científicos publicados en los últimos 6 años; recerca en bases de datos utilizando la combinación de términos MeSH: “cannabis use”, “first-episode psychosis”y “cognitive impairment”. 3.Resultados y conclusiones: Los estudios desarrollados se han centrado en la relación entre el consumo de cannabis y cognición en PEP, con la evaluación de funciones neurocognitivas a registrar mayor afección en la atención, memoria verbal y funciones executivas. Sin embargo, algunos resultados han sido contradictorios debido a fatores como: heterogeneidad de cuadros clínicos (hay estudios con un enfoque en psicosis en general, incluyendo psicosis afectivas, mientras que otros se centran específicamente en esquizofrenia o PEP); El cannabis presenta tetrahidrocanabinol (THC) y canabidiol (CBD) que pueden tener efetos opuestos en la cognición. El THC tiene un efeto prejudicial y hay evidencia de que el CBD puede mejorar la cognición. Son necesarios nuevos estudios para evaluar la asociación entre el consumo de cannabis y disfunción cognitiva. Sin embargo, las muestras deben tener un tamaño significativo, uniformidad diagnostica y deben ser controlados los fatores confundentes en las variables evaluadas. Así, deben ser estudiadas las características diferenciales entre cuadros clínicos aisladamente para que los resultados pueden ser verificados y replicados.

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Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.714878 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chen-Chung Liu ◽

Chih-Min Liu ◽

Yi-Ling Chien ◽

Yi-Ting Lin ◽

Ming H. Hsieh ◽

...

Keyword(s):

Low Dose ◽

First Episode Psychosis ◽

Fine Tuning ◽

First Episode ◽

Antipsychotic Treatment ◽

Full Time ◽

Episode Psychosis ◽

Employment Education

Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications.Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose.Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients.Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

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White Matter Integrity and Cognitive Impairment in First-Episode Psychosis

American Journal of Psychiatry ◽

10.1176/appi.ajp.2009.09050716 ◽

2010 ◽

Vol 167 (4) ◽

pp. 451-458 ◽

Cited By ~ 96

Author(s):

Roc��o Pérez-Iglesias ◽

Diana Tordesillas-Gutiérrez ◽

Philip K. McGuire ◽

Gareth J. Barker ◽

Roberto Roiz-Santiañez ◽

...

Keyword(s):

Cognitive Impairment ◽

White Matter ◽

First Episode Psychosis ◽

White Matter Integrity ◽

First Episode ◽

Episode Psychosis

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Very Low-Dose Risperidone in First-Episode Psychosis: A Safe and Effective Way to Initiate Treatment

Schizophrenia Research and Treatment ◽

10.1155/2011/631690 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Patrick D. McGorry ◽

John Cocks ◽

Paddy Power ◽

Peter Burnett ◽

Susy Harrigan ◽

...

Keyword(s):

Low Dose ◽

Chronic Schizophrenia ◽

First Episode Psychosis ◽

First Episode ◽

Psychotic Episode ◽

Open Label ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Open Label Trial ◽

Risperidone Treatment

Patients experiencing a first psychotic episode have high rates of extrapyramidal symptoms (EPSs) when treated with the doses of neuroleptics used in multiepisode or chronic schizophrenia. There is some evidence that lower doses may be equally, if not more, effective but less toxic in this population. Here, we report the results of a biphasic open label trial designed to assess the efficacy, safety, and tolerability of low-dose (2–4 mg/day) risperidone treatment in a group of 96 first-episode nonaffective psychosis patients. At the end of the trial, 62% of patients met the response criteria although approximately 80% had achieved a response at some time during the study. Reports of EPS remained low, and there were no dystonic reactions. We conclude that even at a dose of 2 mg/day, risperidone was highly effective in reducing acute symptomatology in a real world sample of young first-episode psychosis patients.

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