Prevalence of N-Methyl-d-Aspartate Receptor antibody (NMDAR-Ab) encephalitis in patients with first episode psychosis and treatment resistant schizophrenia on clozapine, a population based study

Abstract We investigated the feasibility of including plasma anti-NMDAR antibody screening in the assessment of first-episode psychosis patients in an early intervention programme in the Southern hemisphere. Anti-NMDAR IgG antibodies were assessed by ELISA in 166 patients (64.0% men), 166 matched population-based controls and 76 patients’ siblings (30.3% men). Fisher’s exact test and ANOVA were performed. Positive anti-NMDAR antibody patients were more often observed in bipolar disorder (10.0%) than schizophrenia (2.4%) or psychotic depression (3.1%), although no significant differences were observed. Our results are not conclusive regarding the inclusion of plasma anti-NMDAR IgG antibodies in differential diagnostic protocols for psychosis.

Download Full-text

Risk factors associated with treatment-resistant schizophrenia in first-episode psychosis

Revista Debates em Psiquiatria ◽

10.25118/2236-918x-7-4-1 ◽

2017 ◽

Vol Ano 7 ◽

pp. 8-12

Author(s):

Ana Beatriz de Oliveira Assis ◽

Jayse Gimenez Pereira Brandão ◽

Pedro Otávio Piva Espósito ◽

Osmar Tessari Junior ◽

Bruno Berlucci Ortiz

Keyword(s):

Risk Factors ◽

First Episode Psychosis ◽

First Episode ◽

Treatment Resistant ◽

Factors Associated ◽

Syndrome Scale ◽

Episode Psychosis ◽

Negative Syndrome

Objetivo: Ainda não está claro quais são os fatores de risco para a esquizofrenia resistente ao tratamento (ERT) em primeiro episódio psicótico (PEP). O objetivo deste trabalho é investigar indicadores de risco para ERT em PEP. Métodos: Foram selecionados 53 pacientes em primeiro episódio psicótico, com diagnóstico de esquizofrenia, que deram entrada à enfermaria de psiquiatria do Hospital das Clínicas Luzia de Pinho Melo entre 2011 e 2015. Ao ser admitido na enfermaria, o paciente era avaliado com a Escala de Sintomas para as Síndromes Positiva e Negativa (Positive and Negative Syndrome Scale – PANSS) e recebia tratamento inicial por 4 semanas. Caso sua resposta fosse inferior a 40% de redução na PANSS, o antipsicótico era trocado, e as escalas eram aplicadas novamente após mais 4 semanas. Após a falha com dois antipsicóticos, em doses plenas, por 4 semanas cada, a clozapina era introduzida, e o paciente era considerado ERT. Uma regressão logística foi aplicada onde sexo, idade de início, tempo de doença não tratada, uso de substâncias, avaliação global do funcionamento inicial e PANSS inicial total foram inseridos como variáveis independentes, e ERT foi inserida como variável dependente. Resultados: Tempo de doença não tratada apresentou significância de p = 0,038 e Exp (B) = 4,29, enquanto que PANSS total apresentou p = 0,012 e Exp (B) = 1,06. Conclusão: Identificar os fatores associados à resistência precoce ao tratamento poderia permitir aos clínicos evitar o atraso na introdução da clozapina e prevenir um pior prognóstico para esses pacientes.

Download Full-text

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

Psychological Medicine ◽

10.1017/s0033291718002933 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2091-2099 ◽

Cited By ~ 8

Author(s):

Kelly K. Anderson ◽

Ross Norman ◽

Arlene G. MacDougall ◽

Jordan Edwards ◽

Lena Palaniyappan ◽

...

Keyword(s):

Psychotic Disorder ◽

Administrative Data ◽

Catchment Area ◽

Population Based ◽

First Episode Psychosis ◽

Case Definition ◽

First Episode ◽

Affective Psychosis ◽

Health Administrative Data ◽

Episode Psychosis

AbstractBackgroundDiscrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates.MethodsWe constructed a retrospective cohort (1997–2015) of incident cases of non-affective psychosis aged 16–50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach.ResultsOur case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4–35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4–20.3).ConclusionsCase ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

Download Full-text

Clozapine use – has practice changed?

Journal of Psychopharmacology ◽

10.1177/0269881120913152 ◽

2020 ◽

Vol 34 (5) ◽

pp. 567-573

Author(s):

Roberta Rowntree ◽

Sean Murray ◽

Felicity Fanning ◽

Dolores Keating ◽

Atilla Szigeti ◽

...

Keyword(s):

Hospital Admissions ◽

First Episode Psychosis ◽

Prescribing Patterns ◽

First Episode ◽

Service Utilisation ◽

Treatment Resistant ◽

Nice Guidelines ◽

Episode Psychosis ◽

The Mean ◽

The Impact

Background: One-third of individuals with schizophrenia have treatment-resistant illness. Of these, up to 60% will respond to clozapine treatment. Aims: This study retrospectively examined clozapine prescribing patterns against National Institute for Health and Care Excellence (NICE) guidelines as treatment-resistant illness emerged in a first-episode psychosis cohort. Methods: A total of 339 individuals with a first-episode psychosis were included in the study. Clozapine prescribing patterns were compared against the NICE guidelines and the impact of clozapine use on one index of service utilisation (hospitalisation) was assessed. Results: A total of 32 individuals (9.4%) from the cohort were prescribed clozapine. The mean time to clozapine trial was 2.1 years (SD 1.95; range 0.17–6.25). The mean number of adequate trials of antipsychotic prior to starting clozapine was 2.74 (SD 1.13; range 1–5). Following clozapine initiation, mean hospital admissions per year reduced from 2.3 to 0.3 ( p=0.00). Mean hospital days pre- and post-clozapine also reduced (147 vs. 53; p=0.00). In total, 18 patients discontinued clozapine use during follow-up – 5 temporarily and 13 permanently. Conclusions: Patients are being prescribed clozapine earlier than previously demonstrated, though delays are still evident, and many patients discontinue treatment. More work needs to be undertaken to understand and address factors which lead to its discontinuation.

Download Full-text

First-episode psychosis in treatment-resistant schizophrenia: a cross-sectional study of a long-term follow-up cohort

BMC Psychiatry ◽

10.1186/s12888-018-1853-1 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Nobuhisa Kanahara ◽

Hiroshi Yamanaka ◽

Tomotaka Suzuki ◽

Masayuki Takase ◽

Masaomi Iyo

Keyword(s):

Cross Sectional Study ◽

First Episode Psychosis ◽

First Episode ◽

Sectional Study ◽

Treatment Resistant ◽

Cross Sectional ◽

Episode Psychosis ◽

Long Term Follow Up

Download Full-text

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

Psychological Medicine ◽

10.1017/s0033291717000435 ◽

2017 ◽

Vol 47 (11) ◽

pp. 1981-1989 ◽

Cited By ~ 78

Author(s):

A. Demjaha ◽

J. M. Lappin ◽

D. Stahl ◽

M. X. Patel ◽

J. H. MacCabe ◽

...

Keyword(s):

Negative Symptoms ◽

Age At Onset ◽

Treatment Resistance ◽

First Episode Psychosis ◽

First Episode ◽

Antipsychotic Treatment ◽

Treatment Resistant ◽

Illness Onset ◽

Episode Psychosis

BackgroundWe examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.MethodThe study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.ResultsFrom the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.ConclusionsThe striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

Download Full-text