scholarly journals Prodromal Schizophrenia: The Dilemma of Prediction and Early Intervention

CNS Spectrums ◽  
2004 ◽  
Vol 9 (8) ◽  
pp. 578-578 ◽  
Author(s):  
Michael Davidson ◽  
Mark Weiser
Keyword(s):  
Early Intervention ◽  
Antipsychotic Drugs ◽  
Age Of Onset ◽  
Current Level ◽  
Duration Of Untreated Psychosis ◽  
Prodromal Phase ◽  
Early Course ◽  
Risk Benefit Assessment ◽  
Level Of Knowledge ◽  
Novel Antipsychotic

The notion that subtle cognitive, emotional, behavioral, and functional deviations from norms are present in many individuals several years before a formal diagnosis of schizophrenia has been around for almost a century. This notion has been at the base of the developmental hypothesis of schizophrenia and has been the impetus for the use of cognition as an endophenotype for studying the illness. The recent enthusiasm for prodromal research derives from two unrelated and controversial claims: that short duration of untreated psychosis is associated with better prognosis and that novel antipsychotic drugs have a better safety profile, supposedly enabling early intervention at a relatively lower risk of side effects to the patient.At the current level of knowledge, the risk-benefit assessment of prodromal interventions turns out to be an almost unsolvable conundrum. On one hand, the age of onset of psychosis and schizophrenia, early and mid-ado-lescence, coincides with the age at which life-long social and vocational characteristics are shaped. Any intervention that could produce even minimal delay in onset of active psychosis or ameliorate its early course might have a life-long impact. Therefore, the idea of prodromal intervention cannot be easily dismissed. On the other hand, in absence of accurate markers for imminent psychosis and strong data indicating that treatment during the prodromal phase is effective, exposing adolescents to the stigma associated with the illness and the adverse effects of antipsychotics has raised serious hesitations among many researchers and clinicians.

Epidemiology of schizophrenia. The disease model of schizophrenia in the light of current epidemiological knowledge

1995 ◽  
Vol 10 (5) ◽  
pp. 217-227 ◽  
Author(s):  
H Häfner
Keyword(s):  
Age Of Onset ◽  
Disease Model ◽  
Sound Studies ◽  
Prodromal Phase ◽  
Early Course ◽  
Brain Anomalies ◽  
Specific Disorders ◽  
Core Symptoms ◽  
The Brain ◽  
Control Study

SummaryAttempting an update of the epidemiology of schizophrenia, it is pointed out that schizophrenia seems to occur with the same core symptoms and almost at the same frequency in all countries and cultures studied. Methodologically sound studies have failed to produce evidence for a secular trend of the morbid risk. The genotype of schizophrenia is expressed as psychosis, personality disorders and non-specific disorders or it goes without manifest psychopathology. Minor brain anomalies are present in most cases. The British Child Development Study showed that behavioural, cognitive, emotional and neuromotor antecedents occur in 50% of cases, thus pointing to disordered brain development, very likely not specific to schizophrenia, since found in many other mental disorders as well. A look into the hidden early course of schizophrenia revealed a significant sex difference in age of onset and a prodromal phase of some 3 to 4 years throughout the cases. A case-control study showed that it is mainly during this early course before first admission that social disadvantage in schizophrenia arises. In the prephase a disease-related lack of social ascent plays a greater role than steps of social decline. The early social course differs between the sexes mainly due to an earlier onset of the disorder in males. The actual disease variables, that is, core symptoms and type of course, do not show any essential differences between males and females. These results indicate that schizophrenia is one of the rare uniform patterns of response of the brain, capable of being triggered by a large number of causes or favoured by non-specific risk factors. In this context the protective effect of estrogens will be discussed.

The Novel Antipsychotic Drug Cariprazine and Cognition Enhancing Drugs: Indications for Their Use as an Add-on Therapy in Schizophrenia

2020 ◽  
Vol 26 ◽  
Author(s):  
Felix-Martin Werner ◽  
Rafael Coveñas
Keyword(s):  
Clinical Trials ◽  
Maintenance Therapy ◽  
Antipsychotic Drug ◽  
Cognitive Functions ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Therapeutic Effects ◽  
Treatment Resistant ◽  
Long Acting ◽  
Novel Antipsychotic

Background: Schizophrenia and schizoaffective disorder are treated with antipsychotic drugs. Some patients show treatment-resistant forms of psychotic disorders and, in this case, they can be treated with clozapine. In these patients and based on previous reviews on novel antipsychotic drugs, it is important to know whether an add-on therapy with new drugs can ameliorate the positive and negative schizophrenic scale (PANSS) total score. Objective: The aim of this review is to suggest an appropriate treatment for patients with treatment-resistant forms of psychotic disorders. A combination of current available antipsychotic drugs with novel antipsychotic or modulating drugs might improve negative schizophrenic symptoms and cognitive function and thereby social functioning and quality of life. Results: The mechanisms of action, the therapeutic effects and the pharmacokinetic profiles of novel antipsychotic drugs such as cariprazine, brexipiprazole and lumateperone are up-dated. Published case reports of patients with treatmentresistant psychoses are also discussed. These patients were treated with clozapine but a high PANSS total score was observed. Only an add-on therapy with cariprazine improved the score and, above all, negative schizophrenic symptoms and cognitive functions. To ensure a constant antipsychotic drug concentration, long-acting injectable antipsychotic drugs may be a choice for a maintenance therapy in schizophrenia. New modulating drugs, such as receptor positive allosteric modulators (N-methyl-D-aspartate receptor; subtype 5 of the metabotropic glutamatergic receptor) and encenicline, an alpha7 nicotinic cholinergic receptor agonist, are being investigated in preclinical and clinical trials. Conclusion: In clinical trials, patients with treatment-resistant forms of psychosis should be examined to know whether a combination therapy with clozapine and a novel antipsychotic drug can ameliorate the PANSS total score. In schizophrenia, long-acting injectable antipsychotic drugs are a safe and tolerable maintenance therapy. In further clinical studies, it should be investigated whether patients with treatment-resistant forms of psychoses can improve negative schizophrenic symptoms and cognitive functions by an add-on therapy with cognition enhancing drugs.

Evaluating the Importance of Reducing the Duration of Untreated Psychosis

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A145-A149 ◽  
Author(s):  
Patrick D. McGorry
Keyword(s):  
Early Intervention ◽  
Treatment Delay ◽  
Duration Of Untreated Psychosis ◽  
Design Studies ◽  
Research Designs ◽  
Strong Candidate ◽  
The Impact

Objective The concept of duration of untreated psychosis or DUP has been a strong candidate for intervention as part of the early intervention paradigm. However, its importance has been questioned. This paper aims to present selected issues concerning attempts to reduce DUP and evaluate the impact of these attempts. Method Current research designs are critiqued and alternatives considered. Results Evidence suggests that it is difficult to design studies that are both ethical and potent enough to determine the contribution of treatment delay to outcome. Conclusions Further research is justified but this should not obstruct commonsense service reforms.

Novel Antipsychotic Drugs

1993 ◽  
Vol 5 (1) ◽  
pp. 111-112
Author(s):  
Lewis A. Opler
Keyword(s):  
Antipsychotic Drugs ◽  
Novel Antipsychotic

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

2011 ◽  
Vol 21 (1) ◽  
pp. 47-57 ◽  
Author(s):  
G. de Girolamo ◽  
J. Dagani ◽  
R. Purcell ◽  
A. Cocchi ◽  
P. D. McGorry
Keyword(s):  
Early Intervention ◽  
Mental Disorders ◽  
Transition To Adulthood ◽  
Psychotic Disorders ◽  
Age Of Onset ◽  
Early Stage ◽  
Early Adulthood ◽  
Special Focus ◽  
Long Term Effects ◽  
Health Services Needs

Purpose of review.In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.Recent findings.The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.Summary.Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

scholarly journals Understanding Components of Duration of Untreated Psychosis and Relevance for Early Intervention Services in the Canadian Context: Comprendre les Composantes de la Durée de la Psychose Non Traitée et la Pertinence de Services D’intervention Précoce Dans le Contexte Canadien

2021 ◽  
pp. 070674372199267
Author(s):  
Ashok Malla ◽  
Manish Dama ◽  
Srividya Iyer ◽  
Ridha Joober ◽  
Norbert Schmitz ◽  
...  
Keyword(s):  
Early Intervention ◽  
Help Seeking ◽  
Multivariate Analyses ◽  
Patient Characteristics ◽  
Pathways To Care ◽  
Duration Of Untreated Psychosis ◽  
Present Sample ◽  
Early Intervention Services ◽  
Rapid Access ◽  
Intervention Services

Background: Clinical, functional, and cost-effectiveness outcomes from early intervention services (EIS) for psychosis are significantly associated with the duration of untreated psychosis (DUP) for the patients they serve. However, most EIS patients continue to report long DUP, while a reduction of DUP may improve outcomes. An understanding of different components of DUP and the factors associated with them may assist in targeting interventions toward specific sources of DUP. Objectives: To examine the components of DUP and their respective determinants in order to inform strategies for reducing delay in treatment in the context of an EIS. Methods: Help-seeking (DUP-H), Referral (DUP-R), and Administrative (DUP-A) components of DUP, pathways to care, and patient characteristics were assessed in first episode psychosis ( N = 532) patients entering an EIS that focuses on systemic interventions to promote rapid access. Determinants of each component were identified in the present sample using multivariate analyses. Results: DUP-H (mean 25.64 ± 59.00) was longer than DUP-R (mean = 14.95 ± 45.67) and DUP-A (mean 1.48 ± 2.55). Multivariate analyses showed that DUP-H is modestly influenced by patient characteristics (diagnosis and premorbid adjustment; R 2 = 0.12) and DUP-R by a combination of personal characteristics (age of onset and education) and systemic factors (first health services contact and final source of referral; R 2 = 0.21). Comorbid substance abuse and referral from hospital emergency services have a modest influence on DUP-A ( R 2 = 0.08). Patients with health care contact prior to onset of psychosis had a shorter DUP-H and DUP-R than those whose first contact was after psychosis onset (F(1, 498) = 4.85, P < 0.03 and F(1, 492) = 3.34, P < 0.07). Conclusions: Although much of the variance in DUP is unexplained, especially for help-seeking component, the systemic portion of DUP may be partially determined by relatively malleable factors. Interventions directed at altering pathways to care and promote rapid access may be important targets for reducing DUP. Simplifying administrative procedures may further assist in reducing DUP.

scholarly journals Drug resistance of M. tuberculosis (historical aspects, current level of knowledge)

2020 ◽  
Vol 98 (1) ◽  
pp. 54-61
Author(s):  
I. A. Burmistrova ◽  
A. G. Samoylova ◽  
T. E. Tyulkova ◽  
E. V. Vaniev ◽  
G. S. Balasanyants ◽  
...  
Keyword(s):  
Drug Resistance ◽  
20Th Century ◽  
Current Level ◽  
Drug Resistant ◽  
Historical Aspects ◽  
Level Of Knowledge ◽  
New Research

The review presents data on the frequency of detection of drug resistant (DR) tuberculosis mycobacteria (MTB) as well as on the change in DR patterns in Russia and abroad from the mid-50s of the 20th century till the present. Along with the well-known mechanisms for DR MTB development, it tells about new research describing mutations associated with drug resistance.

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