scholarly journals Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study

CNS Spectrums ◽  
2013 ◽  
Vol 19 (5) ◽  
pp. 374-381 ◽  
Author(s):  
Jan Volavka ◽  
Pál Czobor ◽  
Leslie Citrome ◽  
Richard A. Van Dorn
Keyword(s):  
Aggressive Behavior ◽  
Antipsychotic Drugs ◽  
Phase 1 ◽  
The Other ◽  
First Episode ◽  
Intervention Effectiveness ◽  
Primary Analysis ◽  
Syndrome Scale ◽  
First Episode Schizophrenia ◽  
Negative Syndrome

IntroductionAggressive behavior can be a dangerous complication of schizophrenia. Hostility is related to aggression. This study aimed to compare the effects of olanzapine, perphenazine, risperidone, quetiapine, and ziprasidone on hostility in schizophrenia.MethodsWe used the data that were acquired in the 18-month Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. We analyzed the scores of the Positive and Negative Syndrome Scale (PANSS) hostility item in a subset of 614 patients who showed at least minimal hostility (a score ≥ 2) at baseline.ResultsThe primary analysis of hostility indicated an effect of difference between treatments (F4,1487 = 7.78, P < 0.0001). Olanzapine was significantly superior to perphenazine and quetiapine at months 1, 3, 6, and 9. It was also significantly superior to ziprasidone at months 1, 3, and 6, and to risperidone at months 3 and 6.DiscussionOur results are consistent with those of a similar post-hoc analysis of hostility in first-episode subjects with schizophrenia enrolled in the European First-Episode Schizophrenia Trial (EUFEST) trial, where olanzapine demonstrated advantages compared with haloperidol, quetiapine, and amisulpride.ConclusionOlanzapine demonstrated advantages in terms of a specific antihostility effect over the other antipsychotics tested in Phase 1 of the CATIE trial.

Eine Stellungnahme zur Debatte über die „atypischen“ Antipsychotika

2010 ◽  
Vol 07 (01) ◽  
pp. 11-17
Author(s):  
A. Schmied ◽  
W. Kissling ◽  
J. M. Davis ◽  
S. Leucht
Keyword(s):  
Antipsychotic Drugs ◽  
Second Generation ◽  
Cost Utility ◽  
First Episode ◽  
Intervention Effectiveness ◽  
Second Generation Antipsychotics ◽  
First Episode Schizophrenia

ZusammenfassungSeit etwa zehn Jahren gibt es eine kontrovers geführte Debatte über die Antipsychotika der zweiten Generation („second generation antipsychotics“, SGA) in der Schizophreniebehandlung, die in der Publikation der sogenannten Effektivitätsstudien CATIE (Clinical Antipsychotic Trial of Intervention Effectiveness), CUtLASS (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) und EUFEST (European First-Episode Schizophrenia Trial) gipfelte. In der vorliegenden Übersicht fassen wir die Ergebnisse dreier aktueller systematischer Reviews zusammen, in denen die Antipsychotika der zweiten Generation (SGAs) mit Placebo, mit konventionellen Antipsychotika oder direkt miteinander verglichen wurden. Wir stellen die Metaanalysen in den Kontext anderer systematischer Reviews und beleuchten sie vor dem Hintergrund von CATIE, CUtLASS und EUFEST. Unserer Meinung nach sind viele Ergebnisse konsistent, sie werden aber von verschiedenen Experten und Interessensvertretern unterschiedlich interpretiert. Die Daten zeigen, dass SGAs keine homogene Gruppe darstellen und dass diese eher verwirrende Einteilung aufgegeben werden sollte. Unserer Meinung nach stellen die SGAs nicht den Durchbruch dar, den die Industrie gerne sehen würde. Ihre unterschiedlichen Eigenschaften erlauben aber eine bessere Ausrichtung des Behandlungsplans an den Problemen des individuellen Patienten. Diese Medikamente haben die Behandlungspalette deutlich erweitert und die meisten Psychiater, ganz zu schweigen von den Patienten, würden wohl nur sehr ungerne auf diese Präparate verzichten wollen.

The mediating effect of brain-derived neurotrophic factor levels on childhood trauma and psychiatric symptoms in patients with first-episode schizophrenia

2021 ◽  
pp. 000486742110314
Author(s):  
Leilei Wang ◽  
Yi Yin ◽  
Yanfang Zhou ◽  
Junchao Huang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Childhood Trauma ◽  
Neurotrophic Factor ◽  
Brain Derived Neurotrophic Factor ◽  
First Episode ◽  
Emotional Neglect ◽  
Childhood Trauma Questionnaire ◽  
Syndrome Scale ◽  
First Episode Schizophrenia ◽  
Negative Syndrome ◽  
The Relationship

Background: Previous studies have implicated childhood trauma and abnormal brain-derived neurotrophic factor in the pathogenesis of schizophrenia. Here, we explored whether brain-derived neurotrophic factor levels mediated the relationship between childhood trauma and psychopathological symptoms in patients with first-episode schizophrenia. Methods: Patients with first-episode schizophrenia ( n = 192) and healthy controls ( n = 136) were enrolled. Childhood traumatic experiences and psychopathology were assessed by Childhood Trauma Questionnaire and Positive and Negative Syndrome Scale, respectively. Enzyme-linked immunosorbent assay was used to quantify brain-derived neurotrophic factor levels. Results: The patients with first-episode schizophrenia experienced more severe childhood trauma and had lower serum brain-derived neurotrophic factor levels than healthy controls. Emotional abuse and Childhood Trauma Questionnaire total score showed positive correlation with Positive and Negative Syndrome Scale positive, general psychopathological subscore and total score. Emotional neglect showed positive correlation with Positive and Negative Syndrome Scale positive subscore. Physical neglect was positively associated with Positive and Negative Syndrome Scale negative subscore. Emotional neglect and Childhood Trauma Questionnaire total score were negatively correlated with serum brain-derived neurotrophic factor levels. The serum brain-derived neurotrophic factor levels mediated the relationship between both Childhood Trauma Questionnaire total score and Positive and Negative Syndrome Scale total score and negative symptoms in the patients. The brain-derived neurotrophic factor levels also mediated the relationship between emotional neglect and Positive and Negative Syndrome Scale total score in the patients. Conclusion: Childhood trauma might contribute to the clinical symptoms of schizophrenia by affecting brain-derived neurotrophic factor levels. Perhaps we can prevent schizophrenia by reducing childhood traumatic experiences.

scholarly journals An early improvement threshold to predict response and remission in first-episode schizophrenia

2010 ◽  
Vol 196 (6) ◽  
pp. 460-466 ◽  
Author(s):  
R. Schennach-Wolff ◽  
F. H. Seemüller ◽  
A. Mayr ◽  
W. Maier ◽  
S. Klingberg ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Area Under The Curve ◽  
First Episode ◽  
Early Improvement ◽  
Score Improvement ◽  
Syndrome Scale ◽  
Definition Of ◽  
First Episode Schizophrenia ◽  
Negative Syndrome ◽  
First Episode Of Schizophrenia

BackgroundEarly improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.AimsTo develop a valid definition of early improvement and test its predictive validity regarding response and remission.MethodWe examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.ResultsReasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.ConclusionsPatients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.

Longitudinal invariance of the positive and negative syndrome scale negative dimension in antipsychotic naïve first‐episode schizophrenia

2021 ◽  
Author(s):  
Simão Kagan ◽  
Hugo Cogo‐Moreira ◽  
Matheus Ghossain Barbosa ◽  
Daniel Cavalcante ◽  
André Shinji ◽  
...  
Keyword(s):  
First Episode ◽  
Negative Dimension ◽  
Syndrome Scale ◽  
First Episode Schizophrenia ◽  
Negative Syndrome

Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena

2003 ◽  
Vol 33 (8) ◽  
pp. 1479-1484 ◽  
Author(s):  
P. WHITTY ◽  
M. CLARKE ◽  
S. BROWNE ◽  
O. McTIGUE ◽  
M. KAMALI ◽  
...  
Keyword(s):  
Clinical Course ◽  
Clinical State ◽  
First Episode ◽  
Neurological Soft Signs ◽  
Syndrome Scale ◽  
Dsm Iv ◽  
A Prospective Study ◽  
First Episode Schizophrenia ◽  
Negative Syndrome

Background. Although patients with schizophrenia have increased rates of neurological soft signs, few studies have examined prospectively their trait or state characteristics in relation to psychopathology.Method. In a prospective study of 97 patients with first-episode schizophrenia (DSM-IV criteria) we assessed neurological soft signs and psychopathology at presentation and at 6 month follow-up for 73 cases. To establish whether soft signs were associated with variations in clinical state, neurological soft signs were measured using two validated examinations (Neurological Evaluation Scale and Condensed Neurological Examination); psychopathology was assessed using the Positive and Negative Syndrome Scale.Results. There was significant improvement in overall neurological function, primarily in motor-related and cortical signs, which were associated with improvement in psychopathology. Conversely, ‘harder’ signs were unrelated to improvement in psychopathology.Conclusions. Neurological soft signs in schizophrenia are heterogenous. Motor and cortical signs evidence state-like characteristics and vary with clinical course, while ‘harder’ signs evidence more static, trait-like characteristics in accordance with a neurodevelopmental basis.

Prevalence and clinical correlates of depression in the acute phase of first episode schizophrenia

2010 ◽  
Vol 27 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Eric Roche ◽  
Mary Clarke ◽  
Stephen Browne ◽  
Niall Turner ◽  
Orflaith McTuige ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Depression Scale ◽  
First Episode ◽  
Syndrome Scale ◽  
Prevalence Of Depression ◽  
History Of ◽  
First Episode Schizophrenia ◽  
Negative Syndrome ◽  
First Episode Of Schizophrenia

AbstractBackground: Reported rates of depression in schizophrenia vary considerably.Objective: To measure the prevalence of depression in a first episode sample of people with schizophrenia.Methods: All referrals with a first episode of schizophrenia diagnosed using SCID interviews were assessed pre-discharge and again six months later. We used the Calgary Depression Scale for Schizophrenia (CDSS) and Positive and Negative Syndrome Scale (PANSS) to assess the severity of symptoms.Results: Pre-discharge, 10.4% of the sample met CDSS criteria for depression. According to the PANSS depression (PANSS -D) subscale, 3% of patients were depressed, with a mean score of 7.48 (SD = 2.97). Only 3% of patients pre-discharge were found to be depressed on both the CDSS and the PANSS-D. Six months later 6.5% were depressed according to the CDSS. However none reached depression criteria according to the PANSS-D. The CDSS correlated with PANSS-D both pre-discharge and at follow-up. Feelings of depression and self-deprecation were the most common symptoms at baseline and follow-up. The CDSS was unrelated to negative symptoms at both stages. A lifetime history of alcohol abuse increased the risk for depression.Conclusion: Rates of depression in this sample were low. The CDSS appears to discriminate between depression and negative symptoms. Like the general population, alcohol misuse is a risk factor for depression in first episode schizophrenia.

scholarly journals Hostility in schizophrenia: An integrated analysis of the combined Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and the European First Episode Schizophrenia Trial (EUFEST) studies

2016 ◽  
Vol 31 ◽  
pp. 13-19 ◽  
Author(s):  
J. Volavka ◽  
R.A. Van Dorn ◽  
L Citrome ◽  
R.S. Kahn ◽  
W.W. Fleischhacker ◽  
...  
Keyword(s):  
Phase 1 ◽  
Psychosocial Interventions ◽  
Chronic Schizophrenia ◽  
First Episode ◽  
Integrated Analysis ◽  
Intervention Effectiveness ◽  
Younger Age ◽  
Two Samples ◽  
First Episode Schizophrenia ◽  
Lower Adherence

AbstractPhase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study enrolled a sample of 1493 chronic schizophrenia patients. The European First Episode Schizophrenia Trial (EUFEST) enrolled 498 patients. We have combined these two samples to study the effects of hostility on study discontinuation as well as to examine correlates and predictors of hostility. Individual data from 1154 patients with complete data were used for analyses. Survival analysis demonstrated that higher hostility was associated with earlier all-cause treatment discontinuation. Furthermore, regression analysis indicated that increased hostility was associated with more severe positive symptoms, lower adherence to pharmacological treatment, younger age, impaired insight, and more drug or alcohol consumption. The clinical implications of the results point to the importance of establishing therapeutic alliance while managing patient's symptoms of hostility with antipsychotics such as olanzapine combined with psychosocial interventions to improve insight and reduce substance use.

Predictors of noncompliance in males with first-episode schizophrenia, schizophreniform and schizoaffective disorder

2002 ◽  
Vol 17 (3) ◽  
pp. 148-154 ◽  
Author(s):  
Virginija Novak-Grubic ◽  
Rok Tavcar
Keyword(s):  
Schizoaffective Disorder ◽  
Dropout Rate ◽  
First Episode ◽  
First Year ◽  
Syndrome Scale ◽  
Naturalistic Setting ◽  
High Dropout Rate ◽  
Male Patients ◽  
First Episode Schizophrenia ◽  
Negative Syndrome

SummaryPurposeMany factors influencing compliance in schizophrenia have been reported in the literature. Our aim was to assess predictors of noncompliance in male patients with first-episode schizophrenia, schizophreniform and schizoaffective disorder in a naturalistic setting.Subjects and methodsFifty-six male patients, discharged from hospital, were included in a 1-year follow-up study. Psychopathological symptoms were assessed with positive and negative syndrome scale at admission and discharge, while extrapyramidal side effects were recorded weekly during hospitalisation using the Simpson–Angus and Barnes akathisia scales. Socio-demographic and some other variables were also recorded.ResultsThirty patients (53.6%) dropped out of treatment in the first year and 21 of them relapsed. With the Cox survival analysis three predictors of noncompliance were found: diagnosis of schizophrenia versus the other two diagnoses, positive symptoms at admission, and lack of insight at discharge.DiscussionIn spite of a specific methodology and selection of only first-episode male patients, the results are in accordance with the findings of other authors. This confirms the universality of noncompliance in psychotic patients.ConclusionsFirst-episode patients have a high dropout rate. However, in compliant patients, the relapse rate was low, and therefore special attention and compliance-promoting interventions in first-episode patients are needed.

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

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.

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