Treatment of Schizophrenia Spectrum Disorders and First-Episode Psychosis

2021 ◽  
pp. 247-261
Author(s):  
Kirstin Painter ◽  
Maria Scannapieco
Keyword(s):  
Behavioral Therapy ◽  
Real Life ◽  
First Episode Psychosis ◽  
First Episode ◽  
Class Discussion ◽  
Schizophrenia Spectrum Disorders ◽  
Life Outcomes ◽  
Preventative Measures ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis

Currently there is no cure for schizophrenia and no sure way to prevent it. However, people who possess risk factors for schizophrenia can minimize their symptoms or prevent them from getting worse by taking preventative measures. And if symptoms do appear, early treatment may lessen the severity of the symptoms and improve the trajectory of the disorder. This chapter covers the prescribing of psychotropic medications for treating children and adolescents with schizophrenia and discusses promising and effective treatments, including multisystemic therapy-psychiatric, cognitive-behavioral therapy, and coordinated specialty care for first-episode psychosis. Chapter 16 returns to the case studies presented in Chapter 15 and describes the real-life outcomes along with questions for class discussion.

scholarly journals Predicting first-episode psychosis patients who will never relapse over 10 years

2018 ◽  
Vol 49 (13) ◽  
pp. 2206-2214 ◽  
Author(s):  
Christy LM Hui ◽  
William G Honer ◽  
Edwin HM Lee ◽  
WC Chang ◽  
Sherry KW Chan ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
First Episode ◽  
Psychotic Episode ◽  
Positive Symptoms ◽  
Schizophrenia Spectrum Disorders ◽  
Medication Discontinuation ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Spectrum Disorders

AbstractBackgroundAlthough relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.MethodPatients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.ResultsOut of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.ConclusionsTreatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.

scholarly journals The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore

2021 ◽  
Vol 12 ◽  
Author(s):  
Nigel Ian Ming Chong ◽  
Yogeswary Maniam ◽  
Yi Chian Chua ◽  
Charmaine Tang
Keyword(s):  
Verbal Memory ◽  
Cognitive Abilities ◽  
Statistical Significance ◽  
Real Life ◽  
Cognitive Remediation ◽  
First Episode Psychosis ◽  
Early Psychosis ◽  
First Episode ◽  
Educational Approach ◽  
Episode Psychosis

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.

scholarly journals S132. SAMPLING BIAS IN STUDIES OF FIRST-EPISODE PSYCHOSIS – A FOLLOW-UP STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S85-S86
Author(s):  
Maija Walta ◽  
Heikki Laurikainen ◽  
Reetta-Liina Armio ◽  
Tiina From ◽  
Raimo K R Salokangas ◽  
...  
Keyword(s):  
Clinical Care ◽  
Real Life ◽  
Sampling Bias ◽  
First Episode Psychosis ◽  
Dropping Out ◽  
First Episode ◽  
Episode Psychosis ◽  
Involuntary Care ◽  
One Year

Abstract Background Attrition rates and sampling bias in controlled clinical studies are a concern when evaluating the relevance of the results to a specific patient population in a real-life clinical / treatment setting. Dropout rates in studies on psychotic disorders are high and many eligibility criteria may lead to bias in study samples. We wanted to analyze how representative are the patient samples typically included in first-episode psychosis studies such as the Turku Early Psychosis (TEPS) study by using a platform of 3772 consecutive admissions to clinical psychiatric services of Turku Psychiatry. Methods TEPS study was started in 2011 as a part of a larger study on psychosis treatment processes in Turku Psychiatric services. Each patient, inpatient and outpatient, went through initial clinical screening by the treatment group which was followed by a structured evaluation if the screen for first-episode psychosis was positive. Between Oct 2011 and June 2016 there were 195 patients with first-episode psychosis (FEP) suitable to the TEPS study. Of them 102 were willing and 93 were not willing to participate or were not reached in a baseline structured evaluation. Using patient records, we compared if these two groups differed in terms of clinical variables, treatment or prognosis during a 1-year follow-up. Time of hospital stay, involuntary vs. voluntary admission, coercive measures during the hospital care, re-hospitalizations and drop-out from the clinical care during the follow-up were used as outcomes. Results Non-participating (NTP) group had higher rate of involuntary care than participating (TP) group (70 % vs 62 %) as well as higher rate of coercion during the treatment and higher rate of re-admissions during the follow-up than the TP group (36 % vs 22 % and 41 % vs 34 %, respectively) but these differences did not reach statistical significance. During the one-year follow-up NTP group had a significantly higher rate of dropping out from the clinical care than participating TP group (48 % vs 30 %, p=0.01). NTP group had also higher rate of dropping out of clinical treatment mainly because of patient non-adherence (33 % vs 16 %, p=0.03). Discussion Nearly half (47 %) of the intent-to-study FEP patients were not reached or declined to participate in our study. Non-participating patients had a slightly more severe illness and poorer treatment adherence during one-year follow-up. The clinical differences were not as marked as we expected. E.g. involuntary care, inpatient care and more coercion during the follow-up were not significantly different between NTP and TP groups. Nevertheless, the data suggest considerable differences between participating and non-participating patients with first-episode psychosis which should be taken in to account when evaluating the generalizability of the results for an unselected group of psychotic patients in ‘real-life’ clinical care.

Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

2010 ◽  
Vol 40 (10) ◽  
pp. 1619-1626 ◽  
Author(s):  
M. Nordentoft ◽  
J. Øhlenschlæger ◽  
A. Thorup ◽  
L. Petersen ◽  
Pia Jeppesen ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Supported Housing ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Bed Days ◽  
Spectrum Disorders ◽  
First Episode Schizophrenia

BackgroundThe effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.ResultsIt was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.ConclusionsThe study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

Diagnostic Stability and Clinical Characteristics in First-episode Psychosis

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Berge ◽  
A. Mane ◽  
P. Salgado ◽  
O. Vilarroya ◽  
A. Merino ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
First Episode ◽  
Schizophreniform Disorder ◽  
Schizophrenia Spectrum Disorders ◽  
Diagnostic Stability ◽  
Episode Psychosis ◽  
Hospitalization Period ◽  
Wide Variability ◽  
One Year

Introduction:Diagnostic stability in first-episode psychosis shows a wide variability between studies. Amini and cols reported a 50% rate of patients schizophreniform disorder shifting to schizophrenia during the first 12 months period. We report the preliminary follow-up results of our recently ongoing first- episode psychosis unit.Methods:Forty-six patients admitted for a first-episode psichosis to our Inpatient Psychiatric Unit from January 2006 to January 2008 were recruited. Clinical and socio-demographic characteristics were registered during admission period and during the follow-up period.Results:At admission 52% of the first-episode subjects had a diagnosis of psychosis NOS and 32% a schizophreniform disorder diagnosis. after discharge, most of the patients (72%) had a diagnosis of schizophreniform disorder, 16% psychosis NOS and 8% brief psychotic disorder. Six months later, half of the followed-up patients had a schizophreniform disorder diagnosis, and 23% had a diagnosis of schizophrenia. 30% of the patients were drop-outs, mainly referred to other out-patient services. Patients shifting to schizophrenia were younger, predominantly male (75% vs 50% in non-schizophrenia shift), had a lower proportion of university studies and presented a longer hospitalization period at admission. No differences in familial history of psychosis and cannabis use were found. after one-year follow-up period, 50% preserved a schizophreniform disorder diagnosis and 30% were diagnosed as schizophrenia.Conclusions:Schizophrenia spectrum disorders have a high stability in first-episode psychosis during first year follow-up. as in previous studies, male gender is one of the factors that best predicts the shift to schizophrenia.

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