scholarly journals T38. POSTER PRESENTATION: HAMLETT: HANDLING ANTIPSYCHOTIC MEDICATION, A LONGTERM EVALUATION OF TARGETED TREATMENT A PRAGMATIC SINGLE-BLIND RANDOMISED CONTROLLED TRIAL OF CONTINUATION VERSUS DISCONTINUATION OF PSYCHOTIC MEDICATION

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S246-S246
Author(s):  
Erna van‘t Hag
Keyword(s):  
Antipsychotic Medication ◽  
Controlled Trial ◽  
Well Being ◽  
First Episode ◽  
Psychotic Episode ◽  
Subjective Well Being ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
General Functioning

Abstract Background When achieving remission after a first psychotic episode using antipsychotic medication, international guidelines generally recommend continuation of use for >1 year. However, patients often have a strong wish to stop earlier due to side-effects, affecting everyday functioning. Recently, guidelines have been questioned as one Dutch study found that more patients achieved long-term functional remission after early discontinuation. Yet, this finding has not yet been replicated. Psychiatrists, patients and family are unsure which regime to follow: to continue or not to continue? Methods In total 512 participants will be included who achieved remission after first-episode psychosis and use antipsychotic medication. Recruitment takes place at 24 Dutch sites. HAMLETT is a multicenter pragmatic single-blind randomized controlled trial with two conditions (1:1): maintenance treatment versus discontinuation/dose reduction of antipsychotic medication. Main research question: Is long-term general functioning better if patients reduce/discontinue antipsychotic medication at an early stage (3–6 months after remission of their first psychotic episode), than when they continue medication >1 year? General functioning is measured in two ways: with the WHO-DAS interview and with Ecological Momentary Assessments (EMA). EMA is a structured diary method in which individuals are asked in daily life to report on their current thoughts, feelings and symptoms, as well as the context (e.g. location, company, activity) and the appraisal of the context (e.g. stress). Diaries are completed via a smartphone diary app maximally 10 times daily at semi-random moments, over eight consecutive days. Momentary positive/negative affect, self-esteem, subjective well-being, paranoia, hallucinations, sleep, and frequency, type and appraisal of social company and activities are assessed on a 1–7 scale. At baseline and after 6 months, 1, 2, 3 and 4 years follow-up, patients of both arms will perform EMA. This results in an intensive time series of psychopathology, subjective well-being and social functioning in relation to antipsychotic medication and a range of contextual influences. Results The study is active and currently recruiting patients (since September 2017), At present 194 patients have been included, 20% participated in EMA measurements. Results of the interim analysis and preliminary of EMA data will be presented. Discussion The HAMLETT study investigates the effects of maintenance treatment versus discontinuation/dose reduction of antipsychotic medication after remission of first episode psychosis on personal and social functioning, psychotic symptom severity, health-related quality of life and cognitive functioning. The HAMLETT study will offer evidence to guide patients and clinicians when evaluating optimal treatment duration for psychotic disorders. Using different types of outcome measures will provide a more in-depth analysis of effects of continuation/ discontinuation on functioning.

Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S271-S272
Author(s):  
S. Malta Vacas ◽  
R. Carvalho ◽  
M.J. Heitor
Keyword(s):  
Great Majority ◽  
First Episode ◽  
Psychotic Episode ◽  
Term Care ◽  
First Psychotic Episode ◽  
Effective Interventions ◽  
Episode Psychosis ◽  
Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Brief psychotic disorder associated with quarantine and mild COVID-19

2020 ◽  
Vol 13 (12) ◽  
pp. e240088
Author(s):  
Peter M Haddad ◽  
Majid Al Abdulla ◽  
Javed Latoo ◽  
Yousaf Iqbal
Keyword(s):  
Psychotic Disorder ◽  
Physical Symptoms ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Psychiatric Medication ◽  
Diagnostic And Statistical Manual ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

The pathways to mental health care of first-episode psychosis patients: a systematic review

2010 ◽  
Vol 40 (10) ◽  
pp. 1585-1597 ◽  
Author(s):  
K. K. Anderson ◽  
R. Fuhrer ◽  
A. K. Malla
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
First Contact ◽  
Pathway To Care ◽  
Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

scholarly journals Neurological soft signs in first-episode psychosis: A systematic review

2002 ◽  
Vol 181 (S43) ◽  
pp. s50-s57 ◽  
Author(s):  
Paola Dazzan ◽  
Robin M. Murray
Keyword(s):  
Motor Coordination ◽  
First Episode Psychosis ◽  
The Body ◽  
First Episode ◽  
Psychotic Episode ◽  
Neurological Soft Signs ◽  
First Psychotic Episode ◽  
Cerebral Dysfunction ◽  
Episode Psychosis ◽  
First Onset

BackgroundNeurological soft signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. Their presence has been documented extensively in schizophrenia but not during the first psychotic episode.AimsTo review studies that have specifically investigated NSS at the time of the first psychotic episode.MethodA review of studies investigating neurological function in first-episode psychosis, using a clinical examination.ResultsPatients with first-episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. Furthermore, NSS may be associated with a specific laterality pattern.ConclusionsMore studies on first-onset schizophrenia are needed, evaluating both sensory and motor neurological domains (scoring separately for the two sides of the body), integrating this knowledge with neuroimaging findings and clarifying the role of NSS as markers of cognitive dysfunction.

Disturbance of neurotransmitters monoamines and indices of reducing-oxidizing processes in patient with the first episode of schizophrenia (FES)

2011 ◽  
Vol 26 (S2) ◽  
pp. 1412-1412
Author(s):  
V. Kalinina ◽  
Y. Gryzunov ◽  
N. Smolina ◽  
M. Uzbekov ◽  
E. Misionzhnik ◽  
...  
Keyword(s):  
Oxidase Activity ◽  
Amine Oxidase ◽  
Social Activity ◽  
First Episode ◽  
Psychotic Episode ◽  
Metabolic Disturbances ◽  
Biophysical Parameters ◽  
First Psychotic Episode ◽  
Sh Group

IntroductionEffective treatment of FES patients may lead to achievement of long-term remission, decrease the number of relapses and increase the level of social activity and quality of life.AimTo study some pathophysiological mechanisms of FES.MethodsThe group of patients who were investigated clinically and biochemically consists of 26 persons (11 women and 15 men, average age 28.2 ± 9.5 years) with the first psychotic episode (F20.0; F20.3). Some biochemical parameters, representing the monoaminergic systems, and some biophysical parameters, representing reducing-oxidizing processes, were investigated. These parameters in all patients were estimated following the admission and prior to any treatment.ResultsThe severity of the disorder on admission to the clinic according to PANSS score was 75,5 ± 2,2 (i.e., moderately severe). Patients with FES were characterized by a significant increase of platelet momnoamine oxidase activity (by 107%; р < 0,01) and decrease of serum semicarbazide-sensitive amine oxidase activity (by 29%; p < 0,001) in comparison to the controls. Both reactive capability of SH-group (Cys-34 residue) of serum albumin, the main source of thiols of plasma and intersticial fluid, measured in reaction with thiol-specific reagent - dithyonitrobenzoic acide, and kinetic coefficient were decreased in FES patients (by 24%; p = 0,02) in comparison to controls.ConclusionThese results show that FES patients are characterized by pronounced metabolic disturbances.

A Young Man with First-Episode Psychosis: Case Presentation and Discussion

1998 ◽  
Vol 43 (1_suppl) ◽  
pp. 4S-6S
Author(s):  
Angelo Fallu ◽  
Lili Kopala ◽  
Ashok Malla ◽  
Lilian Thorpe
Keyword(s):  
Young Patients ◽  
Antipsychotic Agents ◽  
First Episode Psychosis ◽  
First Episode ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
Dosing Regimens ◽  
History Of ◽  
Patient’S History

Objective: To review and discuss the issues and challenges involved in the treatment of first-episode psychosis in young patients, including choice of appropriate antipsychotic agents and adjunctive medications, dosing regimens, and biopsychosocial interventions. Methods: The case of a young man in his late teens with a history of substance abuse who experienced an acute dystonic reaction to treatment for his first psychotic episode is presented and discussed. Results: Each contributing author provides an evaluation of the intervention strategies presented in the patient's history and factors that influenced the treatment outcomes. Conclusions: The successful management of young patients with psychosis must go beyond the control of positive symptoms. A comprehensive psychosocial and psychoeducational approach combined with a well-tolerated treatment regimen can help the patient achieve positive outcomes.

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

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
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.

Social cognition, functional capacity and symptoms in the longitudinal prediction of outcome in subjects with first-episode schizophrenia

2016 ◽  
Vol 33 (S1) ◽  
pp. S67-S67
Author(s):  
M. Nordentoft ◽  
R. Wills ◽  
D. Gotfredsen
Keyword(s):  
Antipsychotic Medication ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Schizophrenia Spectrum Disorders ◽  
National Guidelines ◽  
Term Outcome ◽  
Long Term Outcome

BackgroundSeveral national guidelines recommend continuous use of antipsychotic medication after a psychotic episode in order to minimize the risk of relapse. However some studies have identified a subgroup of patients who can obtain remission of psychotic symptoms while not being on antipsychotic medication for a long period of time. This study investigated the long-term outcome and characteristics of patients in remission of psychotic symptoms with no use of antipsychotic medication at the 10-year follow-up.MethodsThe study was a cohort study including 496 patients diagnosed with schizophrenia spectrum disorders (ICD 10: F20 and F22-29). Patients were included in the Danish OPUS Trial and followed up 10 years after inclusion, where patient data was collected on socio-demographic factors, psychopathology, level of functioning and medication.FindingsAmong the patients, 30% had remission of psychotic symptoms at the time of the 10-year follow up with no current use of antipsychotic medication. This favorable outcome was associated with female gender, high GAF-F score, participation in the labor market and absence of substance abuse.InterpretationResults from several RCTs advise against discontinuation of antipsychotic medication, but our results from the 10-year follow-up indicate that a subgroup do obtain long-term remission while not being on antipsychotic medication. Hence, guidelines on antipsychotic medication do not pay sufficient attention to patients who discontinue antipsychotic medication and are still able to obtain remission of psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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