scholarly journals M138. THE STRUCTURAL AND FUNCTIONAL BRAIN IMPACT OF CLOZAPINE IN SCHIZOPHRENIC PATIENTS: REVIEW OF THE LITERATURE

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S188-S188
Author(s):  
Lucie Metivier ◽  
Anais Vandevelde
Keyword(s):  
Frontal Cortex ◽  
Treatment Response ◽  
Mode Of Action ◽  
Negative Symptoms ◽  
Cerebral Metabolism ◽  
Point Of View ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Functional Brain ◽  
Pubmed Database

Abstract Background Schizophrenia is a common and severe mental disorder. The actual treatment is neuroleptic. Clozapine (CLZ), the atypical antipsychotic leader, is the best treatment of the resistant schizophrenia. Neuroimaging studies are important to understand better the neurological effects of CLZ. The main goal of this study is to analyze actual data of anatomic imaging studies (MRI, DTI, fMRI, PET and SPECT), evaluate CLZ anatomical and functional brain effect on patients suffering resistant schizophrenia (SZ) in order to characterize the mode of action of CLZ, identify the neural bases of the CLZ treatment response and establish the link between the mode of action and CLZ and the treatment response on patients suffering resistant SZ. Methods We have analyzed literature using PUBMED database with the following keywords: « clozapine », « neuroimaging », »MRI », « DTI », « VBM », « functional magnetic resonnance imaging », « PET », « fMRI », « SPECT ». Results 51 studies were included. 10 on anatomical imagery and 41 on functional imagery. From an anatomic point of view, studies suggest best cerebral integrity on patients with CLZ treatment compared to other antipsychotics, on grey nuclei, prefrontal cortex and on white matter beams belonging to the fronto sub cortical network. LEROUX et col, OCZELIK et col. From the functional point of view, studies show a functional connectivity modulation and an action on the cerebral metabolism MOLINA et col, especially in the frontal cortex of patients that respond to CLZ treatment compared to patients who have received another antipsychotic treatment. The PET and SPECT studies show the CLZ action mechanism especially on the glutamatergic system FUKUYAMA et col. Concerning CLZ-treated patients’ response, many studies have shown a larger perfusion on the frontal cortex and thalamic region on patient responding to CLZ compared non-responders. MOLINA et col, ERTUGUL et col. About clinical evolution, the longitudinal studies show an amelioration of the psychotic symptoms (positive symptoms, negative symptoms, suicidal risk and cognitive alteration) on CLZ-treated patients compared than the ones who have been treated with another antispychotic. ARANGO et col, MOLINA et col. CLZ treatment allows a decrease of craving on patients who suffer cannabis usage disorders compared with patients who are treated with risperidone. MACHIELSEN et col. Discussion These results bring a new light on SZ psychopathological, on CLZ cerebral mechanism and open the debate of actual prescription recommendations. However, we won’t conclude with certainly due heterogeneity of the experimental design, as other studies are necessary to complete knowledge of this subject.

scholarly journals T119. NO DIFFERENCE BETWEEN VOLITIVE AND EXPRESSIVE NEGATIVE SYMPTOMS FOR EARLY TREATMENT RESPONSE IN FIRST EPISODE OF PSYCHOSIS ANTIPSYCHOTIC NAïVE PATIENTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S276-S276
Author(s):  
Bernardo Haguiara ◽  
Gabriela Koga Tonsig ◽  
Simão Kagan ◽  
Daniel Cavalcante ◽  
Cristiano Noto ◽  
...  
Keyword(s):  
Treatment Response ◽  
Negative Symptoms ◽  
Real Life ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Social Avoidance ◽  
F Test ◽  
The Social ◽  
Highly Correlated

Abstract Background Negative symptoms are associated with a range of poor clinical and real-life functioning outcomes in people with schizophrenia. The division of negative symptoms into two separate factors, named “expressive deficits” and “social amotivation” could enable more accurate analysis and the development of new therapeutic tools. We aim to investigate whether the different symptoms that make up the negative dimension at baseline differently predict treatment response in first episode psychosis (FEP) antipsychotic naïve patients. Methods Patients with FEP (n=80), without previous use of antipsychotics, were recruited at an emergency service in São Paulo, Brazil, between 2014 and 2019. Individuals were assessed at admission and after 10 weeks of follow-up. Patients with schizophrenia, schizoaffective disorder and schizophreniform disorder were included. The diagnosis was confirmed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I). Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at the baseline and after 10 weeks of treatment. The “expressive deficits” factor was defined as the sum of the six following items of the PANSS: N1 (blunted affect), N3 (poor rapport), N6 (lack of spontaneity and flow of conversation), G5 (mannerisms and posturing), G7 (motor retardation), G13 (disturbance of volition). The “social amotivation” factor was defined as the sum of N2 (emotional withdrawal), N4 (passive/apathetic social withdrawal) and G16 (active social avoidance). To evaluate treatment response, we used the difference between the PANSS score at baseline and after ten weeks of follow-up (delta-PANSS). We performed three linear regressions, one using the “expressive deficits” factor, one using the “social amotivation” factor and another using the total negative symptom score at baseline. Results The mean age was 26.01 years old (SD ± 7.2), and the majority was male (58.75%). “Expressive deficits” (p=0.005, R-squared=0.084, F-test=8.28, β=8.24, df=78), “social amotivation” (p=0.009, R-squared=0,072, F-test=7.14, β=5.59, df=78); and negative symptoms (p=0.002, R-squared=0.105, F-test=10.23, β=9.08, df=78) at baseline behaved similarly in relation to delta-PANSS. All measures of negative symptoms are highly correlated to PANSS total at both time points. Discussion The results were different from our initial hypothesis of worse outcome for patients with higher expressive negative symptoms. We found that negative symptoms overall and both subdomains are highly correlated to PANSS total in acute phase in early stages, what can explain the association to better outcomes with antipsychotic treatment. Longer follow-up can help us to investigate whether differences between the subdomains of negative symptoms can be observed in more stable patients.

scholarly journals Sarcoidosis and Corticosteroid Therapy: Dilemma from a Psychiatric Point of View

2020 ◽  
Vol 57 (1) ◽  
pp. 81-86
Author(s):  
Mohd Amiruddin Mohd Kassim ◽  
Ruziana Masiran ◽  
Nicholas Pang
Keyword(s):  
Depressive Symptoms ◽  
Partial Response ◽  
Corticosteroid Therapy ◽  
Point Of View ◽  
Panic Attacks ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Exam Score ◽  
Treatment Results ◽  
Cognitive Difficulties

Introduction and Methods: A man diagnosed with sarcoidosis developed partial retrograde amnesia followed by three months of depressive symptoms with panic attacks, which remitted with an antidepressant and a benzodiazepine. However, three months later hallucinations and overvalued persecutory ideations subsequently emerged, only to show partial response to antipsychotic treatment. Results: Sarcoidosis was treated with corticosteroids but serial thorax imaging shows minimal response. Corticosteroid was onboard throughout treatment, corresponding with non-remission of psychotic symptoms. There are persistent subjective cognitive difficulties but Mini Mental State Exam score is full. He is currently being treated with escitalopram, alprazolam and quetiapine. Conclusion: This case illustrated the dilemma between prolonging the corticosteroid therapy for sarcoidosis treatment and the psychiatric sequalae. While symptomatic antipsychotic treatment is effective, multi-disciplinary approach is imperative in determining the duration of the corticosteroid therapy.

Individualized risk components guiding antipsychotic delivery in patients with a clinical high risk of psychosis: application of a risk calculator

2021 ◽  
pp. 1-10
Author(s):  
TianHong Zhang ◽  
LiHua Xu ◽  
HuiJun Li ◽  
HuiRu Cui ◽  
YingYing Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Negative Symptoms ◽  
Psychotic Symptoms ◽  
Risk Level ◽  
Antipsychotic Treatment ◽  
Positive Symptoms ◽  
General Function ◽  
Clinical High Risk ◽  
Risk Calculator ◽  
Personal Risk

Abstract Background Antipsychotics are widely used for treating patients with psychosis, and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) for psychosis are characterized by subthreshold psychotic symptoms. It is currently unclear who might benefit from antipsychotic treatment. Our objective was to apply a risk calculator (RC) to identify people that would benefit from antipsychotics. Methods Drawing on 400 CHR individuals recruited between 2011 and 2016, 208 individuals who received antipsychotic treatment were included. Clinical and cognitive variables were entered into an individualized RC for psychosis; personal risk was estimated and 4 risk components (negative symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive symptoms-RC-PS) were constructed. The sample was further stratified according to the risk level. Higher risk was defined based on the estimated risk score (20% or higher). Results In total, 208 CHR individuals received daily antipsychotic treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR increased, the conversion rate decreased. A small group (15%) of CHR individuals at higher-risk and an FR >1 benefitted from the antipsychotic treatment. Conclusions Through applying a personal risk assessment, the administration of antipsychotics should be limited to CHR individuals with predominantly positive symptoms and related function decline. A strict antipsychotic prescription strategy should be introduced to reduce inappropriate use.

scholarly journals Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis

2007 ◽  
Vol 191 (S51) ◽  
pp. s88-s95 ◽  
Author(s):  
Stephan Ruhrmann ◽  
Andreas Bechdolf ◽  
Kai-Uwe Kühn ◽  
Michael Wagner ◽  
Frauke Schultze-Lutter ◽  
...  
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Controlled Study ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Extrapyramidal Side Effects ◽  
Acute Effects ◽  
Global Functioning ◽  
Prodromal Symptoms ◽  
Symptomatic Benefit

BackgroundPeople in a putatively late prodromal state not only have an enhanced risk for psychosis but already suffer from mental and functional disturbancesAimsTo evaluate the acute effects of a combined supportive and antipsychotic treatment on prodromal symptomsMethodPutatively prodromal individuals were randomly assigned to a needs-focused intervention without (n=59) or with amisulpride (n=65). Outcome measures at 12-weeks effects were prodromal symptoms, global functioning and extrapyramidal side-effectsResultsAmisulpride plus the needs-focused intervention produced superior effects on attenuated and full-blown psychotic symptoms, basic, depressive and negative symptoms, and global functioning. Main side-effects were prolactin associatedConclusionsCoadministration of amisulpride yielded a marked symptomatic benefit. Effects require confirmation by a placebo-controlled study

scholarly journals Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders

2004 ◽  
Vol 185 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Diana O. Perkins ◽  
Jeffrey A. Lieberman ◽  
Hongbin Gu ◽  
Mauricio Tohen ◽  
Joseph McEvoy ◽  
...  
Keyword(s):  
Clinical Response ◽  
Treatment Response ◽  
Negative Symptoms ◽  
Positive Symptom ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Duration Of Untreated Psychosis ◽  
First Episode Schizophrenia ◽  
Relationship Of ◽  
The Relationship

BackgroundDuration of untreated psychosis (DUP) may contribute to the observed heterogeneity of the treatment response in first-episode schizophrenia.AimsTo examine the relationship of DUP and premorbid function with clinical outcomes following up to 2 years of antipsychotic treatment.MethodFor a subsample (n = 191) of subjects participating in a clinical trial, DUP and premorbid function were prospectively compared with clinical response to olanzapine or haloperidol.ResultsShorter DUP and good premorbid function each independently are associated with better clinical response, including improvement in overall psychopathology and negative symptoms. Premorbid function also is associated with positive symptom, social and vocational outcomes.ConclusionsEarlier antipsychotic treatment is associated with better outcomes in first-episode schizophrenia. Poor premorbid function could indicate an illness subtype less likely to respond to antipsychotic treatment regardless of when it is instituted.

P01-366-New treatment option in resistant schizophrenia in adolescence - case study

2011 ◽  
Vol 26 (S2) ◽  
pp. 368-368 ◽  
Author(s):  
A. Wisniewski
Keyword(s):  
Negative Symptoms ◽  
Poor Response ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Antipsychotic Treatment ◽  
Second Generation Antipsychotics ◽  
Paranoid Type ◽  
New Treatment ◽  
Long Acting

Early-onset schizophrenia has not only more severe course than in adults, it is also associated with poor response to antipsychotic treatment. There are only limited data about effectiveness, safety and tolerability of second generation antipsychotics (SGA) in children, but current recommendations suggest using atypical antipsychotics as the first line treatment.Case study15-year-old schoolboy admitted to psychiatric hospital after acute psychotic episode. His symptoms started 2 years ago. After a few months he was diagnosed schizophrenia paranoid type. During 2 years he has been hospitalized many times because of persistent psychotic symptoms. He was treated using: risperidon, olanzapine, amisulpride, quetiapine, ziprasidone, perfenazin. All the drugs were ineffective, all were used in full doses, given no shorter than 8 weeks. Patient did not cooperate in treatment - he spits out or has hide the tablets, has to be controlled during drug supplies. He did not responded to long-acting injections of risperidon. Finally the treatment has been changed to new form of olanzapine in extended release injections started 210 mg i.m. every 14 days increased to 300 mg after 2 weeks. After 2 months of treatment (5 injections) reduction of positive and negative symptoms of schizophrenia was observed. Patients starts to socialize, attend school. He is on the drug now, the drug is well tolerated.

scholarly journals T210. REVIEW OF USE OF ADJUNCTIVE PSYCHOSTIMULANTS IN PATIENTS WITH SCHIZOPHRENIA: A RETROSPECTIVE STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S312-S313
Author(s):  
Naista Zhand ◽  
Roisin Osborne ◽  
Marika Stuyt ◽  
Anna Hatko ◽  
Alain Labelle
Keyword(s):  
Negative Symptoms ◽  
Chart Review ◽  
Treatment Options ◽  
Health Centre ◽  
Tertiary Care ◽  
Real Life ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Tertiary Care Centre ◽  
Major Drawback

Abstract Background Augmentation with psychostimulants has been postulated as one of the potential treatment options for negative and/or cognitive symptoms of schizophrenia. However, the major drawback for use of these agents is a potential risk of relapse or worsening of psychosis through direct or indirect dopamine agonism activity. Therefore a great deal of caution is required when using stimulants in individuals with psychosis. The present study aims to review the rate of adjunct psychostimulant prescription, and their efficacy and safety in a real life setting. Furthermore, we intend to compare the efficacy of psychostimulants when added to clozapine compared to other antipsychotics. Data was obtained from a schizophrenia outpatient clinic, in a tertiary care centre in Canada. Methods A chart review was conducted on outpatients enrolled in the schizophrenia program at the Royal Ottawa Mental Health Centre, between 31/5/2014 - 1/6/2019. For patients who were prescribed any psychostimulants at any time point up to 3-months prior to the study end date, clinical information related to efficacy and tolerability of stimulants, psychotic symptoms and concomitant antipsychotic treatment was collected. Results A total number of 1300 patients were included in the chart review study. Of those, 80 patients (6.15%) were prescribed stimulants during the study period. Of the participants who prescribed stimulants, 70% were male, 17.5% had a diagnosis of ADHD, and 38.75% were on clozapine. 21.25% had more than one trial of stimulant medications. Over half of participants continued on stimulants during the study period, with an overall good response in 36.25%, and minimal or equivocal response in 20% of participants on stimulants. Stimulants were discontinued in 13.75% of patients due to lack of efficacy, and 30% due to problematic symptoms. The data is currently being analysed; Comprehensive results to follow. Discussion The preliminary results indicate that the use of stimulants was associated with improvement in cognitive and/or negative symptoms in a subset of patients and resulted in worsening of psychosis in some patients. The authors will discuss the efficacy and tolerability of use of adjunctive stimulants in outpatients with schizophrenia. Potential factors associated with the observed response and side effects will be discussed further.

Effect of Disrupted-in-Schizophrenia 1 gene on treatment response in patients with a first episode of psychosis

2016 ◽  
Vol 33 (S1) ◽  
pp. S183-S183
Author(s):  
J. Vázquez Bourgon ◽  
R. Ayesa Arriola ◽  
P. Suarez Pinilla ◽  
R. Roiz Santiañez ◽  
D. Tordesillas Gutierrez ◽  
...  
Keyword(s):  
Treatment Response ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Genetic Alterations ◽  
Individual Variability ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Positive Symptoms ◽  
Drug Naïve ◽  
Competing Interest

IntroductionThere is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.ObjectivesThe aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.MethodsTwo hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.ResultsWe found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).ConclusionsOur results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Regional Cerebral Glucose Metabolism in Three Sets of Identical Twins with Psychotic Symptoms

1989 ◽  
Vol 34 (4) ◽  
pp. 263-270 ◽  
Author(s):  
C. Clark ◽  
H. Klonoff ◽  
J.S. Tyhurst ◽  
D. Li ◽  
W. Martin ◽  
...  
Keyword(s):  
Glucose Metabolism ◽  
Frontal Cortex ◽  
Cerebral Metabolism ◽  
Identical Twins ◽  
Psychological Status ◽  
Initial Assessment ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Orbital Frontal Cortex ◽  
Regional Cerebral Glucose Metabolism

Three sets of young identical twins where at least one had a psychotic episode were assessed in terms of psychiatric and psychological status and integrity of cerebral structure and metabolism. The psychiatric diagnoses for each set were normal/schizophrenia, prodromal/schizophrenia and schizoaffective/schizoaffective. The latter two sets were reexamined two years after the initial assessment. The data are considered from a case study perspective. Reduced cerebral metabolism was found for at least one region on eight of nine scans of patients with a psychotic history. On seven of the nine scans, glucose metabolism in the orbital frontal cortex was reduced. These findings are discussed with respect to previous studies of glucose metabolism inpatients with schizophrenia, metabolic similarities found in normal identical twins and the known functional specialization of the orbital frontal cortex.

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