scholarly journals F69. SYMPTOM PREDICTORS OF TREATMENT-RESISTANCE IN FIRST-EPISODE PATIENTS

2019 ◽  
Vol 45 (Supplement_2) ◽  
pp. S281-S281
Author(s):  
Gabriela Tonsig ◽  
Bernardo Haguiara ◽  
Luccas Coutinho ◽  
Bruno Ortiz ◽  
Cristiano Noto ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
First Episode ◽  
Symptom Predictors

scholarly journals Treatment Resistance: A Time-Based Approach for Early Identification in First Episode Psychosis

2021 ◽  
Vol 11 (8) ◽  
pp. 711
Author(s):  
Kara Dempster ◽  
Annie Li ◽  
Priyadharshini Sabesan ◽  
Ross Norman ◽  
Lena Palaniyappan
Keyword(s):  
Ecological Validity ◽  
Treatment Resistance ◽  
Positive Symptom ◽  
First Episode ◽  
Symptom Reduction ◽  
Symptom Change ◽  
Global Functioning ◽  
Episode Psychosis ◽  
First Episode Schizophrenia

Although approximately 1/3 of individuals with schizophrenia are Treatment Resistant (TR), identifying these subjects prospectively remains challenging. The Treatment Response and Resistance in Psychosis working group defines <20% improvement as an indicator of TR, though its utility in First Episode Schizophrenia (FES) remains unknown. In a prospective cohort of FES (n = 129) followed up for 5 years, we evaluated two improvement thresholds for ‘probable TR’; <20% and <50% based on positive, negative, and total symptoms. We ascertained (1) the ecological validity (i.e., the ability to identify an expected subgroup of 1/3rd of patients); (2) the predictive validity (i.e., ability to predict poor global functioning) and (3) the clinical utility (association with clozapine use at the 5th year). Using the criteria of a total symptom reduction of <50% or negative symptom reduction of <20% resulted in ‘probable TR’ rates of 37% and 33%, respectively. Using <20% positive or total symptoms criteria resulted in very low rates, indicating minimal utility in FES. <50% total symptom criterion best predicted the global functioning over 5 years. Clozapine use was only predicted by positive symptom criterion. Prospective characterization of TRS is possible at 6 months after FES through a time-based approach using a 50% threshold for symptom change in treatment-adherent patients.

scholarly journals Familial and socioeconomic contributions to premorbid functioning in psychosis: Impact on age at onset and treatment response

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Alex Hatzimanolis ◽  
Pentagiotissa Stefanatou ◽  
Emmanouil Kattoulas ◽  
Irene Ralli ◽  
Stefanos Dimitrakopoulos ◽  
...  
Keyword(s):  
Treatment Response ◽  
Social Functioning ◽  
Early Adolescence ◽  
Psychotic Disorders ◽  
Age At Onset ◽  
Familial Risk ◽  
Treatment Resistance ◽  
Joint Effect ◽  
First Episode ◽  
Environment Interaction

Abstract Background. Premorbid adjustment (PA) abnormalities in psychotic disorders are associated with an earlier age at onset (AAO) and unfavorable clinical outcomes, including treatment resistance. Prior family studies suggest that familial liability, likely reflecting increased genetic risk, and socioeconomic status (SES) contribute to premorbid maladjustment. However, their joint effect possibly indicating gene–environment interaction has not been evaluated. Methods. We examined whether family history of psychosis (FHP) and parental SES may predict PA and AAO in unrelated cases with first-episode psychosis (n = 108) and schizophrenia (n = 104). Premorbid academic and social functioning domains during childhood and early adolescence were retrospectively assessed. Regression analyses were performed to investigate main effects of FHP and parental SES, as well as their interaction. The relationships between PA, AAO, and response to antipsychotic medication were also explored. Results. Positive FHP associated with academic PA difficulties and importantly interacted with parental SES to moderate social PA during childhood (interaction p = 0.024). Positive FHP and parental SES did not predict differences in AAO. Nevertheless, an earlier AAO was observed among cases with worse social PA in childhood (β = −0.20; p = 0.005) and early adolescence (β = −0.19; p = 0.007). Further, confirming evidence emerged for an association between deficient childhood social PA and poor treatment response (p = 0.04). Conclusions. Familial risk for psychosis may interact with parental socioeconomic position influencing social PA in childhood. In addition, this study supports the link between social PA deviations, early psychosis onset, and treatment resistance, which highlights premorbid social functioning as a promising clinical indicator.

scholarly journals Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

2017 ◽  
Vol 47 (11) ◽  
pp. 1981-1989 ◽  
Author(s):  
A. Demjaha ◽  
J. M. Lappin ◽  
D. Stahl ◽  
M. X. Patel ◽  
J. H. MacCabe ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Age At Onset ◽  
Treatment Resistance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Episode Psychosis

BackgroundWe examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.MethodThe study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.ResultsFrom the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.ConclusionsThe striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

scholarly journals Special Issue: Psychosis from early intervention to treatment resistance

2019 ◽  
Vol 36 (4) ◽  
pp. 239-241 ◽  
Author(s):  
C. McDonald ◽  
D.R. Cotter
Keyword(s):  
Early Intervention ◽  
Clinical Research ◽  
Social Stress ◽  
Psychotic Disorders ◽  
Management Strategies ◽  
Treatment Resistance ◽  
Research Network ◽  
First Episode ◽  
Special Issue ◽  
Health Service Provision

Psychotic disorders are central to mental health service provision and a common theme of academic research programmes in Ireland, which explore the neurobiological and psychosocial risk factors underpinning the development and progression of these illnesses. While we await the discovery of novel pharmacological treatment targets for psychotic disorders, it is important to employ our existing management strategies to optimal effect. In this special issue on psychosis, a selection of clinical research studies and reviews from Irish researchers, and often of Irish populations, are brought together which span the trajectory of psychotic illness from early intervention to treatment resistance. The topics include the characteristics and course of first episode psychosis cohorts, real-world evaluation of early intervention services, management strategies for treatment resistant schizophrenia and neurobiological research into social stress. The current editorial provides an overview of these papers and highlights the initial steps of the Irish Psychosis Research Network towards developing an integrated clinical research network focusing on the treatment and research into psychotic disorders.

ECT in schizophrenia: a review of the evidence

2018 ◽  
Vol 31 (03) ◽  
pp. 115-127 ◽  
Author(s):  
Sandeep Grover ◽  
Swapnajeet Sahoo ◽  
Anjumoni Rabha ◽  
Raman Koirala
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Suicidal Behaviour ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
First Episode ◽  
Treatment Resistant ◽  
Predictors Of Response ◽  
First Episode Schizophrenia

AbstractElectroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.

scholarly journals Forecasting prognostic trajectories with mismatch negativity in early psychosis

2021 ◽  
pp. 1-11
Author(s):  
Minah Kim ◽  
Taekwan Kim ◽  
Wu Jeong Hwang ◽  
Silvia Kyungjin Lho ◽  
Sun-Young Moon ◽  
...  
Keyword(s):  
Early Intervention ◽  
Clinical Outcome ◽  
Mismatch Negativity ◽  
Psychotic Disorders ◽  
Prognostic Biomarker ◽  
Treatment Resistance ◽  
Binary Logistic Regression ◽  
Early Psychosis ◽  
Prognostic Biomarkers ◽  
First Episode

Abstract Background Prognostic heterogeneity in early psychosis patients yields significant difficulties in determining the degree and duration of early intervention; this heterogeneity highlights the need for prognostic biomarkers. Although mismatch negativity (MMN) has been widely studied across early phases of psychotic disorders, its potential as a common prognostic biomarker in early periods, such as clinical high risk (CHR) for psychosis and first-episode psychosis (FEP), has not been fully studied. Methods A total of 104 FEP patients, 102 CHR individuals, and 107 healthy controls (HCs) participated in baseline MMN recording. Clinical outcomes were assessed; 17 FEP patients were treatment resistant, 73 FEP patients were nonresistant, 56 CHR individuals were nonremitters (15 transitioned to a psychotic disorder), and 22 CHR subjects were remitters. Baseline MMN amplitudes were compared across clinical outcome groups and tested for utility prognostic biomarkers using binary logistic regression. Results MMN amplitudes were greatest in HCs, intermediate in CHR subjects, and smallest in FEP patients. In the clinical outcome groups, MMN amplitudes were reduced from the baseline in both FEP and CHR patients with poor prognostic trajectories. Reduced baseline MMN amplitudes were a significant predictor of later treatment resistance in FEP patients [Exp(β) = 2.100, 95% confidence interval (CI) 1.104–3.993, p = 0.024] and nonremission in CHR individuals [Exp(β) = 1.898, 95% CI 1.065–3.374, p = 0.030]. Conclusions These findings suggest that MMN could be used as a common prognostic biomarker across early psychosis periods, which will aid clinical decisions for early intervention.

Sign in / Sign up

Export Citation Format

Share Document