Predictors of Treatment Response, Remission, Relapse and Rehospitalization in First-Episode Psychosis Patients in Medellin, Colombia

Background: Most studies with first episode psychosis patients have been conducted in high-income countries. On the other hand, very few first episode studies have been conducted in Latin-America. Therefore, the goal of our study is to determine predictors of treatment response, remission, relapse and rehospitalization in a first episode psychosis population from Medellin, Colombia. Methods: Data was obtained from electronic health records from first episode patients with a diagnosis of schizophrenia-spectrum disorder diagnoses who were evaluated between January 2014 and December 2016 at two psychiatric institutions in Medellin, Colombia. Survival and Cox proportional hazard models were used for the analysis. Results: Duration of untreated psychosis and hospitalization at the time of presentation was associated with both response and remission. Response was also predicted by less first-order symptoms and more years of education. Remission was predicted by older age of onset. Relapse and rehospitalization were predicted by use of substances and poor adherence to pharmacologic treatment. Less years of education and hospitalization at the time of presentation were also associated with rehospitalization. Conclusion: Predictors of treatment response, remission, relapse and rehospitalization in first-episode patients are similar in Colombia compared to other high-income regions such as the United States and Europe. Keywords: schizophrenia, first episode, Colombia, Medellin, predictors, treatment response

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Paliperidone induced neutropenia in first episode psychosis: a case report

BMC Psychiatry ◽

10.1186/s12888-021-03073-w ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Natalie Martos ◽

William Hall ◽

Alicia Marhefka ◽

Thomas W. Sedlak ◽

Frederick C. Nucifora

Keyword(s):

Adverse Effect ◽

Case Report ◽

The United States ◽

First Episode Psychosis ◽

Potential Adverse Effect ◽

Severe Neutropenia ◽

First Episode ◽

Antipsychotic Medications ◽

Increased Risk ◽

Episode Psychosis

Abstract Background Neutropenia, a decrease in total number of neutrophils below 1500/mm3 and particularly severe neutropenia, defined as neutrophils less than 500/mm3, is a potential adverse effect of antipsychotic medications that can lead to increased risk of infections and death. However, much of the attention on the potential adverse effect is centered exclusively on clozapine, which remains the only antipsychotic medication in the United States requiring standardized monitoring of blood work. We demonstrate here that paliperidone can also cause neutropenia and therefore clinicians should be aware of this possibility especially during initiation of treatment. Case presentation The following report presents the case of a 23-year-old African American male with first episode psychosis who developed neutropenia after initiation of paliperidone. Neutropenia resolved after discontinuation of paliperidone and initiation of an alternative antipsychotic, haloperidol. Conclusions This case report demonstrates an example of paliperidone induced neutropenia which resolved with a switch to haloperidol. We conclude that when initiating paliperidone, clinicians should be more aware of the risk of neutropenia. Moreover, neutropenia may be a more common and overlooked issue in patients on antipsychotic medications other than clozapine and increased awareness of comparative risk across antipsychotics could help direct treatment.

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Implementation of NAVIGATE Coordinated Specialty Care for First Episode Psychosis: the Michigan Experience

CNS Spectrums ◽

10.1017/s1092852920002928 ◽

2021 ◽

Vol 26 (2) ◽

pp. 177-178

Author(s):

Eric D. Achtyes ◽

Kari Kempema ◽

Zhehui Luo ◽

Katharine N. Thakkar ◽

Catherine Adams ◽

...

Keyword(s):

Mental Health ◽

Clinical Symptoms ◽

The United States ◽

First Episode Psychosis ◽

Specialty Care ◽

First Episode ◽

Control Group ◽

Evidence Based ◽

Block Grant ◽

Episode Psychosis

AbstractStudy ObjectivesCoordinated specialty care (CSC) is widely accepted as an evidence-based treatment for first episode psychosis (FEP). The NAVIGATE intervention from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study is a CSC intervention which offers a suite of evidence-based treatments shown to improve engagement and clinical outcomes, especially in those with shorter duration of untreated psychosis (DUP). Coincident with the publication of this study, legislation was passed by the United States Congress in 2014–15 to fund CSC for FEP via a Substance Abuse and Mental Health Services Administration (SAMHSA) block grant set-aside for each state. In Michigan (MI) the management of this grant was delegated to Network180, the community mental health authority in Kent County, with the goal of making CSC more widely available to the 10 million people in MI. Limited research describes the outcomes of implementation of CSC into community practices with no published accounts evaluating the use of the NAVIGATE intervention in a naturalistic setting. We describe the outcomes of NAVIGATE implementation in the state of MI.MethodsIn 2014, 3 centers in MI were selected and trained to provide NAVIGATE CSC for FEP. In 2016 a 4th center was added, and 2 existing centers were expanded to provide additional access to NAVIGATE. Inclusion: age 18–31, served in 1 of 4 FEP centers in MI. Data collection began in 2015 for basic demographics, global illness (CGI q3 mo), hospital/ED use and work/school (SURF q3 mo) and was expanded in 2016 to include further demographics, diagnosis, DUP, vital signs; and in 2018 for clinical symptoms with the modified Colorado Symptom Inventory (mCSI q6 mo), reported via an online portal. This analysis used data until 12/31/19. Mixed effects models adjusted by age, sex and race were used to account for correlated data within patients.ResultsN=283 had useable demographic information and were included in the analysis. Age at enrollment was 21.6 ± 3.0 yrs; 74.2% male; 53.4% Caucasian, 34.6% African American; 12.9 ± 1.7 yrs of education (N=195). 18 mo retention was 67% with no difference by sex or race. CGI scores decreased 20% from baseline (BL) to 18 mo (BL=3.5, N=134; 15–18 mo=2.8, N=60). Service utilization via the SURF was measured at BL (N=172) and 18 mo (N=72): psychiatric hospitalizations occurred in 37% at BL and 6% at 18 mo (p<0.01); ER visits occurred in 40% at BL and 13% at 18 mo (p<0.01). 44% were working or in school at BL and 68% at 18 mo (p<0.01). 21% were on antipsychotics (AP) at BL (N=178) and 85% at 18 mo (N=13) with 8% and 54% on long acting injectable-AP at BL and 18 mo, respectively. Limitations include missing data and lack of a control group.ConclusionThe implementation of the NAVIGATE CSC program for FEP in MI resulted in meaningful clinical improvement for enrollees. Further support could make this evidence-based intervention available to more people with FEP.FundingSupported by funds from the SAMHSA Medicaid State Block Grant set-aside awarded to Network180 (Achtyes, Kempema). The funders had no role in the design of the study, the analysis or the decision to publish the results.

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Improved social functioning following social recovery therapy in first episode psychosis: Do social cognition and neurocognition change following therapy, and do they predict treatment response?

Schizophrenia Research ◽

10.1016/j.schres.2020.12.023 ◽

2021 ◽

Vol 228 ◽

pp. 249-255

Author(s):

Siân Lowri Griffiths ◽

Stephen J. Wood ◽

David Fowler ◽

Nick Freemantle ◽

Joanne Hodgekins ◽

...

Keyword(s):

Social Cognition ◽

Treatment Response ◽

Social Functioning ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Social Recovery ◽

Predict Treatment Response

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Serum NMDA Receptor Antibodies Do Not Predict Treatment Response in a Sample of People With First-Episode Psychosis

Biological Psychiatry ◽

10.1016/j.biopsych.2021.04.017 ◽

2021 ◽

Vol 90 (1) ◽

pp. e1-e2

Author(s):

Natalie Shoham

Keyword(s):

Nmda Receptor ◽

Treatment Response ◽

First Episode Psychosis ◽

First Episode ◽

Episode Psychosis ◽

Receptor Antibodies ◽

Predict Treatment Response

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Frontal lobe functioning during a simple response conflict task in first-episode psychosis and its relationship to treatment response

Brain Imaging and Behavior ◽

10.1007/s11682-018-9876-2 ◽

2018 ◽

Vol 13 (2) ◽

pp. 541-553 ◽

Cited By ~ 5

Author(s):

Keith M. Shafritz ◽

Toshikazu Ikuta ◽

Allison Greene ◽

Delbert G. Robinson ◽

Juan Gallego ◽

...

Keyword(s):

Treatment Response ◽

Frontal Lobe ◽

First Episode Psychosis ◽

Response Conflict ◽

First Episode ◽

Conflict Task ◽

Episode Psychosis ◽

Frontal Lobe Functioning

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Relationship between substance abuse and first-episode psychosis - a South African perspective

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v9i1.129 ◽

2003 ◽

Vol 9 (1) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Sandra Brink ◽

Piet Oosthuizen ◽

Robin Emsley ◽

Irene Mbanga ◽

Natasha Keyter

Keyword(s):

Substance Abuse ◽

South African ◽

Age Of Onset ◽

First Episode Psychosis ◽

First Episode ◽

Younger Age ◽

Co Morbidity ◽

Episode Psychosis ◽

First Onset ◽

African Perspective

Background. Co-morbidity between substance abuse and psy- chotic disorders is high. Few studies have examined therelationship between first-episode psychosis and substance abuse. Several questions emerge from this common relationship and many of them remain unanswered.Objectives. To determine the effect of substance abuse on psychosis in terms of onset, duration, severity of symptoms, use of medication and outcome.Method. Thirty - three subjects with first-episode psychosis, as well as primary caregivers, were interviewed re g a rding substance abuse and its relation to illness. Thirty-six control subjects were also interv i e w e d .Results. Twenty-seven per cent of subjects abused substances in the 3 months before onset of illness, and 77.8% of the abusers w e re male. Subjects in the first-episode psychosis group were m o re likely to choose cannabis as their substance of abuse than c o n t rols. They also started abusing substances at a younger age than controls. Subjects with first-episode psychosis who abused substances presented at an earlier age than non-abusers. Substances affected symptoms at baseline presentation .Conclusions. Substance abuse has a significant impact on first- onset psychosis as far as age of onset and symptom severity are c o n c e rned. Subjects with an underlying vulnerability to psychosis seem to start abusing substances at an earlier age than the general population. Males are more likely to abuse substances than females.

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