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.

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.

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.

First-Episode Psychosis: A Window of Opportunity for Best Practices

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S15) ◽  
pp. 1-16 ◽  
Author(s):  
Peter F. Buckley ◽  
Christoph U. Correll ◽  
Alexander L. Miller
Keyword(s):  
Functional Impairment ◽  
Second Generation ◽  
Early Stage ◽  
First Episode Psychosis ◽  
First Episode ◽  
Psychotic Episode ◽  
Effective Treatment Option ◽  
Course Of Illness ◽  
First Psychotic Episode ◽  
Episode Psychosis

AbstractPatients experiencing a first psychotic episode or early stages of psychosis present with key diagnostic issues for clinicians. At the time of first-episode psychosis presentation, it is crucial that clinicians select the most effective treatment option as immediate intervention offers the best chance for containing the illness. Functional impairment occurs most rapidly at the early stage of illness, and such impairment can influence the patient's future prognosis, alter the level of necessary treatment, and affect morbidity. Although research has shown a decrease in brain gray matter as well as signs of functional impairment in those who develop psychosis, many of these patients remain untreated for extended periods of time and do not visit a clinician due to fear of stigma, a failure to recognize the problem, or complexities of their care system. Prior studies have shown that untreated psychosis results in worse outcome for patients compared to psychosis that is treated earlier in the course of illness. There is a range of treatment options for psychosis, including use of first-generation or second-generation antipsychotic medication. Clinicians should note that both medication types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively. For all antipsychotics, doses should be lower for patients with a first psychotic episode than for patients with chronic psychosis. Finally, clinicians must consider that patients may present with various comorbidities, such as substance abuse, that also may affect treatment.This expert roundtable supplement will address the diagnosis and treatment selection for first-episode psychosis as well as comorbidities related to the condition. The use of first- or second-generation antipsychotics for psychosis treatment, dosing guidelines, and the antipsychotic side-effect profile will also be addressed.

Cognitive training using a web-based tailor-made program for first-episode psychosis patients: An exploratory trial

2016 ◽  
Vol 33 (S1) ◽  
pp. s235-s235
Author(s):  
B. Moura ◽  
T. Mendes ◽  
F. Antunes ◽  
R. Barandas ◽  
M. Croca ◽  
...  
Keyword(s):  
Cognitive Training ◽  
Intervention Program ◽  
Individual Case ◽  
First Episode Psychosis ◽  
Cognitive Stimulation ◽  
First Episode ◽  
Psychotic Episode ◽  
Training Time ◽  
First Psychotic Episode ◽  
Episode Psychosis

IntroductionCognitive deficits are a core feature of the first psychotic episode patients and could be an obstacle to functional ability. Cognitive stimulation could be a promising method to surpass neuropsychological deficits.Objectives–to implement an online training protocol to stable first psychotic episode outpatients;–to assess adherence to the intervention;–to measure neurocognitive, psychopathological and functional outcomes pre- and post-training.AimsTo investigate the feasibility of an online-based resource for cognitive stimulation (COGWEB®) and explore possible benefits in different domains.MethodsFifteen patients were enrolled from the Early Psychosis Intervention Program (PROFIP) at the Department of Psychiatry of Santa Maria Hospital, Lisbon. The training consisted on 30-40-minute online sessions performed every weekday during 6 months at home. Assessments were performed at baseline and after program completion and included: psychopathological scores; personal and social functioning scores; Clinical Global Impression and a neuropsychological battery.ResultsEvery participant had some kind of impairment on baseline. Mean training time was 36 h. Six patients left the program before completion (half of them because they got employed). The program showed overall good feasibility and safety with no reported significant psychiatric occurrences or hospitalizations. Results regarding final neuropsychological, psychopathological and functioning showed a tendency for stability or improvement on an individual case analysis.ConclusionsOur results show that cognitive training using an online-based stimulation software is a feasible intervention for first-episode psychosis patients with possible benefits for this population. However, results should be analyzed very carefully because of different participant trajectories and of study limitations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Patterns and predictors of hospitalisation in first-episode psychosis

2001 ◽  
Vol 178 (6) ◽  
pp. 518-523 ◽  
Author(s):  
Attila Sipos ◽  
Glynn Harrison ◽  
David Gunnell ◽  
Shazad Amin ◽  
Swaran P. Singh
Keyword(s):  
Negative Symptoms ◽  
First Episode Psychosis ◽  
Psychiatric Services ◽  
First Episode ◽  
Psychotic Episode ◽  
Duration Of Untreated Illness ◽  
Specialist Services ◽  
Increased Risk ◽  
Episode Psychosis

BackgroundLittle is known about predictors of hospitalisation in patients with first-episode psychosis.AimsTo identify the pattern and predictors of hospitalisation of patients with a first psychotic episode making their first contact with specialist services.MethodThree-year follow-up of a cohort of 166 patients with a first episode of psychosis making contact with psychiatric services in Nottingham between June 1992 and May 1994.ResultsEighty-eight (53.0%) patients were admitted within 1 week of presentation; 32 (19.3%) were never admitted during the 3 years of follow-up. Manic symptoms at presentation were associated with an increased risk of rapid admission and an increased overall risk of admission; negative symptoms and a longer duration of untreated illness had an increased risk of late admission.ConclusionsCommunity-oriented psychiatric services might only delay, rather than prevent, admission of patients with predominantly negative symptoms and a longer duration of untreated illness. First-episode studies based upon first admissions are likely to be subject to selection biases, which may limit their representativeness.

scholarly journals Aggressive incidents in first-episode psychosis

2001 ◽  
Vol 178 (5) ◽  
pp. 433-440 ◽  
Author(s):  
John Milton ◽  
Shazad Amin ◽  
Swaran P. Singh ◽  
Glynn Harrison ◽  
Peter Jones ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Increased Risk ◽  
Episode Psychosis ◽  
Clinical Associations ◽  
Independent Effects ◽  
One Act ◽  
Service Contact

BackgroundRecent research has reported increased risk of aggressive incidents by individuals with psychotic illness.AimsTo examine acts of aggression in first-episode psychosis.MethodSubjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records.ResultsOf the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95%CI 1.6–8.0), comorbid substance misuse (OR=3.1, CI 1.1–8.8) and symptoms of overactivity at service contact (OR=6.9, CI 2.7–17.8) had independent effects on risk of aggression.ConclusionsWe confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed.

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.

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