scholarly journals Are we getting any better at staying better? The long view on relapse and recovery in first episode nonaffective psychosis and schizophrenia

2019 ◽  
Vol 9 ◽  
pp. 204512531987003 ◽  
Author(s):  
Mark Taylor ◽  
Sameer Jauhar
Keyword(s):  
Systematic Reviews ◽  
Antipsychotic Medication ◽  
Maintenance Treatment ◽  
Relevant Literature ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Long Term Outcomes ◽  
Medication Discontinuation ◽  
Recent Debate

Relapse in, and recovery from, schizophrenia has been acknowledged since the disease was first described. In this review the authors summarize the long-term (>100 years) data on relapse and recovery in schizophrenia by reviewing the extant older and modern relevant literature. The authors systematically question the utility of pharmacological and nonpharmacological interventions, with an emphasis on first episode nonaffective psychosis. The method used is a narrative review of earlier meta-analytic and systematic reviews. Antipsychotic medication discontinuation studies suggest a role for prophylactic maintenance treatment in the majority of people with schizophrenia, despite recent debate on this subject. The authors conclude that long-term outcomes, including relapse and recovery rates, have improved in the last 100 years, though prospectively identifying those people who do not require long-term antipsychotic treatment has not yet been possible. Data also suggests that interventions and outcomes during the first 5 years of the disease can influence the long-term schizophrenia trajectory.

scholarly journals Maintenance antipsychotic treatment versus discontinuation strategies following remission from first episode psychosis: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 215-225 ◽  
Author(s):  
Andrew Thompson ◽  
Catherine Winsper ◽  
Steven Marwaha ◽  
Jon Haynes ◽  
Mario Alvarez-Jimenez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Maintenance Treatment ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Risk Difference ◽  
First Episode ◽  
Control Group ◽  
Antipsychotic Treatment ◽  
Medication Discontinuation ◽  
Episode Psychosis

BackgroundUnderstanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice.MethodA systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP.ResultsSeven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; N = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; N = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis.ConclusionsThere is a higher risk of relapse for those who undergo total or targeted discontinuation strategies compared with maintenance antipsychotics in FEP samples. The effect size is moderate and the risk difference is lower in trials of targeted discontinuation strategies.Declaration of interestA.T. has received honoraria and support from Janssen-Cilag and Otsuka Pharmaceuticals for meetings and has been has been an investigator on unrestricted investigator-initiated trials funded by AstraZeneca and Janssen-Cilag. He has also previously held a Pfizer Neurosciences Research Grant. S.M. has received sponsorship from Otsuka and Lundbeck to attend an academic congress and owns shares in GlaxoSmithKline and AstraZeneca. J.H. has attended meetings supported by Sunovion Pharmaceuticals.

The report of the joint WPA/CINP workgroup on the use and usefulness of antipsychotic medication in the treatment of schizophrenia

CNS Spectrums ◽  
2020 ◽  
pp. 1-25
Author(s):  
Konstantinos N. Fountoulakis ◽  
Hans-Jurgen Moeller ◽  
Siegfried Kasper ◽  
Carol Tamminga ◽  
Shigeto Yamawaki ◽  
...  
Keyword(s):  
Maintenance Phase ◽  
Cell Loss ◽  
Current Data ◽  
Lower Mortality ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Volume Loss ◽  
Long Term Outcomes ◽  
International College

Abstract This is a report of a joint World Psychiatric Association/International College of Neuropsychopharmacology (WPA/CINP) workgroup concerning the risk/benefit ratio of antipsychotics in the treatment of schizophrenia. It utilized a selective but, within topic, comprehensive review of the literature, taking into consideration all the recently discussed arguments on the matter and avoiding taking sides when the results in the literature were equivocal. The workgroup’s conclusions suggested that antipsychotics are efficacious both during the acute and the maintenance phase, and that the current data do not support the existence of a supersensitivity rebound psychosis. Long-term treated patients have better overall outcome and lower mortality than those not taking antipsychotics. Longer duration of untreated psychosis and relapses are modestly related to worse outcome. Loss of brain volume is evident already at first episode and concerns loss of neuropil volume rather than cell loss. Progression of volume loss probably happens in a subgroup of patients with worse prognosis. In humans, antipsychotic treatment neither causes nor worsens volume loss, while there are some data in favor for a protective effect. Schizophrenia manifests 2 to 3 times higher mortality vs the general population, and treatment with antipsychotics includes a number of dangers, including tardive dyskinesia and metabolic syndrome; however, antipsychotic treatment is related to lower mortality, including cardiovascular mortality. In conclusion, the literature strongly supports the use of antipsychotics both during the acute and the maintenance phase without suggesting that it is wise to discontinue antipsychotics after a certain period of time. Antipsychotic treatment improves long-term outcomes and lowers overall and specific-cause mortality.

Trajectories after first-episode psychosis: Complement to ambiguous outcomes of long-term antipsychotic treatment by exploring a few hidden cases

2018 ◽  
Vol 13 (4) ◽  
pp. 895-901 ◽  
Author(s):  
Chen-Chung Liu ◽  
Yi-Ting Lin ◽  
Chih-Min Liu ◽  
Ming H. Hsieh ◽  
Yi-Ling Chien ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Episode Psychosis

Early striatal hypertrophy in first-episode psychosis within 3 weeks of initiating antipsychotic drug treatment

2008 ◽  
Vol 39 (5) ◽  
pp. 793-800 ◽  
Author(s):  
S. E. Chua ◽  
Y. Deng ◽  
E. Y. H. Chen ◽  
C. W. Law ◽  
C. P. Y. Chiu ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Grey Matter ◽  
Economic Status ◽  
Region Of Interest ◽  
Brain Morphology ◽  
Group Differences ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Caudate Nuclei ◽  
The Right

BackgroundWe and others have reported that patients experiencing their first episode of psychosis already have significant structural brain abnormalities. Antipsychotics seem to reverse subcortical volume deficits after months of treatment. However, the early impact of medication on brain morphology is not known.MethodForty-eight individuals in their first episode of psychosis underwent magnetic resonance imaging (MRI) brain scanning. Twenty-six were antipsychotic naive and 22 were newly treated with antipsychotic medication for a median period of 3 weeks. In each group, 80% of subjects received a diagnosis of schizophrenia. The two groups were balanced for age, sex, handedness, ethnicity, height, years of education, paternal socio-economic status (SES) and Positive and Negative Syndrome Scale (PANSS) score. Group differences in whole-brain grey matter were compared voxel by voxel, using Brain Activation and Morphological Mapping (BAMM) software. We also conducted testing of group differences with region-of-interest (ROI) measurements of the caudate nucleus.ResultsRelative to the untreated group, those receiving antipsychotic medication for 3–4 weeks had significantly greater grey-matter volumes in the bilateral caudate and cingulate gyri, extending to the left medial frontal gyrus. ROI analysis confirmed that, in treated patients, the right and left caudate nuclei were significantly larger by 10% (p<0.039, two-tailed) and 9% (p<0.048, two-tailed) respectively.ConclusionsEarly striatal grey-matter enlargement may occur within the first 3–4 weeks of antipsychotic treatment. Possible reasons for putative striatal hypertrophy and its implications are discussed.

Korean medication algorithm for depressive disorder (KMAP-DD) 2017: Maintenance treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S530-S530
Author(s):  
D.I. Jon ◽  
W. Kim ◽  
H.R. Wang ◽  
Y.S. Woo ◽  
J.S. Seo ◽  
...  
Keyword(s):  
Depressive Disorder ◽  
Maintenance Treatment ◽  
Treatment Strategies ◽  
First Episode ◽  
Psychotic Depression ◽  
Maintenance Strategies ◽  
Item Questionnaire ◽  
Competing Interest ◽  
Depressive Episodes

IntroductionThe international guideline for treating depression has been widely used.ObjectivesThe current study focused on the maintenance treatment section of the third revision of Korean Medication Algorithm for Depressive Disorder (KMAP-DD)MethodsA 44-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for depressive disorder. Of the 144 committee members, 79 psychiatrists responded to the survey. Each treatment strategy or treatment option was evaluated with the nine-point scale.ResultsMost clinicians answered to maintain both antidepressants (AD) and atypical antipsychotics (AAP) for psychotic depression in remission state. The duration of AD maintenance: from 19.8 weeks to 46.8 weeks for patients in remission of the first episode, from 34.8 weeks to 78.4 weeks for the second depressive episode, and long-term continuation for three or more depressive episodes. Aripiprazole was the most preferred AAP. The preferred doses of AD and AAP in maintenance treatment were about 75% and 50% of those in acute treatment The maintenance of AAP in the psychotic depression in remission was similar to the AD, although shorter and less.ConclusionsThe maintenance strategies of KMAP-DD 2017 were similar to those of KMAP-DD 2012. Most clinicians preferred to maintain AD for substantial duration after achieving remission. The maintenance of AAP was also preferred, but the duration was shorter than AD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Changes in the cytokine profile in first episode, drug-naïve patients with psychosis after short-term antipsychotic treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S371-S371
Author(s):  
P. Petrikis ◽  
P. Voulgari ◽  
V. Boumba ◽  
D. Archimandriti ◽  
P. Skapinakis ◽  
...  
Keyword(s):  
Antipsychotic Medication ◽  
Transforming Growth Factor ◽  
Serum Levels ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Enzyme Linked Immunosorbent Assay ◽  
Antipsychotic Treatment ◽  
Before And After ◽  
Drug Naïve ◽  
Competing Interest

IntroductionAn increasing body of evidence suggests that antipsychotic medication can cause immunological changes that could be attributed to the amelioration of psychotic symptoms or the metabolic side effects of the drugs. So far, the results of the studies remain controversial.ObjectiveOur aim was to compare the levels of interleukin (IL) IL-2, IL-6 and transforming growth factor-β2 (TGF-β2) in drug-naïve, first-episode patients with psychosis before and after six weeks of antipsychotic medication.MethodsThirty-nine first episode patients with psychosis were enrolled in the study. Serum levels of IL-2, IL-6 and TGF-β2 were measured by enzyme linked immunosorbent assay (ELISA) before and six weeks after the initiation of antipsychotic medication. In addition, clinical psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS) before and after treatment.ResultsSerum levels of IL-2 were significantly higher in the study group six weeks after the initiation of antipsychotic treatment (P < 0.001) while TGF-β2 levels were decreased (P < 0.001) and IL-6 levels were slightly reduced (P < 0.004).ConclusionThe changes in cytokine levels may be attributed to the action of antipsychotic medication and the remission of psychopathology. The reduction in TGF-β2 levels is observed in all patients and with all antipsychotic medications used. TGF-β2 may be a marker of clinical efficacy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

How “DUP” and “EE” Predict the Dynamic OD Syndromes in the Long - Termcourse of Schizophrenia?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Cechnicki ◽  
R. Polczyk ◽  
A. Bielańska
Keyword(s):  
Repeated Measures ◽  
First Episode ◽  
First Year ◽  
List Type ◽  
Type Number ◽  
Long Term Outcomes ◽  
Course Of Illness ◽  
Negative Syndrome

Objective:The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.Subjects and methods:58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. The Follow-Up Chart, BPRS, and CFI were used. As the outcome criteria only dynamic of symptoms were included. The dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.Results:1.General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). The negative syndrome decreased less rapidly during the first year.2.The dynamic of general and positive syndrome were modified by the DUP and by EE. In long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. After the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).3.The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).Conclusion:The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. The dynamic of negative syndrome was not modified by DUP and EE.

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