Does food responsiveness change in people with first episode psychosis (FEP) over a period of 6 months after commencing antipsychotics? Preliminary results

AimsWe here present preliminary results from our study to understand better the changes in people’ s experience of food in the months after diagnosis with first episode psychosis (FEP). Weight gain often occurs in the weeks/months after diagnosis and is related to an increase in appetite and food intake. Many drugs that are effective in treating psychosis are associated with changes in the way that people experience reward when they eat.The aim of this project is to increase our understanding of exactly why this happens in terms of an individual's experience of food reward and reduced satiety – and therefore how we can help people with FEP to keep their weight down. At this stage we are looking at the feasibility of applying currently available evaluation tools to people in this situation.MethodA convenience sample was used to recruit 10 service users from RDaSH NHS FT Early Intervention Services. This is a feasibility study which will provide data to underpin a fully powered, larger trial.Rating scales applied were:Power of food questionnaire: measures responsiveness to the food environment.Intuitive Eating Scale: measures an individual's tendency to follow their physical hunger and satiety cues.The loss of control over eating scale (LOCES): measures a global sense of whether individuals experience LOC over eating.Dutch Eating Behaviour Questionnaire (DEBQ): measures restrained eating, emotional eating and external eating.ResultThe ages of the participants ranged from 17-26 years. All were started on Olanzapine at the dose of 5 or 10 mg daily.Baseline total scores for the Power of Food (2.47-3.80)/5 (higher score = more responsiveness) and Intuitive Eating scales (2.10-2.62)/5 (higher score = greater tendency to follow hunger and satiety cues) were in the mid-range, while the LOCES scores varied widely from 1.50-2.38/5.The DEBQ restrained subscale score range was 2.40-2.80/5 (higher indicates greater restraint with food) while the DEBQ external subscale ranged from 2.70—3.00/5 (higher = greater tendency to overeat) and the DEBQ emotional subtotal score was 1.92-1.94/5, in keeping with a relatively low emotional drive to eat.ConclusionOur preliminary results reveal at the beginning of antipsychotic treatment a moderate responsiveness to food and tendency to follow hunger/ satiety cues, with scores for Loss of Control of eating in the low to moderate range and a low emotional drive to eat. The difference between these and the follow-up eating behaviour scores will provide important clues as to the precise changes in eating behaviour with anti-psychotic treatment in FEP.

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Treatment response after 6 and 26 weeks is related to baseline glutamate and GABA levels in antipsychotic-naïve patients with psychosis

Psychological Medicine ◽

10.1017/s0033291719002277 ◽

2019 ◽

Vol 50 (13) ◽

pp. 2182-2193 ◽

Cited By ~ 11

Author(s):

Kirsten B. Bojesen ◽

Bjørn H. Ebdrup ◽

Kasper Jessen ◽

Anne Sigvard ◽

Karen Tangmose ◽

...

Keyword(s):

Psychotic Disorders ◽

Poor Response ◽

First Episode Psychosis ◽

Anterior Cingulate ◽

First Episode ◽

Antipsychotic Treatment ◽

Resonance Spectroscopy ◽

Reference Levels ◽

Clinical Prognosis ◽

Episode Psychosis

AbstractBackgroundPoor response to dopaminergic antipsychotics constitutes a major challenge in the treatment of psychotic disorders and markers for non-response during first-episode are warranted. Previous studies have found increased levels of glutamate and γ-aminobutyric acid (GABA) in non-responding first-episode patients compared to responders, but it is unknown if non-responders can be identified using reference levels from healthy controls (HCs).MethodsThirty-nine antipsychotic-naïve patients with first-episode psychosis and 36 matched HCs underwent repeated assessments with the Positive and Negative Syndrome Scale and 3T magnetic resonance spectroscopy. Glutamate scaled to total creatine (/Cr) was measured in the anterior cingulate cortex (ACC) and left thalamus, and levels of GABA/Cr were measured in ACC. After 6 weeks, we re-examined 32 patients on aripiprazole monotherapy and 35 HCs, and after 26 weeks we re-examined 30 patients on naturalistic antipsychotic treatment and 32 HCs. The Andreasen criteria defined non-response.ResultsBefore treatment, thalamic glutamate/Cr was higher in the whole group of patients but levels normalized after treatment. ACC levels of glutamate/Cr and GABA/Cr were lower at all assessments and unaffected by treatment. When compared with HCs, non-responders at week 6 (19 patients) and week 26 (16 patients) had higher baseline glutamate/Cr in the thalamus. Moreover, non-responders at 26 weeks had lower baseline GABA/Cr in ACC. Baseline levels in responders and HCs did not differ.ConclusionGlutamatergic and GABAergic abnormalities in antipsychotic-naïve patients appear driven by non-responders to antipsychotic treatment. If replicated, normative reference levels for glutamate and GABA may aid estimation of clinical prognosis in first-episode psychosis patients.

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Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

BMJ Open ◽

10.1136/bmjopen-2015-009888 ◽

2016 ◽

Vol 6 (3) ◽

pp. e009888 ◽

Cited By ~ 56

Author(s):

Rashmi Patel ◽

Robin Wilson ◽

Richard Jackson ◽

Michael Ball ◽

Hitesh Shetty ◽

...

Keyword(s):

Observational Study ◽

Hospital Admission ◽

Treatment Failure ◽

First Episode Psychosis ◽

Cannabis Use ◽

First Episode ◽

Antipsychotic Treatment ◽

Episode Psychosis

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

Early Intervention in Psychiatry ◽

10.1111/eip.12696 ◽

2018 ◽

Vol 13 (4) ◽

pp. 895-901 ◽

Cited By ~ 1

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

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Innate Immune Cells and C-Reactive Protein in Acute First-Episode Psychosis and Schizophrenia: Relationship to Psychopathology and Treatment

Schizophrenia Bulletin ◽

10.1093/schbul/sbz068 ◽

2019 ◽

Cited By ~ 2

Author(s):

Johann Steiner ◽

Thomas Frodl ◽

Kolja Schiltz ◽

Henrik Dobrowolny ◽

Roland Jacobs ◽

...

Keyword(s):

Innate Immunity ◽

First Episode Psychosis ◽

Innate Immune ◽

First Episode ◽

Antipsychotic Treatment ◽

C Reactive Protein ◽

Activation Markers ◽

Reactive Protein ◽

Immune System Activation ◽

Episode Psychosis

Abstract Innate immunity has been linked to initiation of Alzheimer’s disease and multiple sclerosis. Moreover, risk of first-episode psychosis (FEP) and schizophrenia (Sz) is increased after various infections in predisposed individuals. Thus, we hypothesized an analogous role of innate immunity with increased C-reactive protein (CRP) in non-affective psychosis. Differential blood count, CRP, neutrophil and monocyte–macrophage activation markers, cortisol and psychotic symptoms (Positive and Negative Syndrome Scale [PANSS]) were assessed in controls (n = 294) and acutely ill unmedicated FEP (n = 129) and Sz (n = 124) patients at baseline and after 6 weeks treatment. Neutrophils, monocytes, and CRP were increased in patients vs controls at baseline (P < .001), and neutrophil and monocyte counts correlated positively with activation markers. Eosinophils were lower at baseline in FEP (P < .001) and Sz (P = .021) vs controls. Differences in neutrophils (P = .023), eosinophils (P < .001), and CRP (P < .001) were also present when controlling for smoking and cortisol, and partially remitted after antipsychotic treatment. FEP patients with high neutrophils (P = .048) or monocytes (P = .021) had higher PANSS-P scores at baseline but similar disease course. CRP correlated with PANSS-P at baseline (ρ = 0.204, P = .012). Improvement of positive symptoms after treatment correlated with declining neutrophils (ρ = 0.186, P = .015) or CRP (ρ = 0.237, P = .002) and rising eosinophils (ρ = −0.161, P = .036). In FEP, normalization of neutrophils (ρ = −0.231, P = .029) and eosinophils (ρ = 0.209, P = .048) correlated with drug dosage. In conclusion, innate immune system activation correlated with PANSS-P, supporting the immune hypothesis of psychosis. Neutrophil and monocyte counts and CRP levels may be useful markers of disease acuity, severity, and treatment response.

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Remission from antipsychotic treatment in first episode psychosis related to longitudinal changes in brain glutamate

npj Schizophrenia ◽

10.1038/s41537-019-0080-1 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 7

Author(s):

Kate Merritt ◽

Rocio Perez-Iglesias ◽

Kyra-Verena Sendt ◽

Rhianna Goozee ◽

Sameer Jauhar ◽

...

Keyword(s):

First Episode Psychosis ◽

First Episode ◽

Antipsychotic Treatment ◽

Longitudinal Changes ◽

Episode Psychosis

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O8.4. CORTICAL DOPAMINE RELEASE IN RESPONSE TO A COGNITIVE CHALLENGE: PRELIMINARY RESULTS IN FIRST EPISODE PSYCHOSIS AND CLINICAL HIGH RISK

Schizophrenia Bulletin ◽

10.1093/schbul/sbz021.236 ◽

2019 ◽

Vol 45 (Supplement_2) ◽

pp. S184-S184

Author(s):

Abanti Tagore ◽

Naren Rao ◽

Christin Schifani ◽

Huai-Hsuan Tseng ◽

Pablo Rusjan ◽

...

Keyword(s):

High Risk ◽

Dopamine Release ◽

First Episode Psychosis ◽

First Episode ◽

Clinical High Risk ◽

Preliminary Results ◽

Episode Psychosis ◽

Cognitive Challenge

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Effect of discontinuation v. maintenance of antipsychotic medication on relapse rates in patients with remitted/stable first-episode psychosis: a meta-analysis

Psychological Medicine ◽

10.1017/s0033291718001393 ◽

2018 ◽

Vol 49 (5) ◽

pp. 772-779 ◽

Cited By ~ 5

Author(s):

Taro Kishi ◽

Toshikazu Ikuta ◽

Yuki Matsui ◽

Ken Inada ◽

Yuki Matsuda ◽

...

Keyword(s):

Meta Analysis ◽

First Episode Psychosis ◽

First Episode ◽

Antipsychotic Treatment ◽

Episode Psychosis ◽

Numbers Needed To Treat ◽

Reported Data ◽

Relapse Rates ◽

Risk Of Relapse ◽

Maintenance Group

AbstractBackgroundDiscontinuation of antipsychotics predisposes patients with remitted/stable first-episode psychosis (FEP) to a higher risk of relapse, but it remains unclear how long discontinuation increases the relapse rate in these patients compared with maintenance.MethodsThis meta-analysis of randomized controlled trials (RCTs) compared relapse rates in FEP patients between antipsychotic treatment discontinuation and maintenance groups at 1, 2, 3, 6, 9, 12 (primary), and 18–24 months. The risk ratio (RR) and numbers needed to treat/harm (NNT/NNH) were calculated using a random-effects model.ResultsTen RCTs were identified (n = 776; mean study duration, 18.6 ± 6.0 months). The antipsychotics were discontinued abruptly in four RCTs (which reported data only at 12 months) and after tapering off gradually over several months (mean length, 3 months) in six RCTs. Compared with the discontinuation group, the maintenance group experienced significantly fewer relapses at all time points except 1 month [RR (NNT): 2 months, 0.49 (13); 3 months, 0.46 (9); 6 months, 0.55 (6); 9 months, 0.48 (3); 12 months, 0.47 (3); and 18–24 months, 0.57 (4)]. The maintenance group was associated with higher discontinuation due to adverse events (RR, 2.61; NNH, not significant).ConclusionsMaintaining antipsychotic treatment prevented relapse for up to 24 months in FEP patients. Discontinuation of antipsychotics for ⩾2 months significantly increased the risk of relapse. However, 45.7% of patients who discontinued antipsychotics for 12 months (39.4% after 18–24 months) did not experience a relapse.

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The Psychology of Food Cravings in Patients With First-Episode Psychosis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.587486 ◽

2020 ◽

Vol 11 ◽

Author(s):

Young-Hyuk Kim ◽

Seunghyong Ryu ◽

Hee-Jung Nam ◽

Mina Kim ◽

Min Jhon ◽

...

Keyword(s):

Body Weight ◽

Weight Gain ◽

Perceived Stress ◽

First Episode Psychosis ◽

Psychological Characteristics ◽

First Episode ◽

Loss Of Control ◽

Food Cravings ◽

Significant Weight Gain ◽

Episode Psychosis

Objectives: Food cravings may cause weight gain in patients with schizophrenia. This study investigated psychological characteristics associated with food cravings in patients with first-episode psychosis.Methods: This study analyzed data from a clinical cohort of first-episode psychosis patients taking antipsychotics for 3 months or less. The strength of food cravings was measured using the General Food Cravings Questionnaire-Trait (G-FCQ-T). Psychological characteristics and psychiatric symptoms were investigated with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale, Rosenberg Self-Esteem Scale (RSES), and Perceived Stress Scale (PSS). Clinical characteristics were compared according to significant weight gain (≥10% increase in body weight compared to baseline) over 3 months. Associations between the G-FCQ-T and other psychiatric scales were investigated. We conducted sex-stratified analyses.Results: In total, 182 patients (78 males and 104 females) with first-episode psychosis were enrolled in this study. In females, the G-FCQ-T total score at baseline was associated with baseline body weight and significant weight gain over 3 months. The PSS scales were significantly associated the G-FCQ-T total and all subscale scores in female participants. Scores on the RSES and CDSS were significantly associated with the G-FCQ-T total score and with the preoccupation and loss of control subscale scores. The PANSS negative and general subscales were significantly associated with the positive outcome expectancy and loss of control subscales of the G-FCQ-T, respectively. In males, the only significant association was between the loss of control subscale and RSES scores. Linear regression analysis showed significant associations of PSS scores with the total and all subscale scores of the G-FCQ-T despite the loss of significance for other variables.Conclusion: These results indicate that the food cravings in patients with first-episode psychosis, which were associated with weight gain, were influenced by perceived stress in females. To reduce food cravings in female patients with schizophrenia, interventions aimed at perceived stress should be considered.

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Paliperidone palmitate log-acting injection in patients with psychotic active clinic: start, change or increase of dose

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.634 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s249-s250

Author(s):

A.L. Gonzalez Galdamez ◽

M.D. Piqueras Acevedo ◽

M.R. Raposo Hernández ◽

I. Martínez Pérez ◽

P. Manzur Rojas ◽

...

Keyword(s):

Acute Exacerbation ◽

Descriptive Study ◽

First Episode Psychosis ◽

Paliperidone Palmitate ◽

First Episode ◽

Antipsychotic Treatment ◽

Early Stages ◽

Episode Psychosis ◽

Competing Interest ◽

Long Acting

The aim is to describe the experience of treatment with Paliperidone Palmitate long acting injection (PP) in patients with psychotic active clinic, whether diagnoses with schizophrenia or in patients with the first episode psychosis, as well as to reflect the improvement in the control of the symptoms that the patients can improve increasing the dose.MethodsWe have done a descriptive study of 34 patients hospitalized in psychiatry between January and July 2015 for psychotic active clinic who started treatment with PP or the previous dose was increased.Results91.2% of patients admitted for acute exacerbation of their usual pathology and 8.8% for a first episode psychosis. In the CGI scale, all the patients admitted scored as severe or markedly ill; going mostly mildly ill at discharge. For 55.9% of patients, the treatment was changed to PP, 29.4% of the dose was increased PP and 14.7% antipsychotic treatment was started with PP. Among patients change treatment, the main reason was non-adherence (47.4%). 70.6% of our patients were discharged with PP as only antipsychotic and 29.4% which was discharged with another antipsychotic, the most frequent association was of PP with Quetiapine (80%).ConclusionsPP is a highly effective medicament in the treatment of the schizophrenia that improves the adherence to the treatment, so in our experience and we consider it a medicament to be considered in the early stages of the disease. According to our experience and there are patients who can benefit from better control of symptoms adjusting the dose individually.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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