Pharmacotherapy of first-episode schizophrenia

1998 ◽  
Vol 172 (S33) ◽  
pp. 66-70 ◽  
Author(s):  
Gary Remington ◽  
Shitij Kapur ◽  
Robert B. Zipursky
Keyword(s):  
Side Effects ◽  
Effective Treatment ◽  
Low Dose ◽  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission ◽  
Binding Data ◽  
Neuroimaging Data ◽  
First Episode Schizophrenia

Background A growing interest in first-episode schizophrenia reflects the belief that this line of investigation will lead to further developments regarding schizophrenia's aetiology, course and outcome.Method Evidence from more recent clinical trials involving first-episode schizophrenia is integrated with neuroimaging data, specifically positron emission tomography, to provide direction regarding pharmacotherapy.Results Individuals with a first episode of schizophrenia appear particularly responsive to pharmacotherapy, as well as quite sensitive to side-effects. At the same time, current clinical and receptor-binding data support the efficacy of low-dose neuroleptic treatment.Conclusions Early and effective treatment of schizophrenia has been associated with better long-term outcome. Low-dose neuroleptic therapy is an effective treatment strategy and the diminished risk of side-effects with this approach may further enhance compliance and outcome.

First-Episode Schizophrenia

CNS Spectrums ◽  
2010 ◽  
Vol 15 (S6) ◽  
pp. 4-7 ◽  
Author(s):  
Delbert Robinson
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Previous Treatment ◽  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Illness Onset ◽  
Multiple Episode ◽  
Number Of Patients ◽  
First Episode Schizophrenia

Clinicians treating patients with first-episode (FE) schizophrenia can draw upon the vast literature on the treatment of patients with multiple-episode schizophrenia. Studies with multi-episode patients, however, may not fully generalize to the treatment of FE patients. Studies with multi-episode patients typically recruit from hospitals or other acute care units, settings where patients usually have been either non-responsive or non-adherent to previous treatment, or mixtures of both. Studies of multi-episode patients therefore tend to include patients who are not fully responsive to treatment. Without the filter of prior treatment history, FE compared with multi-episode patients may show a broader range of treatment patterns, ranging from extremely good to very poor. Further, studies of FE patients may be very instructive about side effects, as the confounding effect of prior medication use is particularly important with side effects. Finally, data suggest that much of the deterioration (eg, more severe negative symptoms) associated with schizophrenia may occur during the 5 years following illness onset. Providing patients with better treatment at illness onset offers the hope of improving their long-term outcome.FE studies do have limitations. Relatively few new cases of schizophrenia occur each year. The typically chronic course of schizophrenia results in a large number of patients with multi-episode schizophrenia for every FE patient at any one time. Recruitment for studies of FE schizophrenia compared with those of multi-episode schizophrenia is often more difficult given the smaller number of available patients. We systematically know less about the treatment of FE patients than we do about the treatment of multi-episode patients.

A Comparison of Long-Term Outcome in First-Episode Schizophrenia Following Treatment With Risperidone or a Typical Antipsychotic

2001 ◽  
Vol 62 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Ashok K. Malla ◽  
Ross M. G. Norman ◽  
Derek J. Scholten ◽  
Sandra Zirul ◽  
Vinod Kotteda
Keyword(s):  
First Episode ◽  
Typical Antipsychotic ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First Episode Schizophrenia

scholarly journals Effects of duration of untreated psychosis on long-term outcome of people hospitalized with first episode schizophrenia

2010 ◽  
Vol 52 (2) ◽  
pp. 164 ◽  
Author(s):  
Amresh Shrivastava ◽  
Nilesh Shah ◽  
Megan Johnston ◽  
Larry Stitt ◽  
Meghana Thakar ◽  
...  
Keyword(s):  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First Episode Schizophrenia

scholarly journals Predictors of long-term outcome of first-episode schizophrenia: A ten-year follow-up study

2010 ◽  
Vol 52 (4) ◽  
pp. 320 ◽  
Author(s):  
Amresh Shrivastava ◽  
Nilesh Shah ◽  
Megan Johnston ◽  
Larry Stitt ◽  
Meghana Thakar
Keyword(s):  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Study ◽  
First Episode Schizophrenia

scholarly journals Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis

2016 ◽  
Vol 42 (5) ◽  
pp. 906-917 ◽  
Author(s):  
Pieter Logghe ◽  
Rolf Verlinde ◽  
Frank Bouttens ◽  
Caroline Van den Broecke ◽  
Nathalie Deman ◽  
...  
Keyword(s):  
Side Effects ◽  
Retrospective Analysis ◽  
Low Dose ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Clozapine v. chlorpromazine in treatment-naive, first-episode schizophrenia: 9-year outcomes of a randomised clinical trial

2011 ◽  
Vol 199 (4) ◽  
pp. 281-288 ◽  
Author(s):  
Ragy R. Girgis ◽  
Michael R. Phillips ◽  
Xiaodong Li ◽  
Kejin Li ◽  
Huiping Jiang ◽  
...  
Keyword(s):  
Health Centre ◽  
Randomised Clinical Trial ◽  
Clinical State ◽  
First Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Antipsychotic Medications ◽  
Treatment Naïve ◽  
First Episode Schizophrenia ◽  
First And Second Generation

BackgroundThe differential effects of so-called ‘first- and second-generation’ antipsychotic medications, when given in the first episode, on the long-term outcome of schizophrenia remain to be elucidated.AimsWe compared the 9-year outcomes of individuals initially randomised to clozapine or chlorpromazine.MethodOne-hundred and sixty individuals with treatment-naive, first-episode schizophrenia or schizophreniform disorder in a mental health centre in Beijing, China were randomised to clozapine or chlorpromazine treatment for up to 2 years, followed by up to an additional 7 years of naturalistic treatment. The primary outcome was remission status for individuals in each group.ResultsIndividuals in both groups spent essentially equal amounts of time in each clinical state over the follow-up time period (remission, 78%; intermediate, 8%; relapse, 14%). There were no significant differences on other measures of illness severity. The clozapine group was more likely than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01). There were no significant differences between the two groups on other secondary efficacy outcomes.ConclusionsThese findings support the comparability in effectiveness between antipsychotic medications but with slightly greater tolerability of clozapine in the treatment of first-episode psychosis.

scholarly journals Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

2021 ◽  
pp. 1-14
Author(s):  
S. Fayyaz ◽  
N. Nkire ◽  
B. Nwosu ◽  
N. Amjad ◽  
A. Kinsella ◽  
...  
Keyword(s):  
Early Intervention ◽  
Negative Symptoms ◽  
Education Programme ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Research Findings ◽  
Prospective Research ◽  
Operational Activities

Objectives: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. Methods: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. Results: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. Conclusions: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

scholarly journals Psychosis in youth in Singapore: a case series

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S117-S117
Author(s):  
Pei Ling Lim ◽  
Roselyne Shirley ◽  
Pat Fong
Keyword(s):  
Adult Population ◽  
Psychiatric Service ◽  
Case Series ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Paediatric Hospital ◽  
Seeking Help

ObjectiveIn this report, we present a case series of children with psychotic symptoms referred to a child consultation liaison psychiatric service within a tertiary paediatric hospital in Singapore. The purpose of this case series is to identify common symptoms at presentation, review the current practices in our hospital for investigation and treatment of first episode psychosis and short-term outcomes.Case reportWe identified 9 cases over a 1 year period, for which 7 were seen whilst admitted to hospital and 2 in the outpatient clinic. There were 6 females and 5 males ranging in age from 11 to 16 years old. The commonest symptoms on presentation were perceptual disturbance (88%) most commonly auditory hallucinations and altered behaviour (55%). Of the 7 children admitted to hospital, all were seen by the neurology team prior to the request for a psychiatric opinion. All admitted patients had blood and radiological investigations carried out. Most of the children were started on a short course of antipsychotic medication with the majority continuing to attend follow-up outpatient.DiscussionOnly 9 cases were identified in this case series over a 1 year period highlighting that psychosis is not a common presentation in the paediatric population. From the history alone, it can be challenging to distinguish between primary and secondary causes of psychosis. Acute onset of symptoms and the presence of other neurological signs should raise the suspicion of an underlying organic cause. Out of 9 cases, only 1 case was treated for a presumed organic aetiology, which is consistent with findings from other authors who only found underlying organic factors in 12.5% of cases.In this case series, we also noted that 45% of cases reported having symptoms for over 1 year before seeking help. This is also seen in the adult population in Singapore. Stigma, denial and lack of information about psychosis may all contribute to delay in seeking help. Although prolonged duration of untreated psychosis has been shown to be associated with poor long-term outcome, we found in our case series that even patients who reported a long duration of symptoms still responded well to medication.ConclusionThere is room for collaboration with our neurology colleagues in the approach towards children with first presentation of psychosis, both in terms of investigations and management. Identifying reasons for disengagement from psychiatric care is an area for further investigations to improve outcomes in our patients.

scholarly journals Antipsychotic Treatment Effectiveness in First Episode of Psychosis: PAFIP 3-Year Follow-Up Randomized Clinical Trials Comparing Haloperidol, Olanzapine, Risperidone, Aripiprazole, Quetiapine, and Ziprasidone

2020 ◽  
Vol 23 (4) ◽  
pp. 217-229 ◽  
Author(s):  
Marcos Gómez-Revuelta ◽  
José María Pelayo-Terán ◽  
María Juncal-Ruiz ◽  
Javier Vázquez-Bourgon ◽  
Paula Suárez-Pinilla ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Dropout Rate ◽  
Treatment Discontinuation ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Open Label ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Treatment Groups

Abstract Background Different effectiveness profiles among antipsychotics may be a key point to optimize treatment in patients suffering a first episode of psychosis to impact on long-term outcome. The aim of this study is to compare the clinical effectiveness of olanzapine, risperidone, haloperidol, aripiprazole, ziprasidone, and quetiapine in the treatment of first episode of psychosis at 3-year follow-up. Method From February 2001 to January 2011, 2 phases of a prospective, randomized, open-label study were undertaken. A total of 376 first-episode drug-naïve patients were randomly assigned to olanzapine (n = 55), risperidone (n = 63), haloperidol (n = 56), aripiprazole (n = 78), ziprasidone (n = 62), or quetiapine (n = 62) and followed up for 3 years. The primary effectiveness measure was all cause of treatment discontinuation. In addition, an analysis based on intention-to-treat principle was conducted in the analysis for clinical efficacy. Results The overall dropout rate at 3 years reached 20.75%. Treatment discontinuation rates were significantly different among treatment groups (olanzapine = 69.09, risperidone = 71.43, aripiprazole = 73.08%, ziprasidone = 79.03%, haloperidol = 89.28%, and quetiapine = 95.53%) (χ2 = 79.86; P = .000). Statistically significant differences in terms of lack of efficacy, adherence, and tolerability were observed among treatment groups along the 3-year follow-up, determining significant differences in time to all-cause discontinuation (log-rank = 92.240; P = .000). Significant differences between treatments were found in the categories of sleepiness/sedation, increased sleep duration, akinesia, weight gain, ejaculatory dysfunction, extrapyramidal-symptoms, and amenorrhea. Conclusions Olanzapine, risperidone, and aripiprazole presented advantages for the first-line treatment of first episode of psychosis in terms of effectiveness. Identifying different discontinuation patterns may contribute to optimize treatment selection after first episode of psychosis. ClinicalTrials.gov Identifier: NCT02526030 https://clinicaltrials.gov/show/NCT02526030

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