Is Pre-Psychotic Intervention Realistic in Schizophrenia and Related Disorders?

1997 ◽  
Vol 31 (6) ◽  
pp. 799-805 ◽  
Author(s):  
Alison R. Yung ◽  
Patrick D. McGorry
Keyword(s):  
Psychotic Disorders ◽  
Current Practice ◽  
Critical Evaluation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Preventive Interventions ◽  
Prodromal Phase ◽  
Ongoing Research ◽  
Economic Implications ◽  
Episode Psychosis

Objective: The aim of this paper is to discuss the logistic and ethical questions related to the possibility of intervention prior to the onset of first-episode psychosis (i.e. during the prodromal phase). Method: The method involved examination of the published literature on prevention of psychotic disorders and other mental disorders, and critical evaluation of current practice in treating pre-psychotic individuals. Results: Issues of possibly unnecessary or premature labelling, stigma and treatment arise. The question of whether such early intervention merely diagnoses the disorder earlier but does not actually improve outcome is also discussed, as are the economic implications of shifting emphasis from treatment of established disorders to preventive interventions. Conclusions: There are many legitimate concerns related to intervening in pre-psychotic individuals which must be understood by those involved in planning preventive interventions. Policies should be developed incorporating some of the ethical and economic concerns, and these need to be evaluated and changed in response to ongoing research. However, these issues need not stand in the way of the development of innovative preventive approaches to the treatment of schizophrenia and other psychotic disorders.

scholarly journals First-episode psychosis: An update

2008 ◽  
Vol 14 (1) ◽  
pp. 6
Author(s):  
Bonga Chiliza ◽  
Piet Oosthuizen ◽  
Robin Emsley
Keyword(s):  
Relapse Prevention ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Psychosocial Risk ◽  
High Rate ◽  
First Episode ◽  
Font Size ◽  
Prodromal Phase ◽  
Episode Psychosis ◽  
The Subject

<div style="left: 80.7408px; top: 404.406px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.947259);" data-canvas-width="386.4817499999998">Interest in the subject of first-episode psychosis has increased</div><div style="left: 80.7408px; top: 427.746px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.00913);" data-canvas-width="386.4972000000001">considerably in the last two decades. At present, a number</div><div style="left: 80.7408px; top: 451.086px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.985844);" data-canvas-width="386.45084999999995">of centres around the world focus on early identification</div><div style="left: 80.7408px; top: 474.426px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.08263);" data-canvas-width="386.49719999999996">and intervention in people with psychotic disorders.</div><div style="left: 80.7408px; top: 497.766px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02511);" data-canvas-width="386.46629999999993">Researchers have focused particularly on people who are</div><div style="left: 80.7408px; top: 521.106px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.01431);" data-canvas-width="386.45084999999995">possibly experiencing the prodromal phase of the illness in</div><div style="left: 80.7408px; top: 544.446px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04455);" data-canvas-width="386.48175000000003">the hope that, by instituting appropriate early intervention,</div><div style="left: 80.7408px; top: 567.786px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.983414);" data-canvas-width="386.48175000000003">the outcome of schizophrenia will be improved. Patients</div><div style="left: 80.7408px; top: 591.126px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.996087);" data-canvas-width="386.4817499999999">with first-episode psychosis present with different symptom</div><div style="left: 80.7408px; top: 614.466px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03325);" data-canvas-width="386.43539999999996">domains that should be taken into account when planning</div><div style="left: 80.7408px; top: 637.806px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03598);" data-canvas-width="386.41995">treatment. Most patients initially respond to treatment;</div><div style="left: 80.7408px; top: 661.146px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02223);" data-canvas-width="386.4045">however, there is a high rate of relapse within a few years.</div><div style="left: 80.7408px; top: 684.486px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.02236);" data-canvas-width="386.4508500000001">It is therefore important that we continue to seek improved</div><div style="left: 80.7408px; top: 707.826px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03872);" data-canvas-width="386.4044999999999">relapse prevention strategies. There has also been a</div><div style="left: 80.7408px; top: 731.166px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.958897);" data-canvas-width="386.43539999999985">resurgence of interest in psychosocial risk factors for the</div><div style="left: 80.7408px; top: 754.506px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.04442);" data-canvas-width="386.43539999999996">development of schizophrenia in the recent literature.</div><div style="left: 80.7408px; top: 777.846px; font-size: 15px; font-family: sans-serif; transform: scaleX(0.998581);" data-canvas-width="386.4508499999999">We review the literature on first-episode psychosis and</div><div style="left: 80.7408px; top: 801.186px; font-size: 15px; font-family: sans-serif; transform: scaleX(1.03689);" data-canvas-width="211.52594999999988">highlight the significant findings.</div>

QUALITY OF INDIVIDUAL AND GROUP LEVEL INTERVENTIONS FOR FIRST EPISODE PSYCHOSIS AT THE TERTIARY PSYCHIATRIC HOSPITAL IN UGANDA.

2020 ◽  
Author(s):  
Emmanuel Kiiza Mwesiga ◽  
Noeline Nakasujja ◽  
Lawrence Nankaba ◽  
Juliet Nakku ◽  
Seggane Musisi
Keyword(s):  
Psychiatric Hospital ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Group Level ◽  
Group Interventions ◽  
Episode Psychosis ◽  
Essential Components ◽  
The Individual

Introduction: Individual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear.Methods: The study was performed at Butabika National Psychiatric Teaching and referral hospital in Uganda. A retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was first performed to determine the proportion of participants who received the different essential components for individual and group level interventions. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-Episode Psychosis Services Fidelity Scale (FEPS-FS). The FEPS-FS assigns a grade of 1-5 on a Likert scale depending on the proportion of patients received the different components of the intervention. Results: The final sample included 156 first-episode psychosis patients. The median age was 27 years [IOR (24-36)] with 55% of participants of the female gender. 13 essential components across the individual and group interventions were assessed and their quality quantified. All 13 essential components had poor quality with the range of scores on the FEPS-FS of 1-3. Only one essential component assessed (use of single antipsychotics) had moderate quality.Discussion: Among current services at the National psychiatric hospital of Uganda, the essential for individual and group level interventions for psychotic disorders are of low quality. Further studies are required on how the quality of these interventions can be improved.

scholarly journals Dysregulation of complement and coagulation pathways: emerging mechanisms in the development of psychosis

2021 ◽  
Author(s):  
Meike Heurich ◽  
Melanie Föcking ◽  
David Mongan ◽  
Gerard Cagney ◽  
David R. Cotter
Keyword(s):  
High Risk ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Clinical Symptoms ◽  
First Episode Psychosis ◽  
Specific Protein ◽  
First Episode ◽  
Clinical High Risk ◽  
Blood Proteins ◽  
Episode Psychosis

AbstractEarly identification and treatment significantly improve clinical outcomes of psychotic disorders. Recent studies identified protein components of the complement and coagulation systems as key pathways implicated in psychosis. These specific protein alterations are integral to the inflammatory response and can begin years before the onset of clinical symptoms of psychotic disorder. Critically, they have recently been shown to predict the transition from clinical high risk to first-episode psychosis, enabling stratification of individuals who are most likely to transition to psychotic disorder from those who are not. This reinforces the concept that the psychosis spectrum is likely a central nervous system manifestation of systemic changes and highlights the need to investigate plasma proteins as diagnostic or prognostic biomarkers and pathophysiological mediators. In this review, we integrate evidence of alterations in proteins belonging to the complement and coagulation protein systems, including the coagulation, anticoagulation, and fibrinolytic pathways and their dysregulation in psychosis, into a consolidated mechanism that could be integral to the progression and manifestation of psychosis. We consolidate the findings of altered blood proteins relevant for progression to psychotic disorders, using data from longitudinal studies of the general population in addition to clinical high-risk (CHR) individuals transitioning to psychotic disorder. These are compared to markers identified from first-episode psychosis and schizophrenia as well as other psychosis spectrum disorders. We propose the novel hypothesis that altered complement and coagulation plasma levels enhance their pathways’ activating capacities, while low levels observed in key regulatory components contribute to excessive activation observed in patients. This hypothesis will require future testing through a range of experimental paradigms, and if upheld, complement and coagulation pathways or specific proteins could be useful diagnostic or prognostic tools and targets for early intervention and preventive strategies.

Context-specific abnormalities of the central executive network in first-episode psychosis: relationship with cognition

2020 ◽  
pp. 1-10
Author(s):  
Deepak K. Sarpal ◽  
Goda Tarcijonas ◽  
Finnegan J. Calabro ◽  
William Foran ◽  
Gretchen L. Haas ◽  
...  
Keyword(s):  
Cognitive Control ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Cognitive State ◽  
Cognitive States ◽  
Episode Psychosis ◽  
Dorsolateral Prefrontal ◽  
Parietal Lobule ◽  
Context Specific

Abstract Background Cognitive impairments, which contribute to the profound functional deficits observed in psychotic disorders, have found to be associated with abnormalities in trial-level cognitive control. However, neural tasks operate within the context of sustained cognitive states, which can be assessed with ‘background connectivity’ following the removal of task effects. To date, little is known about the integrity of brain processes supporting the maintenance of a cognitive state in individuals with psychotic disorders. Thus, here we examine background connectivity during executive processing in a cohort of participants with first-episode psychosis (FEP). Methods The following fMRI study examined background connectivity of the dorsolateral prefrontal cortex (DLPFC), during working memory engagement in a group of 43 patients with FEP, relative to 35 healthy controls (HC). Findings were also examined in relation to measures of executive function. Results The FEP group relative to HC showed significantly lower background DLPFC connectivity with bilateral superior parietal lobule (SPL) and left inferior parietal lobule. Background connectivity between DLPFC and SPL was also positively associated with overall cognition across all subjects and in our FEP group. In comparison, resting-state frontoparietal connectivity did not differ between groups and was not significantly associated with overall cognition, suggesting that psychosis-related alterations in executive networks only emerged during states of goal-oriented behavior. Conclusions These results provide novel evidence indicating while frontoparietal connectivity at rest appears intact in psychosis, when engaged during a cognitive state, it is impaired possibly undermining cognitive control capacities in FEP.

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

2019 ◽  
Vol 50 (13) ◽  
pp. 2182-2193 ◽  
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.

scholarly journals S150. EMOTIONAL BEHAVIOUR IN HIGH-RISK AND FIRST-EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S93-S93
Author(s):  
Irina Falkenberg ◽  
Huai-Hsuan Tseng ◽  
Gemma Modinos ◽  
Barbara Wild ◽  
Philip McGuire ◽  
...  
Keyword(s):  
High Risk ◽  
Emotion Recognition ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Healthy Controls ◽  
Emotional Faces ◽  
Facial Movements ◽  
Episode Psychosis ◽  
Ultra High Risk

Abstract Background Studies indicate that people with schizophrenia and first-episode psychosis experience deficits in their ability to accurately detect and display emotions through facial expressions, and that functioning and symptoms are associated with these deficits. This study aims to examine how emotion recognition and facial emotion expression are related to functioning and symptoms in a sample of individuals at ultra-high risk, first-episode psychosis and healthy controls. Methods During fMRI, we combined the presentation of emotional faces with the instruction to react with facial movements predetermined and assigned. 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs) were examined while viewing happy, sad, or neutral faces and were instructed to simultaneously move the corners of their mouths either (a). upwards or (b). downwards, or (c). to refrain from movement. The subjects’ facial movements were recorded with an MR-compatible video camera. Results Neurofunctional and behavioral response to emotional faces were measured. Analyses have only recently commenced and are ongoing. Full results of the clinical and functional impact of behavioral and neuroimaging results will be presented at the meeting. Discussion Increased knowledge about abnormalities in emotion recognition and behaviour as well as their neural correlates and their impact on clinical measures and functional outcome can inform the development of novel treatment approaches to improve social skills early in the course of schizophrenia and psychotic disorders.

scholarly journals Circulating lipids associate with future weight gain in individuals with an at-risk mental state and in first-episode psychosis

2020 ◽  
Author(s):  
Santosh Lamichhane ◽  
Alex M. Dickens ◽  
Partho Sen ◽  
Heikki Laurikainen ◽  
Jaana Suvisaari ◽  
...  
Keyword(s):  
At Risk ◽  
Weight Gain ◽  
High Risk ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
Molecular Signature ◽  
First Episode ◽  
Baseline Serum ◽  
Average Life Span ◽  
Episode Psychosis

AbstractPatients with schizophrenia have a lower than average life span, largely due to the increased prevalence of cardiometabolic co-morbidities. Identification of individuals with psychotic disorders with a high risk of rapid weight gain, and the associated development of metabolic complications, is an unmet need as regards public health. Here, we applied mass spectrometry-based lipidomics in a prospective study comprising 48 controls (CTR), 44 first-episode psychosis (FEP) patients and 22 individuals at clinical-high-risk (CHR) for psychosis, from two study centers (Turku/Finland and London/UK). Baseline serum samples were analyzed by lipidomics, while body mass index (BMI) was assessed at baseline and after 12 months. We found that baseline triacylglycerols with low double bond counts and carbon numbers were positively associated with the change in BMI at follow-up. In addition, a molecular signature comprised of two triacylglycerols (TG(48:0) and TG(45:0)), was predictive of weight gain in individuals with a psychotic disorder, with an area under the receiver operating characteristic curve (AUROC) of 0.74 (95% CI: 0.60–0.85). When independently tested in the CHR group, this molecular signature predicted said weight change with AUROC = 0.73 (95% CI: 0.61–0.83). We conclude that molecular lipids may serve as a predictor of weight gain in psychotic disorders in at-risk individuals, and may thus provide a useful marker for identifying individuals who are most prone to developing cardiometabolic co-morbidities.

scholarly journals HIV seropositivity in patients with first-episode psychosis

2007 ◽  
Vol 13 (3) ◽  
pp. 4 ◽  
Author(s):  
S Mashaphu ◽  
D L Mkize
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Seroprevalence Rate ◽  
Hiv Seropositivity ◽  
Cross Sectional ◽  
Causal Direction ◽  
Episode Psychosis ◽  
Kwazulu Natal ◽  
The Impact

<p><strong>Background.</strong> In order to gauge the impact of the HIV epidemic on psychotic disorders, the magnitude and causal direction of the association between HIV infection and psychosis need to be examined closely.</p><p><strong>Objective.</strong> To determine the HIV seropositivity rate among adult patients presenting with first-episode psychosis (FEP) to Town Hill Hospital in Pietermaritzburg, KwaZulu-Natal.</p><p><strong>Design.</strong> A cross-sectional, point-prevalence study was done over a 6-month period.</p><p><strong>Results.</strong> Of the 63 FEP patients in the study, 48 tested HIV- negative and 15 tested positive, giving a seroprevalence rate of 23.8%.</p><p><strong>Conclusion.</strong> The prevalence of HIV seropositivity is high among patients with FEP.</p>

scholarly journals Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase

2015 ◽  
Vol 207 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Lucia R. Valmaggia ◽  
Majella Byrne ◽  
Fern Day ◽  
Matthew R. Broome ◽  
Louise Johns ◽  
...  
Keyword(s):  
Minority Group ◽  
First Episode Psychosis ◽  
First Episode ◽  
First Year ◽  
Compulsory Treatment ◽  
Duration Of Untreated Psychosis ◽  
Short Term ◽  
Prodromal Phase ◽  
Episode Psychosis ◽  
Poor Outcomes

BackgroundIt is unknown whether prodromal services improve outcomes in those who go on to develop psychosis, and whether these patients are demographically different from the overall first-episode population.AimsTo compare sociodemographic features, duration of untreated psychosis, hospital admission and frequency of compulsory treatment in the first year after the onset of psychosis in patients who present to prodromal services with patients who did not present to services until the first episode of psychosis.MethodWe compared two groups of patients with first-episode psychosis: one who made transition after presenting in the prodromal phase and the other who had presented with a first episode.ResultsThe patients who had presented before the first episode were more likely to be employed and less likely to belong to an ethnic minority group. They had a shorter duration of untreated psychosis, and were less likely to have been admitted to hospital and to have required compulsory treatment.ConclusionsPatients who develop psychosis after being engaged in the prodromal phase have a better short-term clinical outcome than patients who do not present until the first episode. Patients who present during first episodes may be more likely to have sociodemographic features associated with relatively poor outcomes.

The Inter-Rater and Test-Retest Reliabilities of Prodromal Symptoms in First-Episode Psychosis

1996 ◽  
Vol 30 (4) ◽  
pp. 498-504 ◽  
Author(s):  
Henry J. Jackson ◽  
Patrick D. McGorry ◽  
Susan Harrigan ◽  
Jenepher Dakis ◽  
Lisa Henry ◽  
...  
Keyword(s):  
Field Trial ◽  
American Psychiatric Association ◽  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
World Health ◽  
First Episode ◽  
Prodromal Symptoms ◽  
Episode Psychosis ◽  
Dsm Iv ◽  
Health Organization

Objective: As part of the DSM-IV field trial for psychotic disorders, the authors endeavoured to determine the reliability of the DSM-IV prodromal features for schizophrenia in a first-episode sample. Method: Fifty first-episode psychotic patients were assessed using a semi-structured instrument to determine the presence/absence of nine prodromal symptoms. Inter-rater reliability data were calculated for 25 of the patients, and test-retest data were calculated for the remaining 25 patients. Results: Levels of reliability were poor. Conclusions: The results lend some support to American Psychiatric Association and World Health Organization decisions to omit specific criteria for prodromal features from their respective nosologies.

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