scholarly journals Twenty-Four Week, Randomized, Double-Blind, Placebo-Controlled Trial of Metformin for Antipsychotic-Induced Weight Gain in Patients with First-Episode Psychosis: A Pilot Study

2021 ◽  
Vol 19 (1) ◽  
pp. 137
Author(s):  
Charmaine Tang ◽  
Yi Chian Chua ◽  
Edimansyah Abdin ◽  
Mythily Subramaniam ◽  
Swapna Verma
Keyword(s):  
Weight Gain ◽  
Pilot Study ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Episode Psychosis

Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.

Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong

2016 ◽  
Vol 173 (1-2) ◽  
pp. 79-83 ◽  
Author(s):  
Wing Chung Chang ◽  
Vivian Wing Yan Kwong ◽  
Gloria Hoi Kei Chan ◽  
Olivia Tsz Ting Jim ◽  
Emily Sin Kei Lau ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hong Kong ◽  
Early Intervention ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
First Episode ◽  
Randomized Controlled ◽  
Episode Psychosis

scholarly journals Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

2017 ◽  
Vol 47 (11) ◽  
pp. 1981-1989 ◽  
Author(s):  
A. Demjaha ◽  
J. M. Lappin ◽  
D. Stahl ◽  
M. X. Patel ◽  
J. H. MacCabe ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Age At Onset ◽  
Treatment Resistance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Episode Psychosis

BackgroundWe examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.MethodThe study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.ResultsFrom the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.ConclusionsThe striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

scholarly journals Randomized Controlled Trial of Clozapine and CBT for First-Episode Psychosis with Enduring Positive Symptoms: A Pilot Study

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
J. Edwards ◽  
J. Cocks ◽  
P. Burnett ◽  
D. Maud ◽  
L. Wong ◽  
...  
Keyword(s):  
Pilot Study ◽  
Negative Symptoms ◽  
Controlled Trial ◽  
Treatment Phase ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Treatment Groups ◽  
Episode Psychosis ◽  
Symptomatic Remission

Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria () were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52%) of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time.

scholarly journals Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chen-Chung Liu ◽  
Chih-Min Liu ◽  
Yi-Ling Chien ◽  
Yi-Ting Lin ◽  
Ming H. Hsieh ◽  
...  
Keyword(s):  
Low Dose ◽  
First Episode Psychosis ◽  
Fine Tuning ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Full Time ◽  
Episode Psychosis ◽  
Employment Education

Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications.Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose.Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients.Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

Early insulin resistance predicts weight gain and waist circumference increase in first-episode psychosis – A one year follow-up study

2015 ◽  
Vol 169 (1-3) ◽  
pp. 458-463 ◽  
Author(s):  
Jaakko Keinänen ◽  
Outi Mantere ◽  
Tuula Kieseppä ◽  
Teemu Mäntylä ◽  
Minna Torniainen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Waist Circumference ◽  
First Episode Psychosis ◽  
First Episode ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
One Year

scholarly journals S122. TEN-YEAR FOLLOW-UP AFTER FIRST EPISODE PSYCHOSIS: FOCUSED ON LOW DOSE ANTIPSYCHOTIC MAINTENANCE AND FUNCTIONING

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Chen-Chung Liu ◽  
Chih-Min Liu ◽  
Yi-Ling Chien ◽  
Yi-Ting Lin ◽  
Ming H Hsieh ◽  
...  
Keyword(s):  
Low Dose ◽  
First Episode Psychosis ◽  
Fine Tuning ◽  
Careful Examination ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Full Time ◽  
Episode Psychosis

Abstract Background Patients’ long-term phenomenology and outcomes after first episode psychosis are of great interest to patients, their caregivers and care providers. Contradictory messages regarding the necessity of long-term antipsychotic treatment and the factors affecting outcomes warrant careful examination. Methods We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special focus on patients maintaining very low dose antipsychotics and their functioning. Results Of the 81 patients with first episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n=46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit and 10 patients (18.2%) received very low dose antipsychotics (chlorpromazine equivalent [CPZE] dose < 50 mg/d) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization and being on clozapine therapy were correlated to poorer functioning. Fifteen of the 20 good-functioning patients received dosage of antipsychotics no more than the reported minimum effective dose (CPZE 200 mg/d). Antipsychotic-free status was achieved only in two non-psychotic patients. Discussion A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first episode psychosis, even if they cannot successfully discontinue antipsychotic treatment in the long run. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

scholarly journals eNACT: A protocol for a randomised placebo-controlled trial investigating the efficacy and mechanisms of action of adjunctive N-acetylcysteine for first episode psychosis

2019 ◽  
Author(s):  
Sue Cotton ◽  
Michael Berk ◽  
Amity Watson ◽  
Stephen Wood ◽  
Kelly Allott ◽  
...  
Keyword(s):  
Young People ◽  
Nitrosative Stress ◽  
Psychiatric Symptoms ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
First Episode ◽  
Resonance Spectroscopy ◽  
Major Advance ◽  
Episode Psychosis

Abstract Background First episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown the antioxidant amino acid N-acetyl cysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-up. Methods ENACT is a 26-week randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15-25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of; inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Discussion Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry.

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