scholarly journals Treatment Resistance: A Time-Based Approach for Early Identification in First Episode Psychosis

2021 ◽  
Vol 11 (8) ◽  
pp. 711
Author(s):  
Kara Dempster ◽  
Annie Li ◽  
Priyadharshini Sabesan ◽  
Ross Norman ◽  
Lena Palaniyappan
Keyword(s):  
Ecological Validity ◽  
Treatment Resistance ◽  
Positive Symptom ◽  
First Episode ◽  
Symptom Reduction ◽  
Symptom Change ◽  
Global Functioning ◽  
Episode Psychosis ◽  
First Episode Schizophrenia

Although approximately 1/3 of individuals with schizophrenia are Treatment Resistant (TR), identifying these subjects prospectively remains challenging. The Treatment Response and Resistance in Psychosis working group defines <20% improvement as an indicator of TR, though its utility in First Episode Schizophrenia (FES) remains unknown. In a prospective cohort of FES (n = 129) followed up for 5 years, we evaluated two improvement thresholds for ‘probable TR’; <20% and <50% based on positive, negative, and total symptoms. We ascertained (1) the ecological validity (i.e., the ability to identify an expected subgroup of 1/3rd of patients); (2) the predictive validity (i.e., ability to predict poor global functioning) and (3) the clinical utility (association with clozapine use at the 5th year). Using the criteria of a total symptom reduction of <50% or negative symptom reduction of <20% resulted in ‘probable TR’ rates of 37% and 33%, respectively. Using <20% positive or total symptoms criteria resulted in very low rates, indicating minimal utility in FES. <50% total symptom criterion best predicted the global functioning over 5 years. Clozapine use was only predicted by positive symptom criterion. Prospective characterization of TRS is possible at 6 months after FES through a time-based approach using a 50% threshold for symptom change in treatment-adherent patients.

Cognitive deficits and its relation with psychopathology and global functioning in first episode schizophrenia

2013 ◽  
Vol 6 (6) ◽  
pp. 537-543 ◽  
Author(s):  
Shantala Hegde ◽  
Jagadhisha Thirthalli ◽  
Shobini L. Rao ◽  
Ahalya Raguram ◽  
Mariamma Philip ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
First Episode ◽  
Global Functioning ◽  
First Episode Schizophrenia

scholarly journals Clinical Validity of Subjective Clinical Prognosis in First Episode Psychosis Schizophrenia Patients: An Analysis of Data from the European First Episode Schizophrenia Trial (EUFEST) Study

2020 ◽  
Vol Volume 16 ◽  
pp. 1279-1284
Author(s):  
Valentin Petre Matei ◽  
Alexandra Ioana Mihăilescu ◽  
Iuliana Raluca Gheorghe ◽  
Ruxandra Grigoraş ◽  
Andrei Crasan ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
First Episode ◽  
Clinical Validity ◽  
Clinical Prognosis ◽  
Episode Psychosis ◽  
First Episode Schizophrenia

A prospective evaluation of adherence to medication in first episode schizophrenia

2006 ◽  
Vol 21 (1) ◽  
pp. 29-33 ◽  
Author(s):  
M. Kamali ◽  
B.D. Kelly ◽  
M. Clarke ◽  
S. Browne ◽  
M. Gervin ◽  
...  
Keyword(s):  
Alcohol Misuse ◽  
Geographical Area ◽  
Demographic Variables ◽  
Drug Misuse ◽  
Positive Symptom ◽  
First Episode ◽  
Adherence To Medication ◽  
Symptom Scores ◽  
First Episode Schizophrenia

AbstractThe aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N = 100). At six-month follow-up (N = 60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.

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.

Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders

2010 ◽  
Vol 40 (10) ◽  
pp. 1619-1626 ◽  
Author(s):  
M. Nordentoft ◽  
J. Øhlenschlæger ◽  
A. Thorup ◽  
L. Petersen ◽  
Pia Jeppesen ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Supported Housing ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Bed Days ◽  
Spectrum Disorders ◽  
First Episode Schizophrenia

BackgroundThe effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect on use of institutional care of different intensive interventions for patients with first-episode schizophrenia spectrum disorder on use of psychiatric bed days and days in supported housing.MethodA total of 94 severely ill patients with first-episode schizophrenia spectrum disorders were included in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation.ResultsIt was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards and in supported housing throughout the 5-year follow-up period compared with the two other groups. Patients in OPUS treatment spent significantly fewer days in psychiatric wards and supported housing in the first 3 years compared with patients in hospital-based rehabilitation. Due to attrition and small sample size, differences in level of psychotic and negative symptoms at 5-year follow-up could not be evaluated.ConclusionsThe study indicates that hospital-based rehabilitation together with weekly supportive psychodynamic therapy was associated with a continued increased use of psychiatric bed days and days in supported housing. The data cannot justify using hospital-based rehabilitation in first-episode psychosis.

A 12-month outcome study of insight and symptom change in first-episode psychosis

2010 ◽  
Vol 4 (1) ◽  
pp. 79-88 ◽  
Author(s):  
Lisa Buchy ◽  
Michael Bodnar ◽  
Ashok Malla ◽  
Ridha Joober ◽  
Martin Lepage
Keyword(s):  
First Episode Psychosis ◽  
First Episode ◽  
Outcome Study ◽  
Symptom Change ◽  
Episode Psychosis

scholarly journals Impaired Performance on the Reading the Mind in the Eyes Test in First-Episode Psychosis and Clinical High Risk for Psychosis

2020 ◽  
Vol 17 (12) ◽  
pp. 1200-1206
Author(s):  
Seo Woo Kim ◽  
Sun-Young Moon ◽  
Wu Jeong Hwang ◽  
Silvia Kyungjin Lho ◽  
Sanghoon Oh ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Cognitive Abilities ◽  
First Episode Psychosis ◽  
Positive Symptom ◽  
First Episode ◽  
Clinical High Risk ◽  
Impaired Performance ◽  
Episode Psychosis ◽  
Complex Emotion ◽  
The Mind

Objective Although previous studies have reported impaired performance in the reading the mind in the eyes test (RMET), which measures complex emotion recognition abilities, in patients with schizophrenia, reports regarding individuals at clinical high risk (CHR) for psychosis have been inconsistent, mainly due to the interacting confounding effects of general cognitive abilities and age. We compared RMET performances across first-episode psychosis (FEP) patients, CHR individuals, and healthy controls (HCs) while controlling for the effects of both general cognitive abilities and age.Methods A total of 25 FEP, 41 CHR, and 44 HC subjects matched for age participated in this study. RMET performance scores were compared across the groups using analysis of variance with sex and intelligence quotient as covariates. Exploratory Pearson’s correlation analyses were performed to reveal the potential relationships of RMET scores with clinical symptom severity in the FEP and CHR groups.Results RMET performance scores were significantly lower among FEP and CHR participants than among HCs. FEP patients and CHR subjects showed comparable RMET performance scores. RMET scores were negatively correlated with Positive and Negative Syndrome Scale (PANSS) positive symptom subscale scores in the FEP patients. No significant correlation was identified between RMET scores and other clinical scale scores.Conclusion Impaired RMET performance is present from the risk stage of psychosis, which might be related to positive symptom severity in early psychosis. Longitudinal studies are necessary to confirm the stability of complex emotion recognition impairments and their relationship with social functioning in early psychosis patients.

ECT in schizophrenia: a review of the evidence

2018 ◽  
Vol 31 (03) ◽  
pp. 115-127 ◽  
Author(s):  
Sandeep Grover ◽  
Swapnajeet Sahoo ◽  
Anjumoni Rabha ◽  
Raman Koirala
Keyword(s):  
Effective Treatment ◽  
Electroconvulsive Therapy ◽  
Suicidal Behaviour ◽  
Treatment Guidelines ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
First Episode ◽  
Treatment Resistant ◽  
Predictors Of Response ◽  
First Episode Schizophrenia

AbstractElectroconvulsive therapy (ECT) was initially used for the treatment of schizophrenia, but over the years with the advent of antipsychotics, its use in schizophrenia has been limited. Treatment guidelines vary in their recommendations for the use of ECT in schizophrenia. The usual indications of its use among patients with schizophrenia include treatment resistance, to augment pharmacotherapy, to manage catatonia, suicidal behaviour, severe agitation and clozapine-resistant schizophrenia. Available literature, including meta-analysis and systematic reviews, suggest that ECT is a safe and effective treatment in patients with schizophrenia. However, despite the available evidence, it is highly underutilised and is often used as one of the last resort among patients with schizophrenia. This review focuses on the indications of use of ECT in schizophrenia, studies evaluating its effectiveness, efficacy in certain special situations like first episode schizophrenia, adolescents, catatonia etc., predictors of response to ECT in schizophrenia and influence of various ECT-related parameters on efficacy/effectiveness among patients with schizophrenia. From the review, it can be concluded that ECT is not only is beneficial as an augmenting strategy in treatment-resistant schizophrenia but also can be used effectively in patients with schizophrenia in various other situations.

scholarly journals Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis

2020 ◽  
pp. 1-12
Author(s):  
Miranda Bridgwater ◽  
Peter Bachman ◽  
Brenden Tervo-Clemmens ◽  
Gretchen Haas ◽  
Rebecca Hayes ◽  
...  
Keyword(s):  
Negative Symptom ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
Positive Symptom ◽  
First Episode ◽  
Positive Symptoms ◽  
Symptom Expression ◽  
Age Related ◽  
Episode Psychosis

Abstract Background The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated. Methods Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12–40 years, 1–12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. Results Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood. Conclusions These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain–behavior relationships vary as a function of development.

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