Psychofarmaca: pleidooi voor een voorzichtig beleid bij vroege psychose

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.098 ◽

2021 ◽

Author(s):

L. VAN BOUWEL

Keyword(s):

Scientific Literature ◽

Holistic Approach ◽

Early Psychosis ◽

Psychotic Episode ◽

Pharmacological Treatments ◽

Her Family ◽

Existential Crisis ◽

First Psychotic Episode ◽

Intervention Team

Psychopharmaceuticals: a plea for cautious management in early psychosis. From the holistic approach in VRINT (Early psychosis intervention team), a psychotic episode is regarded as an existential crisis in which both biological and psychosocial factors play a role and interact with each other. Non-pharmacological treatments are indispensable and preferred. However, antipsychotics can have an important role and be even lifesaving in certain circumstances. Therefore, in this article 3 questions are explored: How long before prescribing antipsychotics? How long should they be prescribed and is medication tapering possible? Are antipsychotics neuroprotective or rather harmful? Based on the scientific literature regarding antipsychotics as well as their own experience, the authors conclude that they do have their place in treating early psychosis, but they should be prescribed with the necessary caution, since antipsychotics are not harmless products. Treatment with antipsychotics should always consist of administering the lowest possible dose with a minimum of side effects. The decision to start treatment with antipsychotics and the correct adjustment of dosage should always be done in consultation with the person in crisis and his or her family. After a first psychotic episode, medication tapering can be considered, but the tapering off must be properly supervised over a sufficiently long period of time. After all, a full long-term recovery is pursued, whereby the person with psychosis can take control of his or her own life.

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Disturbance of neurotransmitters monoamines and indices of reducing-oxidizing processes in patient with the first episode of schizophrenia (FES)

European Psychiatry ◽

10.1016/s0924-9338(11)73117-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1412-1412

Author(s):

V. Kalinina ◽

Y. Gryzunov ◽

N. Smolina ◽

M. Uzbekov ◽

E. Misionzhnik ◽

...

Keyword(s):

Oxidase Activity ◽

Amine Oxidase ◽

Social Activity ◽

First Episode ◽

Psychotic Episode ◽

Metabolic Disturbances ◽

Biophysical Parameters ◽

First Psychotic Episode ◽

Sh Group

IntroductionEffective treatment of FES patients may lead to achievement of long-term remission, decrease the number of relapses and increase the level of social activity and quality of life.AimTo study some pathophysiological mechanisms of FES.MethodsThe group of patients who were investigated clinically and biochemically consists of 26 persons (11 women and 15 men, average age 28.2 ± 9.5 years) with the first psychotic episode (F20.0; F20.3). Some biochemical parameters, representing the monoaminergic systems, and some biophysical parameters, representing reducing-oxidizing processes, were investigated. These parameters in all patients were estimated following the admission and prior to any treatment.ResultsThe severity of the disorder on admission to the clinic according to PANSS score was 75,5 ± 2,2 (i.e., moderately severe). Patients with FES were characterized by a significant increase of platelet momnoamine oxidase activity (by 107%; р < 0,01) and decrease of serum semicarbazide-sensitive amine oxidase activity (by 29%; p < 0,001) in comparison to the controls. Both reactive capability of SH-group (Cys-34 residue) of serum albumin, the main source of thiols of plasma and intersticial fluid, measured in reaction with thiol-specific reagent - dithyonitrobenzoic acide, and kinetic coefficient were decreased in FES patients (by 24%; p = 0,02) in comparison to controls.ConclusionThese results show that FES patients are characterized by pronounced metabolic disturbances.

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Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.100 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S271-S272

Author(s):

S. Malta Vacas ◽

R. Carvalho ◽

M.J. Heitor

Keyword(s):

Great Majority ◽

First Episode ◽

Psychotic Episode ◽

Term Care ◽

First Psychotic Episode ◽

Effective Interventions ◽

Episode Psychosis ◽

Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A controlled trial of cognitively oriented psychotherapy for early psychosis (COPE) with four-year follow-up readmission data

Psychological Medicine ◽

10.1017/s0033291705004927 ◽

2005 ◽

Vol 35 (9) ◽

pp. 1295-1306 ◽

Cited By ~ 35

Author(s):

HENRY JACKSON ◽

PATRICK McGORRY ◽

JANE EDWARDS ◽

CAROL HULBERT ◽

LISA HENRY ◽

...

Keyword(s):

Controlled Trial ◽

Hospital Readmissions ◽

Public Mental Health ◽

Routine Care ◽

Early Psychosis ◽

Psychotic Episode ◽

Case Register ◽

Intention To Treat ◽

First Psychotic Episode ◽

Pre Treatment

Objectives. Cognitively oriented psychotherapy for early psychosis (COPE) is aimed at facilitating the adjustment of the person, and preventing or alleviating secondary morbidity in the wake of the first psychotic episode. The present study reports on the outcomes of a controlled trial comparing two conditions: COPE versus No-COPE.Method. Ninety-one people participated in the trial which was analysed by intention-to-treat, including 12 people who were assigned to COPE but refused to participate. Assessments were conducted at pre-treatment, mid-treatment and post-treatment. Hospital readmission data were obtained through a Psychiatric Case Register. The study was conducted in a front-line public mental health service, the Early Psychosis Prevention and Intervention Centre (EPPIC). Clients in both COPE and No-COPE were provided with full access to the complete range of EPPIC services.Results. There were no significant differences between the two conditions on the nine primary outcome variables. Hospital readmissions were assessed for each client at yearly intervals up to 4 years following the completion of treatment and again there were no significant between-group differences.Conclusions. The study indicated that there was no significant advantage to COPE over and above routine care at EPPIC.

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Diagnostic Stability in First Psychotic Episode after 5 years follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2138 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S197-S197

Author(s):

M. Mota-Oliveira ◽

M.J. Peixoto ◽

I. Ferraz ◽

E. Pereira ◽

R. Guedes ◽

...

Keyword(s):

Health Clinic ◽

Admission Diagnosis ◽

Psychotic Episode ◽

Diagnostic Stability ◽

First Psychotic Episode ◽

Not Otherwise Specified ◽

Competing Interest ◽

Drop Outs

IntroductionThe diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.Aims and objectivesThe aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).MethodologyA retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.ResultsWe included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.ConclusionsThe diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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P.3.b.005 Oxidative stress at the first psychotic episode: long-term implications

European Neuropsychopharmacology ◽

10.1016/s0924-977x(13)70683-7 ◽

2013 ◽

Vol 23 ◽

pp. S431-S432

Author(s):

M. Martinez-Cengotitabengoa ◽

S. Alberich ◽

S. Barbeito ◽

J.A. Micó ◽

C. Arango ◽

...

Keyword(s):

Oxidative Stress ◽

Psychotic Episode ◽

First Psychotic Episode

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Acute psychotic disorder: Which future?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2107 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S186-S186

Author(s):

R. Ben Soussia ◽

A. Bouallagui ◽

S. Younes ◽

I. Marrag ◽

M. Nasr

Keyword(s):

Mood Disorder ◽

Psychotic Disorder ◽

Psychotic Episode ◽

Psychiatric Ward ◽

Male Predominance ◽

Mode Of Entry ◽

First Psychotic Episode ◽

Study Population ◽

Competing Interest

IntroductionAt present, in absence of reliable clinical and evolutionary data, it is difficult to determine what the consequences of an acute psychotic disorder, specifically if it is a mode of entry into schizophrenia, a mood disorder or a short-lived episode.AimThe objective of this study was to describe the sociodemographic characteristics and evolutionary modalities of a population of patients with a first psychotic episode.MethodsThis is a retrospective descriptive study, which involved patients admitted to psychiatric ward EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. Data collection was conducted from archived observations and through a predetermined sheet.ResultsOne hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 52.3% were from urban, 73% of patients were single, 33.3% were from a consanguineous marriage. Among those patients with a first acute psychotic episode, 43 patients (38.7%) progressed to schizophrenia, 15.3% to bipolar disorder, 23, 4% to recovery while 22.5% were lost view.ConclusionThe long-term evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related primarily to the risk of developing a schizophrenic disorder or a mood disorder. In this context, attention is paid in recent years to recognize and seek the earliest possible factors associated with this development.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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T38. POSTER PRESENTATION: HAMLETT: HANDLING ANTIPSYCHOTIC MEDICATION, A LONGTERM EVALUATION OF TARGETED TREATMENT A PRAGMATIC SINGLE-BLIND RANDOMISED CONTROLLED TRIAL OF CONTINUATION VERSUS DISCONTINUATION OF PSYCHOTIC MEDICATION

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.598 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S246-S246

Author(s):

Erna van‘t Hag

Keyword(s):

Antipsychotic Medication ◽

Controlled Trial ◽

Well Being ◽

First Episode ◽

Psychotic Episode ◽

Subjective Well Being ◽

First Psychotic Episode ◽

Episode Psychosis ◽

General Functioning

Abstract Background When achieving remission after a first psychotic episode using antipsychotic medication, international guidelines generally recommend continuation of use for >1 year. However, patients often have a strong wish to stop earlier due to side-effects, affecting everyday functioning. Recently, guidelines have been questioned as one Dutch study found that more patients achieved long-term functional remission after early discontinuation. Yet, this finding has not yet been replicated. Psychiatrists, patients and family are unsure which regime to follow: to continue or not to continue? Methods In total 512 participants will be included who achieved remission after first-episode psychosis and use antipsychotic medication. Recruitment takes place at 24 Dutch sites. HAMLETT is a multicenter pragmatic single-blind randomized controlled trial with two conditions (1:1): maintenance treatment versus discontinuation/dose reduction of antipsychotic medication. Main research question: Is long-term general functioning better if patients reduce/discontinue antipsychotic medication at an early stage (3–6 months after remission of their first psychotic episode), than when they continue medication >1 year? General functioning is measured in two ways: with the WHO-DAS interview and with Ecological Momentary Assessments (EMA). EMA is a structured diary method in which individuals are asked in daily life to report on their current thoughts, feelings and symptoms, as well as the context (e.g. location, company, activity) and the appraisal of the context (e.g. stress). Diaries are completed via a smartphone diary app maximally 10 times daily at semi-random moments, over eight consecutive days. Momentary positive/negative affect, self-esteem, subjective well-being, paranoia, hallucinations, sleep, and frequency, type and appraisal of social company and activities are assessed on a 1–7 scale. At baseline and after 6 months, 1, 2, 3 and 4 years follow-up, patients of both arms will perform EMA. This results in an intensive time series of psychopathology, subjective well-being and social functioning in relation to antipsychotic medication and a range of contextual influences. Results The study is active and currently recruiting patients (since September 2017), At present 194 patients have been included, 20% participated in EMA measurements. Results of the interim analysis and preliminary of EMA data will be presented. Discussion The HAMLETT study investigates the effects of maintenance treatment versus discontinuation/dose reduction of antipsychotic medication after remission of first episode psychosis on personal and social functioning, psychotic symptom severity, health-related quality of life and cognitive functioning. The HAMLETT study will offer evidence to guide patients and clinicians when evaluating optimal treatment duration for psychotic disorders. Using different types of outcome measures will provide a more in-depth analysis of effects of continuation/ discontinuation on functioning.

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