Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain

Objective: Aripiprazole is often prescribed to young people, although there remain unanswered questions about its effects on weight gain. This study undertook a meta-analysis of weight gain occurring in young people with early psychosis who were prescribed aripiprazole. Method: A systematic search was conducted for studies reporting on aripiprazole and weight change in young people with a psychotic disorder. A meta-analysis integrated the data into an estimate of effect size. Results: Eleven studies met the inclusion criteria amounting to 886 participants (mean age 18 years). The results showed significant weight gain averaging 2.7 kg. These increases were associated with a longer duration of exposure to aripiprazole but not a higher dosage. Conclusions: The results highlight the importance of regular patient monitoring and the early implementation of interventions to manage antipsychotic-related weight gain.

Cariprazine Use in Early Psychosis: Three Case Reports

Objective: Cariprazine is a new atypical antipsychotic approved for the acute and maintenance treatment of schizophrenia (1, 2) and for the treatment of manic or mixed episodes associated with bipolar I disorder (1). Recently, cariprazine also got extended FDA-approval for the treatment of depressive episodes in adults with bipolar I disorder (3). The use of low doses of atypical antipsychotics is an essential component of early intervention in psychosis. For its particular performance and tolerability, cariprazine is becoming an important option for the treatment of first-episode psychosis.Method: Three patients experiencing first-episode psychosis (FEP) were successfully treated with cariprazine. Two patients were in their first months of the disease, and the third patient was in his third year after the FEP.Results: The three patients had a diagnosis of non-affective FEP, which includes schizophrenia, delusional disorder, and schizoaffective disorder. One of them was in their third year after the FEP with a predominance of negative symptoms at this stage of the disorder. All the patients were treated with cariprazine with a target dose of 3–4.5 mg/day. The three patients showed improvements in their psychosis, including a decrease in negative symptoms. No significant side effects were reported.Conclusion: Our three case reports indicate that cariprazine is an atypical antipsychotic beneficial in the treatment of early psychosis. Treatment with low doses of cariprazine could be effective and tolerable in this phase of the disorder. Future studies with longer follow-up of FEP patients are recommended to confirm these positive results of cariprazine in the early phases of psychosis.

Quoted text in the mental healthcare electronic record: an analysis of the distribution and content of single-word quotations

ObjectiveTo investigate the distribution and content of quoted text within the electronic health records (EHRs) using a previously developed natural language processing tool to generate a database of quotations.Designχ2 and logistic regression were used to assess the profile of patients receiving mental healthcare for whom quotations exist. K-means clustering using pre-trained word embeddings developed on general discharge summaries and psychosis specific mental health records were used to group one-word quotations into semantically similar groups and labelled by human subjective judgement.SettingEHRs from a large mental healthcare provider serving a geographic catchment area of 1.3 million residents in South London.ParticipantsFor analysis of distribution, 33 499 individuals receiving mental healthcare on 30 June 2019 in South London and Maudsley. For analysis of content, 1587 unique lemmatised words, appearing a minimum of 20 times on the database of quotations created on 16 January 2020.ResultsThe strongest individual indicator of quoted text is inpatient care in the preceding 12 months (OR 9.79, 95% CI 7.84 to 12.23). Next highest indicator is ethnicity with those with a black background more likely to have quoted text in comparison to white background (OR 2.20, 95% CI 2.08 to 2.33). Both are attenuated slightly in the adjusted model. Early psychosis intervention word embeddings subjectively produced categories pertaining to: mental illness, verbs, negative sentiment, people/relationships, mixed sentiment, aggression/violence and negative connotation.ConclusionsThe findings that inpatients and those from a black ethnic background more commonly have quoted text raise important questions around where clinical attention is focused and whether this may point to any systematic bias. Our study also shows that word embeddings trained on early psychosis intervention records are useful in categorising even small subsets of the clinical records represented by one-word quotations.

The Implementation and Review of Cognitive Remediation Training for First Episode Psychosis in Singapore

Objective: Early intervention in patients with first episode psychosis (FEP) can improve cognitive abilities, with both short- and long-term benefits. In this paper, we describe the implementation and review of cognitive remediation training (CRT) in an Asian FEP population. The outcomes of the training are also evaluated and discussed.Methods: This naturalistic paper describes in detail the real-life implementation and conduct of CRT in an early psychosis intervention service. One hundred and nine patients with FEP underwent a 24-session CRT programme, using Cogpack and Neuropsychological Educational Approach to Remediation. The program is evaluated with pre- and post-CRT assessment scores which included Montreal Cognitive Assessment and Brief Assessment of Cognition in Schizophrenia. The rates of improvement on these cognitive assessments were evaluated using paired t-tests, with statistical significance set at p ≤ 0.05.Results: Of the 109 patients who underwent CRT, a total of 92 (84.4%) completed all 24 sessions. Paired t-tests between pre- and post-CRT assessments scores revealed that participants significantly improved on majority of the measures, including verbal memory, digit sequencing, and symbol coding.Conclusion: As with other cognitive remediation programmes, CRT has shown to improve cognitive functioning in patients with FEP. The results support the use of CRT in an Asian context and may serve as guidance for the implementation of similar training programmes in other Asian early psychosis intervention services.