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Rammou A, Fisher HL, Johnson S, Major B, Rahaman N, Chamberlain-Kent N, Stone JM. Negative symptoms in first-episode psychosis: Clinical correlates and 1-year follow-up outcomes in London Early Intervention Services. Early Interv Psychiatry 2019; 13:443-452. [PMID: 29148264 DOI: 10.1111/eip.12502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
AIM Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up. METHODS Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data. RESULTS Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline (B = -.93, P <. 01). At 1-year follow-up, NS at presentation were associated with worse Global Assessment of Functioning Scale for symptom (B = -.28, P < .01) and disability (B = -.27, P <. 05) and with hospital admission (OR = 1.06, P < .01). CONCLUSIONS Negative symptoms at presentation to EIS were associated with worse functioning at entry and poorer outcomes 1 year later. Future research is required to better understand the aetiology and trajectories of NS in early psychosis and propose novel targeted interventions.
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Affiliation(s)
- Aikaterini Rammou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Helen L Fisher
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Barnaby Major
- EQUIP, Hackney, East London NHS Foundation Trust, London, UK.,Herefordshire Early Intervention Service, 2gether NHS Foundation Trust, Hereford, UK
| | - Nikola Rahaman
- Kensington, Chelsea, Westminster and Brent Early Intervention Service, Central & North West London NHS Foundation Trust, London, UK
| | - Nick Chamberlain-Kent
- Wandsworth Early Intervention Service, South West London & St Georges' Mental Health NHS Trust, London, UK
| | - James M Stone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Bryce SD, Lee SJ, Ponsford JL, Lawrence RJ, Tan EJ, Rossell SL. The impact of intrinsic motivation on session attendance and reliable cognitive improvement in cognitive remediation in schizophrenia. Schizophr Res 2018; 202:354-360. [PMID: 29935884 DOI: 10.1016/j.schres.2018.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/09/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cognitive remediation (CR) is considered a potentially effective method of improving cognitive function in people with schizophrenia. Few studies, however, have explored the role of intrinsic motivation on treatment utilization or training outcomes in CR in this population. This study explored the impact of task-specific intrinsic motivation on attendance and reliable cognitive improvement in a controlled trial comparing CR with a computer game (CG) playing control. METHODS Forty-nine participants with schizophrenia or schizoaffective disorder, allocated to 10 weeks of group-based CR (n = 25) or CG control (n = 24), provided complete outcome data at baseline. Forty-three participants completed their assigned intervention. Cognition, psychopathology and intrinsic motivation were measured at baseline and end-treatment. Regression analyses explored the relative contribution of baseline motivation and other clinical factors to session attendance as well as the association of baseline and change in intrinsic motivation with the odds of reliable cognitive improvement (calculated using reliable change indices). RESULTS Baseline reports of perceived program value were the only significant multivariable predictor of session attendance when including global cognition and psychiatric symptomatology. The odds of reliable cognitive improvement significantly increased with greater improvements in program interest and value from baseline to end-treatment. Motivational changes over time were highly variable between participants. CONCLUSION Task-specific intrinsic motivation in schizophrenia may represent an important patient-related factor that contributes to session attendance and cognitive improvements in CR. Regular evaluation and enhancement of intrinsic motivation in cognitively enhancing interventions may optimize treatment engagement and the likelihood of meaningful training outcomes.
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Affiliation(s)
- S D Bryce
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia.
| | - S J Lee
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia
| | - J L Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | - R J Lawrence
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - E J Tan
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - S L Rossell
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, VIC, Australia; Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; Psychiatry, St Vincent's Hospital, Fitzroy, VIC, Australia
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3
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Schade S, Paulus W. D-Cycloserine in Neuropsychiatric Diseases: A Systematic Review. Int J Neuropsychopharmacol 2015; 19:pyv102. [PMID: 26364274 PMCID: PMC4851259 DOI: 10.1093/ijnp/pyv102] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/03/2015] [Indexed: 11/15/2022] Open
Abstract
D-Cycloserine, known from tuberculosis therapy, has been widely introduced to neuropsychiatric studies, since its central active mechanism as a partial NMDA-agonist has been found. In this review, we evaluate its therapeutic potential in neuropsychological disorders and discuss its pitfalls in terms of dosing and application frequency as well as its safety in low-dose therapy. Therefore, we identified 91 clinical trials by performing a Medline search. We demonstrate in part preliminary but increasing evidence that D-cycloserine may be effective in various psychiatric diseases, including schizophrenia, anxiety disorders, addiction, eating disorders, major depression, and autism as well as in neurological diseases, including dementia, Alzheimer's disease, and spinocerebellar degeneration. D-Cycloserine in low-dose therapy is safe, but there is still a need for new drugs with higher specificity to the different N-methyl-D-aspartate-receptor subunits.
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Affiliation(s)
- Sebastian Schade
- University Medical Center, Georg-August University, Department of Clinical Neurophysiology, Robert-Koch Straße 40, 37075 Göttingen, Germany.
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4
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Vernal DL, Kapoor S, Al-Jadiri A, Sheridan EM, Borenstein Y, Mormando C, David L, Singh S, Seidman AJ, Carbon M, Gerstenberg M, Saito E, Kane JM, Steinhausen HC, Correll CU. Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study. J Child Adolesc Psychopharmacol 2015; 25:535-47. [PMID: 26375767 PMCID: PMC4696429 DOI: 10.1089/cap.2014.0164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. METHODS The study was a prospective, naturalistic, inception cohort study of youth ≤19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and ≤24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. RESULTS Altogether, 130 youth with SCZ-S (n=42) or PsyNOS (n=88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4±2.1 vs. 14.8±3.2, p=0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p=0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0±0.9 vs. 5.5±0.8, p=0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6±9.2 vs. 36.1±8.9, p=0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS≤40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p=0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p=0.97), or nonadherence (29.3% vs. 30.9%, p=0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p=0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups (p=0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores (p=0.012) and more frequently reached higher categorical CGAS group status (p=0.021) than SCZ-S patients. CONCLUSIONS Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.
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Affiliation(s)
- Ditte L. Vernal
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Aseel Al-Jadiri
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Eva M. Sheridan
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Yehonathan Borenstein
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Charles Mormando
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Lisa David
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Sukhbir Singh
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Andrew J. Seidman
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Maren Carbon
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - Miriam Gerstenberg
- University Clinics of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Ema Saito
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York
| | - John M. Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Psychiatric Hospital, Aalborg University Hospital, Denmark.,Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Switzerland.,Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, New York.,Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.,Albert Einstein College of Medicine, Bronx, New York.,The Feinstein Institute for Medical Research, Manhasset, New York
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Abstract
In 2005, the Remission in Schizophrenia Working Group published consensus criteria to define remission. These criteria have been widely accepted and utilized and have provided further insights about schizophrenia management and prognosis. We systematically reviewed studies that utilized these criteria, with the aim of assessing the remission rate in follow-up studies and the variables predicting or associated with remission. Remission has a reported rate of 17% to 78% (weighted mean = 35.6%) in first-episode schizophrenia and 16% to 62% (weighted mean = 37%) in multiple-episode patients, with no statistical difference between the two weighted means (p = .79). Patients who were treated with long-acting injectable risperidone showed high maintenance of remission status. Studies comparing second-generation antipsychotics versus haloperidol showed higher remission rates for the former. The variables most frequently associated with remission were better premorbid function, milder symptoms at baseline (especially negative symptoms), early response to treatment, and shorter duration of untreated psychosis. Variability in the length and frequency of follow-ups, as well as differences in dropout rates, could partially explain the differences in reported rates. Rates of symptomatic remission exceeded reported rates for functional recovery. Moreover, the majority of studies used Remission in Schizophrenia Working Group severity criteria only, neglecting duration. To enhance comparison between future research findings, we suggest further specifiers of the working group's criteria, to better define frequency and duration of follow-up, and proxy measures of remission.
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Affiliation(s)
- Bandar AlAqeel
- Department of Psychiatry and Allan Memorial Institute, Clinical Psychopharmacology and Therapeutics Unit, McGill University Health Centre, McGill University, Montreal, Canada.
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