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DeLisi LE. A lifetime of mental health treatments for people with schizophrenia: update and narrative review. Curr Opin Psychiatry 2024; 37:140-146. [PMID: 38512852 DOI: 10.1097/yco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the most up-to-date thoughts about treatment for schizophrenia at different stages of illness. RECENT FINDINGS The use of Coordinated Specialty Care clinics has arisen as the standard for early on in the treatment of psychosis, providing the notion that recovery is possible. New medications that do not depend on postsynaptic dopamine receptor blockade are soon becoming available. SUMMARY A focus should be made by clinicians to personalize treatment plans for each patient who has the possibility of being diagnosed with a primary psychosis and the plan should be to predict outcomes based on biological markers that include genetic vulnerability, early psychosocial combined with pharmacological treatments as needed and then a plan to determine or maintain treatments going forward into the future. It is important to individualize treatment by stage of illness, as well as characteristics of the individual patient. Research is ongoing to advance knowledge for interventions at each stage from the premorbid period through to chronicity.
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Affiliation(s)
- Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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2
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Wood HJ, Jones N, Eack SM, Chengappa KNR, Prasad KM, Kelly C, Montrose D, Schooler NR, Ganguli R, Carter CS, Keshavan MS, Sarpal DK. Over 30 years of STEP: The Pittsburgh experience with first-episode psychosis. Early Interv Psychiatry 2024. [PMID: 38637133 DOI: 10.1111/eip.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
AIMS For over 30 years, combined research and treatment settings in the US have been critical to conceptualizing care for first-episode psychosis (FEP). Here we describe an early example of such a context, the Services for the Treatment of Early Psychosis (STEP) clinic, which is affiliated with the University of Pittsburgh. METHODS We describe STEP's historical roots and establishment in the early 1990s; STEP's research and treatment contributions, alongside its growth and ongoing leadership. RESULTS Research-based clinics, like STEP, preceded and helped pave the way for the Recovery After an Initial Schizophrenia Episode project in the US and the ensuing Coordinated Specialty Care (CSC) approach, now widely adopted in the US. Early clinic-based research at STEP helped establish protocols for psychopharmacology, the relevance of effective early treatment, including psychosocial approaches, and highlighted disparities in treatment outcomes across race/ethnicity. Multidisciplinary collaboration and dialogue with consumers contributed to early treatment, combining psychosocial and pharmacological approaches. STEP adopted CSC and is situated within a bi-state Learning Health System. STEP has retained a relatively unique 5-year treatment model and exists within continuum of care ideally suited to studying psychotic illness and treatment outcomes. CONCLUSIONS STEP remains the largest academic FEP clinic in Pennsylvania. Academic FEP clinics like STEP will have a critical role within Learning Health Systems nationally to model participatory approaches, sustain early intervention treatment quality and ongoing treatment developments.
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Affiliation(s)
- Helen J Wood
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shaun M Eack
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Konasale M Prasad
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christian Kelly
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Debra Montrose
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Nina R Schooler
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rohan Ganguli
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cameron S Carter
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Deepak K Sarpal
- Services for the Treatment of Early Psychosis (STEP), UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zaher F, Diallo M, Achim AM, Joober R, Roy MA, Demers MF, Subramanian P, Lavigne KM, Lepage M, Gonzalez D, Zeljkovic I, Davis K, Mackinley M, Sabesan P, Lal S, Voppel A, Palaniyappan L. Speech markers to predict and prevent recurrent episodes of psychosis: A narrative overview and emerging opportunities. Schizophr Res 2024; 266:205-215. [PMID: 38428118 DOI: 10.1016/j.schres.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
Preventing relapse in schizophrenia improves long-term health outcomes. Repeated episodes of psychotic symptoms shape the trajectory of this illness and can be a detriment to functional recovery. Despite early intervention programs, high relapse rates persist, calling for alternative approaches in relapse prevention. Predicting imminent relapse at an individual level is critical for effective intervention. While clinical profiles are often used to foresee relapse, they lack the specificity and sensitivity needed for timely prediction. Here, we review the use of speech through Natural Language Processing (NLP) to predict a recurrent psychotic episode. Recent advancements in NLP of speech have shown the ability to detect linguistic markers related to thought disorder and other language disruptions within 2-4 weeks preceding a relapse. This approach has shown to be able to capture individual speech patterns, showing promise in its use as a prediction tool. We outline current developments in remote monitoring for psychotic relapses, discuss the challenges and limitations and present the speech-NLP based approach as an alternative to detect relapses with sufficient accuracy, construct validity and lead time to generate clinical actions towards prevention.
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Affiliation(s)
- Farida Zaher
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Mariama Diallo
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Amélie M Achim
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, QC, Canada; Vitam - Centre de Recherche en Santé Durable, Québec City, QC, Canada; Centre de Recherche CERVO, Québec City, QC, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marc-André Roy
- Département de Psychiatrie et Neurosciences, Université Laval, Québec City, QC, Canada; Centre de Recherche CERVO, Québec City, QC, Canada
| | - Marie-France Demers
- Centre de Recherche CERVO, Québec City, QC, Canada; Faculté de Pharmacie, Université Laval, Québec City, QC, Canada
| | - Priya Subramanian
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Katie M Lavigne
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Daniela Gonzalez
- Prevention and Early Intervention Program for Psychosis, London Health Sciences Center, Lawson Health Research Institute, London, ON, Canada
| | - Irnes Zeljkovic
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada
| | - Kristin Davis
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michael Mackinley
- Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada; Prevention and Early Intervention Program for Psychosis, London Health Sciences Center, Lawson Health Research Institute, London, ON, Canada
| | - Priyadharshini Sabesan
- Lakeshore General Hospital and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Shalini Lal
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
| | - Alban Voppel
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Psychiatry, Schulich School of Medicine, Western University, London, ON, Canada; Robarts Research Institute, Western University, London, ON, Canada.
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4
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Sicotte R, Iyer SN, Lacourse É, Séguin JR, Abdel-Baki A. Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:850-859. [PMID: 37071553 PMCID: PMC10590090 DOI: 10.1177/07067437231167387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. METHOD This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners' reports in 382 FEP patients [mean age = 23.53 (SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. RESULTS Three suicidal ideation trajectories were identified: low and decreasing (n = 325, 85.08%); early decline, then increasing (n = 30, 7.85%), and persistent suicidal ideation (n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. CONCLUSIONS Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group.
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Affiliation(s)
- Roxanne Sicotte
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Srividya N. Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Verdun, Québec, Canada
| | - Éric Lacourse
- Department of Sociology, Faculty of Arts and Sciences, Université de Montréal, Montréal, Québec, Canada
| | - Jean R. Séguin
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
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5
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Segura ÀG, Prohens L, Gassó P, Rodríguez N, Garcia-Rizo C, Moreno-Izco L, Andreu-Bernabeu Á, Zorrilla I, Mane A, Rodriguez-Jimenez R, Roldán A, Sarró S, Ibáñez Á, Usall J, Sáiz PA, Cuesta MJ, Parellada M, González-Pinto A, Berrocoso E, Bernardo M, Mas S, Mezquida G, Arbelo N, De Matteis M, Galvañ J, Duque Guerra A, Arias I Queralt L, Perez-Bacigalupe M, Gonzalez-Ortega I, Toll A, Casanovas F, Sanchez-Pastor L, Valtueña M, Pomarol-Clotet E, García-León MÁ, Butjosa A, Rubio-Abadal E, Ribeiro M, López-Ilundain JM, Saiz-Ruiz J, León-Quismondo L, Rivero O, Ruiz P, Echevarría RS, García-Portilla MP. The polygenic basis of relapse after a first episode of schizophrenia. Eur Neuropsychopharmacol 2023; 75:80-92. [PMID: 37603902 DOI: 10.1016/j.euroneuro.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 08/23/2023]
Abstract
Little is known about genetic predisposition to relapse. Previous studies have linked cognitive and psychopathological (mainly schizophrenia and bipolar disorder) polygenic risk scores (PRS) with clinical manifestations of the disease. This study aims to explore the potential role of PRS from major mental disorders and cognition on schizophrenia relapse. 114 patients recruited in the 2EPs Project were included (56 patients who had not experienced relapse after 3 years of enrollment and 58 patients who relapsed during the 3-year follow-up). PRS for schizophrenia (PRS-SZ), bipolar disorder (PRS-BD), education attainment (PRS-EA) and cognitive performance (PRS-CP) were used to assess the genetic risk of schizophrenia relapse.Patients with higher PRS-EA, showed both a lower risk (OR=0.29, 95% CI [0.11-0.73]) and a later onset of relapse (30.96± 1.74 vs. 23.12± 1.14 months, p=0.007. Our study provides evidence that the genetic burden of neurocognitive function is a potentially predictors of relapse that could be incorporated into future risk prediction models. Moreover, appropriate treatments for cognitive symptoms appear to be important for improving the long-term clinical outcome of relapse.
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Affiliation(s)
- Àlex-González Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Llucia Prohens
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Patricia Gassó
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain
| | - Natalia Rodríguez
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain
| | - Clemente Garcia-Rizo
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, Neuroscience Institute, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lucía Moreno-Izco
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Álvaro Andreu-Bernabeu
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iñaki Zorrilla
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, BIOARABA Health Research Institute Vitoria, Hospital Universitario de Alava, Spain; University of the Basque Country, Vitoria, Spain
| | - Anna Mane
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Hospital del Mar, Medical Research Institute (IMIM), Barcelona, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Universidad Complutense de Madrid (UCM), Madrid, Spain; Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Alexandra Roldán
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Salvador Sarró
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ángela Ibáñez
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcalá de Henares, Universidad de Alcalá, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Pilar A Sáiz
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Instituto de Neurociencias del Principado de Asturias (INEUROPA). Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Manuel J Cuesta
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mara Parellada
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Ana González-Pinto
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, BIOARABA Health Research Institute Vitoria, Hospital Universitario de Alava, Spain; University of the Basque Country, Vitoria, Spain
| | - Ester Berrocoso
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Miquel Bernardo
- Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, Neuroscience Institute, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain.
| | - Gisela Mezquida
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain; Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, Neuroscience Institute, Barcelona, Spain
| | - Néstor Arbelo
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, Neuroscience Institute, Barcelona, Spain
| | - Mario De Matteis
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Joaquín Galvañ
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alejandra Duque Guerra
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Laia Arias I Queralt
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria Perez-Bacigalupe
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, BIOARABA Health Research Institute Vitoria, Hospital Universitario de Alava, Spain; University of the Basque Country, Vitoria, Spain
| | - Itxaso Gonzalez-Ortega
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, BIOARABA Health Research Institute Vitoria, Hospital Universitario de Alava, Spain; University of the Basque Country, Vitoria, Spain
| | - Alba Toll
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Hospital del Mar, Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Luis Sanchez-Pastor
- Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Mercedes Valtueña
- Department of Psychiatry. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Edith Pomarol-Clotet
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Maria Ángeles García-León
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Ana Butjosa
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elena Rubio-Abadal
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - María Ribeiro
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jose M López-Ilundain
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jeronimo Saiz-Ruiz
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcalá de Henares, Universidad de Alcalá, Spain
| | - Luis León-Quismondo
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Alcalá de Henares, Universidad de Alcalá, Spain
| | - Olga Rivero
- Biomedical Research Institute INCLIVA, Fundación Investigación Hospital Clínico de Valencia, Valencia, Spain; Departament of Genetics, Universitat de València, Valencia, Spain
| | - Pedro Ruiz
- Hospital Clínico Universitario and Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain; Department of Medicine and Psychiatry.Universidad de Zaragoza, Zaragoza, Spain
| | - Rafael Segarra Echevarría
- Cruces University Hospital, BioCruces Health Research Institute, Vizcaya, Spain; University of the Basque Country (UPV/EHU) Vizcaya, Spain
| | - M Paz García-Portilla
- Centro de Investigación Biomédica en red en salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). Instituto de Neurociencias del Principado de Asturias (INEUROPA). Mental Health Services of the Principality of Asturias (SESPA), Oviedo, Spain
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Liu CC, Hsieh MH, Chien YL, Liu CM, Lin YT, Hwang TJ, Hwu HG. Dose-tapering trajectories in patients with remitted psychosis undergoing guided antipsychotic reduction to reach minimum effective dose. Eur Psychiatry 2023; 66:e66. [PMID: 37578111 PMCID: PMC10594210 DOI: 10.1192/j.eurpsy.2023.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Patients with remitted psychosis wish to reduce antipsychotic doses yet facing increased risks of relapse. Examining dose-tapering processes may provide insights to re-evaluate the risk-to-benefit balance. We aimed to depict and subgroup tapering trajectories, and explore factors associated with different dose-reduction patterns. METHODS A 2-year open-label randomized prospective comparative trial from August 2017 to September 2022 in Taiwan. Patients with a history of schizophrenia-related psychotic disorders under stable medications and symptoms were eligible, randomizing a proportion to conduct guided dose reduction. We depicted the trajectories of individual patients and named subgroups based on dose-tapering patterns. Predictors of baseline characteristics for designated subgroups were examined by logistic regression analysis; changes in outcomes were compared by paired t-test. RESULTS Fifty-one patients undergoing guided dose reduction, 18 (35.3%) reduced 4 steps consecutively (sequential reducers, SR), 14 (27.5%) reduced 1 to 3 steps (modest reducers, MR), 3 (5.9%) re-escalated to previous level (alert reducers, AR), 7 (13.7%) returned to baseline level (baseline returners, BR), 6 (11.7%) relapsed (failed reducers, FR) and 3 (5.9%) withdrew without relapse (early exits, EE). Patients with a history of relapse assumed a conservative dose-tapering pace; only the SR subgroup exhibited significant improvements in functioning and quality of life while failing to identify variables for predicting who would become SR or FR. CONCLUSIONS Guided dose reduction comprises dynamic processes with differences between individual trajectories. The proposed naming of dose-tapering patterns/subgroups provides a framework depicting patients undergoing dose-tapering. Longer-term observation and more flexible tapering approaches are anticipated to reveal favorable outcomes.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H. Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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7
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Chan SKW, Liao Y, Hui CLM, Wong TY, Suen Y, Chang WC, Lee EHM, Chen EYH. Longitudinal changes of cognitive function and its relationship with subdomains of negative symptoms in patients with adult-onset first-episode schizophrenia: A 4-year follow up study. Schizophr Res 2023; 252:181-188. [PMID: 36657362 DOI: 10.1016/j.schres.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUNDS This study explores the longitudinal changes and trajectories of cognitive functions in patients with adult-onset first-episode schizophrenia (FES) over four years and their relationships with the baseline subdomains of negative symptoms. METHODS A total of 177 patients of age 25-55 with FES were recruited. Baseline demographics, clinical, social and cognitive functions were assessed. Diminished expression and diminished motivation of negative symptoms were assessed with Scale for the Assessment of Negative Symptoms (SANS). Patients had yearly follow-up of cognitive function assessments over four years. Latent class growth analysis (LCGA) and mixed linear regression model were used to explore the longitudinal changes of cognitive functions and the effect of baseline negative symptoms on the longitudinal cognitive function changes. Relationships of baseline negative symptoms subdomains and cognitive functions were also explored. RESULTS Two trajectories of cognitive functions were identified. Longitudinal improvements were found in most cognitive functions apart from the logical memory. One trajectory of patients had significant deterioration of logical memory while the other group had significant improvement. Baseline diminished expression was associated with baseline and longitudinal changes of processing speed and verbal fluency while diminished motivation was associated with baseline and longitudinal changes of processing speed. CONCLUSIONS Adult-onset FES patients had a homogeneous longitudinal improvement in most cognitive functions but not for logical memory suggesting the unique nature of verbal memory. The distinct relationship between baseline subdomains of negative symptoms with baseline and longitudinal cognitive functions suggesting the presence of differential overlapping etiology between negative symptom subdomains and cognitive functions.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Ting Yat Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yinam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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8
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Sousa AE, Ryan JD, Lepage M. Exploring the sociodemographic, clinical and neuropsychological factors associated with relational memory in schizophrenia. Cogn Neuropsychiatry 2023; 28:67-84. [PMID: 36464633 DOI: 10.1080/13546805.2022.2153657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Transverse Patterning (TP) task has been used to measure episodic relational memory (RM) deficits in clinical populations. Individuals with schizophrenia often fail to learn TP with standard, and sometimes extensive training. Identifying the differences between TP learners and non-learners can improve our understanding of successful TP performance and its underlying mechanisms, which may help improve interventions aimed at ameliorating RM performance. We investigated sociodemographic, clinical and neuropsychological factors associated with TP performance in schizophrenia. METHODS Sixty-six participants with schizophrenia completed a semantically rich and a relational-binding dependent version of the TP task and reported on their task awareness and strategy use. RESULTS Twenty-six participants failed to learn the task rules after extensive training. Learners had superior verbal, visual and working memory, executive functions and overall cognitive functioning compared to non-learners. Learners also had superior awareness of task rules and pairs relationships and used elaborated cognitive strategies more often. CONCLUSIONS Our results support previous findings that some individuals with schizophrenia show RM impairment even with extensive TP training. We shed light on neuropsychological and metacognitive factors associated with TP performance. This knowledge could enhance interventions targeted to improve relational memory in schizophrenia when extensive training fails.
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Affiliation(s)
- Ana Elisa Sousa
- Douglas Mental Health University Institute, Montreal, Canada.,Integrated Program in Neuroscience, McGill University, Montréal, Canada
| | - Jennifer D Ryan
- Rotman Research Institute, Baycrest, Department of Psychology, University of Toronto, Toronto, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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9
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Tao TJ, Hui CLM, Hui PWM, Ho ECN, Lam BST, Wong AKH, See SHW, Chan EWT, Suen YN, Lee EHM, Chan SKW, Chang WC, Lo WTL, Chong CSY, Siu CMW, Choi YY, Pomarol-Clotet E, McKenna PJ, Honer WG, Chen EYH. Working memory deterioration as an early warning sign for relapse in remitted psychosis: A one-year naturalistic follow-up study. Psychiatry Res 2023; 319:114976. [PMID: 36462293 DOI: 10.1016/j.psychres.2022.114976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Relapse prevention is an important goal in the clinical management of psychosis. Cognitive deficits/deterioration can provide useful insights for monitoring relapse in psychosis patients. METHODS This was a prospective, naturalistic 1-year follow-up study involving 110 psychosis patients with full clinical remission. Relapse, defined as the recurrence of psychotic symptoms, was monitored monthly along with digital tracking of verbal and visual working memory using a mobile app developed for this study. Cognitive deterioration was defined as worsening performance over 2 months prior to relapse or study termination, whichever was earlier. Other clinical, cognitive, functioning, and psychosocial variables were also collected. RESULTS At 1 year, 18 (16.36%) patients relapsed, of which 6 (33.33%) required hospitalization. Relapse was predicted by verbal working memory deterioration 2 months prior to relapse (p = 0.029), worse medication adherence (p = 0.018), and less resilience (p = 0.014). CONCLUSIONS Verbal working memory deterioration is a novel early sign of relapse. It is a clearly defined, objectively measurable, and reproducible marker that can help clinicians and healthcare workers identify patients at risk of relapse and make decisions about maintenance therapy. Moreover, digital monitoring is a viable tool in the management of relapse.
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Affiliation(s)
- Tiffany Junchen Tao
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong.
| | - Priscilla Wing Man Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Elise Chun Ning Ho
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Bertha Sze Ting Lam
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Andreas Kar Hin Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Sally Hiu Wah See
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Evie Wai Ting Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
| | | | | | | | - Yan Yin Choi
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalaries Research Foundation - CIBERSAM, ISCIII, Barcelona, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalaries Research Foundation - CIBERSAM, ISCIII, Barcelona, Spain
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong
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10
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Solanes A, Mezquida G, Janssen J, Amoretti S, Lobo A, González-Pinto A, Arango C, Vieta E, Castro-Fornieles J, Bergé D, Albacete A, Giné E, Parellada M, Bernardo M, Bioque M, Morén C, Pina-Camacho L, Díaz-Caneja CM, Zorrilla I, Corres EG, De-la-Camara C, Barcones F, Escarti MJ, Aguilar EJ, Legido T, Martin M, Verdolini N, Martinez-Aran A, Baeza I, de la Serna E, Contreras F, Bobes J, García-Portilla MP, Sanchez-Pastor L, Rodriguez-Jimenez R, Usall J, Butjosa A, Salgado-Pineda P, Salvador R, Pomarol-Clotet E, Radua J. Combining MRI and clinical data to detect high relapse risk after the first episode of psychosis. SCHIZOPHRENIA 2022; 8:100. [PMID: 36396933 PMCID: PMC9672064 DOI: 10.1038/s41537-022-00309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
AbstractDetecting patients at high relapse risk after the first episode of psychosis (HRR-FEP) could help the clinician adjust the preventive treatment. To develop a tool to detect patients at HRR using their baseline clinical and structural MRI, we followed 227 patients with FEP for 18–24 months and applied MRIPredict. We previously optimized the MRI-based machine-learning parameters (combining unmodulated and modulated gray and white matter and using voxel-based ensemble) in two independent datasets. Patients estimated to be at HRR-FEP showed a substantially increased risk of relapse (hazard ratio = 4.58, P < 0.05). Accuracy was poorer when we only used clinical or MRI data. We thus show the potential of combining clinical and MRI data to detect which individuals are more likely to relapse, who may benefit from increased frequency of visits, and which are unlikely, who may be currently receiving unnecessary prophylactic treatments. We also provide an updated version of the MRIPredict software.
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11
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Relapse of first-episode schizophrenia patients and neurocognitive impairment: The role of dopaminergic and anticholinergic burden. Schizophr Res 2022; 248:331-340. [PMID: 36155307 DOI: 10.1016/j.schres.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prevention of relapse may be a key factor to diminish the cognitive impairment of first-episode schizophrenia (FES) patients. We aimed to ascertain the effects of relapse, and dopaminergic and anticholinergic treatment burdens on cognitive functioning in the follow-up. METHODS Ninety-nine FES patients participated in this study. Cognitive assessments were performed at baseline and after 3 years of follow-up or, in those patients who relapsed, after >2 months of stabilization of the new acute psychotic episode. The primary outcomes were final cognitive dimensions. RESULTS Repeated measures MANOVA analyses showed improvements in the whole sample on the end-point assessments in processing speed and social cognition. However, only impairment in social cognition showed a significant interaction with relapse by time in this sample. Relapse in FES patients was significantly associated with poor performance on end-point assessments of working memory, social cognition and global cognitive score. Anticholinergic burden, but not dopaminergic burden, was associated with verbal memory impairment. These significant associations resulted after controlling for baseline cognitive functioning, relapse and dopaminergic burden. CONCLUSIONS The relationship between relapse and cognitive impairment in recovered FES patients seems to be particularly complex at the short-term follow-up of these patients. While relapse was associated with working memory, social cognition impairments and global cognitive score, anticholinergic burden might play an additional worsening effect on verbal memory. Thus, tailoring or changing antipsychotics and other drugs to reduce their anticholinergic burden may be a potential modifiable factor to diminish cognitive impairment at this stage of the illness.
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12
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Chan SKW, Chan HYV, Liao Y, Suen YN, Hui CLM, Chang WC, Lee EHM, Chen EYH. Longitudinal relapse pattern of patients with first-episode schizophrenia-spectrum disorders and its predictors and outcomes: A 10-year follow-up study. Asian J Psychiatr 2022; 71:103087. [PMID: 35299139 DOI: 10.1016/j.ajp.2022.103087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/19/2021] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the 10-year pattern of relapse of patients with first-episode schizophrenia-spectrum disorders (FES), predictors and outcomes of early and late relapse. METHODS Patients received EIS (N = 148) in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care (N = 148) one year before. Relapse information over 10 years were obtained and 209 patients were interviewed at 10-year follow-up. Predictors of early relapse ([ER] relapse in initial three years) and late relapse group ([LR] relapse in year 4-10) and their differential outcomes were explored. RESULTS Fifty-six patients (26.8%) were relapse-free over 10 years with more EIS patients. Among the relapsed patients, 63.6% were ER patients who had the poorest longitudinal outcomes, including higher suicide attempts, violence episodes, more hospitalization and lower employment, whereas the LR patients do not differ much from the no relapse group. Relapse-free patients required less hospitalization in the first episode and lower antipsychotic dosage. The LR patients had less positive symptoms in year one but longer first-episode hospitalization and higher antipsychotic dosage. CONCLUSIONS Delaying the first relapse may help to improve the long-term outcomes. Good response to antipsychotic medications was associated with relapse-free over long-term. However, sufficient antipsychotic medications with good symptomatic control during the early stage of the illness is crucial for relapse prevention for other patients. These findings highlight illness heterogeneity and the importance in differential use of antipsychotics in relapse prevention.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Hei Yan Veronica Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
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13
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Sasabayashi D, Takayanagi Y, Takahashi T, Furuichi A, Kobayashi H, Noguchi K, Suzuki M. Increased brain gyrification and subsequent relapse in patients with first-episode schizophrenia. Front Psychiatry 2022; 13:937605. [PMID: 36032231 PMCID: PMC9406142 DOI: 10.3389/fpsyt.2022.937605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Most schizophrenia patients experience psychotic relapses, which may compromise long-term outcome. However, it is difficult to objectively assess the actual risk of relapse for each patient as the biological changes underlying relapse remain unknown. The present study used magnetic resonance imaging (MRI) to investigate the relationship between brain gyrification pattern and subsequent relapse in patients with first-episode schizophrenia. The subjects consisted of 19 patients with and 33 patients without relapse during a 3-year clinical follow-up after baseline MRI scanning. Using FreeSurfer software, we compared the local gyrification index (LGI) between the relapsed and non-relapsed groups. In the relapsed group, we also explored the relationship among LGI and the number of relapses and time to first relapse after MRI scanning. Relapsed patients exhibited a significantly higher LGI in the bilateral parietal and left occipital areas than non-relapsed patients. In addition, the time to first relapse was negatively correlated with LGI in the right inferior temporal cortex. These findings suggest that increased LGI in the temporo-parieto-occipital regions in first-episode schizophrenia patients may be a potential prognostic biomarker that reflects relapse susceptibility in the early course of the illness.
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Affiliation(s)
- Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Arisawabashi Hospital, Toyama, Japan
| | - Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruko Kobayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
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14
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Migoya-Borja M, Martínez-Alés G, Barrigón ML, Palomar-Ciria N, Cegla-Schvartzman F, Baca-García E. A proposal definition criteria for psychotic relapse: Filling the gap for real-world studies. Schizophr Res 2022; 239:29-30. [PMID: 34808414 DOI: 10.1016/j.schres.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | | | | | | | - Enrique Baca-García
- Department of Psychiatry, Fundación Jiménez Díaz, Madrid, Spain; Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain; Department of Psychiatry, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Department of Psychiatry, University Hospital Rey Juan Carlos, Móstoles, Madrid, Spain; Department of Psychiatry, General Hospital of Villalba, Villalba, Madrid, Spain; Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Madrid, Spain; CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain; Universidad Católica del Maule, Talca, Chile; Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, France.
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15
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Solanes A, Radua J. Advances in Using MRI to Estimate the Risk of Future Outcomes in Mental Health - Are We Getting There? Front Psychiatry 2022; 13:fpsyt-13-826111. [PMID: 35492715 PMCID: PMC9039205 DOI: 10.3389/fpsyt.2022.826111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aleix Solanes
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Early Psychosis: Interventions and Clinical-detection Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Clinical Neuroscience, Stockholm Health Care Services, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden
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16
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Gündoğmuş İ, Aydin MB, Öz S, Taşçi AB, Uzun Ö. Clinical and demographic factors associated with early relapse in patients with schizophrenia: a naturalistic observation study. Int Clin Psychopharmacol 2021; 36:288-295. [PMID: 34417787 DOI: 10.1097/yic.0000000000000377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Schizophrenia is a chronic psychiatric disorder progressing in relapses. Identification of many factors that may potentially increase the risk of relapse will be an important step in preventing relapses. The aim of this study was to determine the rate of early relapse in patients with schizophrenia and possible risk factors related to early relapse. The sample of this prospective study with the naturalistic observation design consisted of 308 patients with schizophrenia. The cutoff value for early relapse was determined as 1 year. The mean age of participants was 37.38 ± 12.28 years and 66.6% of them were male (n = 205). The early relapse rate was 38.3%. The age younger than 35 [hazard ratio (HR) = 2.313; 95% confidence interval (CI), 1.518-3.526; P < 0.001], use of psychoactive substance (HR = 2.200; 95% CI, 1.407-3.440; P = 0.001), previous attempt of suicide (HR = 1.565; 95% CI, 1.028-2.384; P = 0.037), bad adherence to treatment (HR = 3.102; 95% CI, 1.358-7.086; P = 0.007), long-acting injectables (LAIs) antipsychotics in the treatment (HR = 0.534; 95% CI, 0.351-0.812; P = 0.003), combination typical-atypical antipsychotics (HR = 0.326; 95% CI, 0.131-0.807; P = 0.015), number of episodes (HR = 1.088; 95% CI, 1.043-1.134), and the score on the Side Effect factor of the Clinical Global Impressions Scale (HR = 1.826; 95% CI, 1.357-2.458; P < 0.001) were identified as the independent predictors of early relapse. It is remarkable that treatment bad adherence, use of psychoactive substance, no LAIs antipsychotics included in the treatment, and the no presence of the combination of typical and atypical antipsychotics are alterable predictors of early relapse.
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Affiliation(s)
- İbrahim Gündoğmuş
- Department of Psychiatry, Kirikkale Yüksek İhtisas Hospital, Kirikkale
| | - Mikail Burak Aydin
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Sefa Öz
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Azize Beril Taşçi
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Özcan Uzun
- Department of Psychiatry, Gülhane Training and Research Hospital, Ankara, Turkey
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Costardi CG, Gadelha A, Bressan RA. Individualizing tapering antipsychotic schemes considering D2 blockade dynamics. J Psychopharmacol 2021; 35:1161-1162. [PMID: 34313143 DOI: 10.1177/02698811211000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Carlos G Costardi
- Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ary Gadelha
- Programa de Esquizofrenia (PROESQ), Departamento de Psiquiatria, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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18
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Honer WG. Better Evidence for Pharmacological Maintenance Treatment in Nonaffective Psychoses: Implications for Relapse Prevention. Am J Psychiatry 2021; 178:369-371. [PMID: 33979537 DOI: 10.1176/appi.ajp.2021.21030281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- William G Honer
- Department of Psychiatry, University of British Columbia, and British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
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19
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Liu CC, Liu CM, Chien YL, Lin YT, Hsieh MH, Hwang TJ, Hwu HG. Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis. Front Psychiatry 2021; 12:714878. [PMID: 34557119 PMCID: PMC8453020 DOI: 10.3389/fpsyt.2021.714878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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20
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Kilciksiz CM, Keefe R, Benoit J, Öngür D, Torous J. Verbal memory measurement towards digital perspectives in first-episode psychosis: A review. Schizophr Res Cogn 2020; 21:100177. [PMID: 32322540 PMCID: PMC7163058 DOI: 10.1016/j.scog.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. METHODS In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. RESULTS We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. DISCUSSION While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
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Affiliation(s)
- Can Mişel Kilciksiz
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Richard Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James Benoit
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States of America
| | - John Torous
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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21
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Ceraso A, Lin JJ, Schneider-Thoma J, Siafis S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM, Leucht S. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2020; 8:CD008016. [PMID: 32840872 PMCID: PMC9702459 DOI: 10.1002/14651858.cd008016.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The symptoms and signs of schizophrenia have been linked to high levels of dopamine in specific areas of the brain (limbic system). Antipsychotic drugs block the transmission of dopamine in the brain and reduce the acute symptoms of the disorder. An original version of the current review, published in 2012, examined whether antipsychotic drugs are also effective for relapse prevention. This is the updated version of the aforesaid review. OBJECTIVES To review the effects of maintaining antipsychotic drugs for people with schizophrenia compared to withdrawing these agents. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including the registries of clinical trials (12 November 2008, 10 October 2017, 3 July 2018, 11 September 2019). SELECTION CRITERIA We included all randomised trials comparing maintenance treatment with antipsychotic drugs and placebo for people with schizophrenia or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD) or standardised mean differences (SMD), again based on a random-effects model. MAIN RESULTS The review currently includes 75 randomised controlled trials (RCTs) involving 9145 participants comparing antipsychotic medication with placebo. The trials were published from 1959 to 2017 and their size ranged between 14 and 420 participants. In many studies the methods of randomisation, allocation and blinding were poorly reported. However, restricting the analysis to studies at low risk of bias gave similar results. Although this and other potential sources of bias limited the overall quality, the efficacy of antipsychotic drugs for maintenance treatment in schizophrenia was clear. Antipsychotic drugs were more effective than placebo in preventing relapse at seven to 12 months (primary outcome; drug 24% versus placebo 61%, 30 RCTs, n = 4249, RR 0.38, 95% CI 0.32 to 0.45, number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 3; high-certainty evidence). Hospitalisation was also reduced, however, the baseline risk was lower (drug 7% versus placebo 18%, 21 RCTs, n = 3558, RR 0.43, 95% CI 0.32 to 0.57, NNTB 8, 95% CI 6 to 14; high-certainty evidence). More participants in the placebo group than in the antipsychotic drug group left the studies early due to any reason (at seven to 12 months: drug 36% versus placebo 62%, 24 RCTs, n = 3951, RR 0.56, 95% CI 0.48 to 0.65, NNTB 4, 95% CI 3 to 5; high-certainty evidence) and due to inefficacy of treatment (at seven to 12 months: drug 18% versus placebo 46%, 24 RCTs, n = 3951, RR 0.37, 95% CI 0.31 to 0.44, NNTB 3, 95% CI 3 to 4). Quality of life might be better in drug-treated participants (7 RCTs, n = 1573 SMD -0.32, 95% CI to -0.57 to -0.07; low-certainty evidence); probably the same for social functioning (15 RCTs, n = 3588, SMD -0.43, 95% CI -0.53 to -0.34; moderate-certainty evidence). Underpowered data revealed no evidence of a difference between groups for the outcome 'Death due to suicide' (drug 0.04% versus placebo 0.1%, 19 RCTs, n = 4634, RR 0.60, 95% CI 0.12 to 2.97,low-certainty evidence) and for the number of participants in employment (at 9 to 15 months, drug 39% versus placebo 34%, 3 RCTs, n = 593, RR 1.08, 95% CI 0.82 to 1.41, low certainty evidence). Antipsychotic drugs (as a group and irrespective of duration) were associated with more participants experiencing movement disorders (e.g. at least one movement disorder: drug 14% versus placebo 8%, 29 RCTs, n = 5276, RR 1.52, 95% CI 1.25 to 1.85, number needed to treat for an additional harmful outcome (NNTH) 20, 95% CI 14 to 50), sedation (drug 8% versus placebo 5%, 18 RCTs, n = 4078, RR 1.52, 95% CI 1.24 to 1.86, NNTH 50, 95% CI not significant), and weight gain (drug 9% versus placebo 6%, 19 RCTs, n = 4767, RR 1.69, 95% CI 1.21 to 2.35, NNTH 25, 95% CI 20 to 50). AUTHORS' CONCLUSIONS For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up. This effect must be weighed against the adverse effects of antipsychotic drugs. Future studies should better clarify the long-term morbidity and mortality associated with these drugs.
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Affiliation(s)
- Anna Ceraso
- Department of Clinical and Experimental Sciences, Section of Psychiatry, University of Brescia, Brescia, Italy
| | - Jessie Jingxia Lin
- School of Nursing, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Magdolna Tardy
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | - Katja Komossa
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Werner Kissling
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John M Davis
- Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Munich, Germany
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