Low dose risperidone in the treatment of schizophrenia-like symptoms in high-risk subjects

Interventions and social functioning in youth at risk of psychosis: A systematic review and meta-analysis

AIM

Youth at clinical high risk (CHR) for psychosis often exhibit difficulties in social functioning and poorer social functioning may be predictive of transition to a psychotic disorder. Therefore, the primary objective of this systematic review was to summarize the impact of all interventions on social functioning in CHR samples.

METHOD

Electronic databases PsycINFO, CINAHL, Embase, EBM, and MEDLINE were searched from 1951 to June 2017. Studies were selected if they included any intervention that reported changes in social functioning in youth at CHR. Data were evaluated using random effects pairwise meta-analyses, stratified by time, and reported as the standardized mean difference (SMD).

RESULTS

Nineteen studies met our inclusion criteria, including a total of 1513 CHR participants. The mean age was 20.5 years and 47% were male. Cognitive behavioural therapy (4 studies) did not significantly improve social functioning at 6 months (SMD = 0.06; 95% confidence interval [CI] = -0.35, 0.46), 12 months (SMD = -0.15; 95% CI = -0.38, 0.08) and 18 months (SMD = 0.20; 95% CI = -0.10, 0.50). Omega-3 (2 studies) did not significantly improve social functioning at 6 months (SMD = 0.01; 95% CI = -0.21, 0.24) and 12 months (SMD = -0.08; 95% CI = -0.33, 0.17). Lastly, cognitive remediation (3 studies) did not significantly improve social functioning at 2- to 3-month follow-up (SMD = 0.13, 95% CI = -0.18, 0.43).

CONCLUSIONS

This systematic review and meta-analysis demonstrated that no treatment significantly improved social functioning in youth at CHR. Future randomized control trials are required that are designed to target and improve social functioning in youth at CHR for psychosis.

Diagnosis and treatment of schizotypal personality disorder: evidence from a systematic review

The main objective of this review was to evaluate studies on the diagnosis, treatment, and course of schizotypal personality disorder and to provide a clinical guidance on the basis of that evaluation. A systematic search in the PubMed/MEDLINE databases was conducted. Two independent reviewers extracted and assessed the quality of the data. A total of 54 studies were eligible for inclusion: 18 were on diagnostic instruments; 22, on pharmacological treatment; 3, on psychotherapy; and 13, on the longitudinal course of the disease. We identified several suitable and reliable questionnaires for screening (PDQ-4+ and SPQ) and diagnosing (SIDP, SIDP-R, and SCID-II) schizotypal personality disorder. Second-generation antipsychotics (mainly risperidone) were the most often studied drug class and were described as beneficial. Studies on the longitudinal course described a moderate remission rate and possible conversion rates to other schizophrenia spectrum disorders. Because of the heterogeneity of the studies and the small sample sizes, it is not yet possible to make evidence-based recommendations for treatment. This is a systematic evaluation of diagnostic instruments and treatment studies in schizotypal personality disorder. We conclude that there is currently only limited evidence on which to base treatment decisions in this disorder. Larger interventional trials are needed to provide the data for evidence-based recommendations.

Long-term administration of the low-dose risperidone in schizotaxia subjects

The term schizotaxia is currently defined as a syndrome of neuropsychological deficits and negative symptoms found in relatives of schizophrenic patients. The aim of this study was to assess the effect of long-term treatment with the low-dose risperidone on cognitive and social functioning in seven schizotaxia patients. There were four males and three females, aged between 17 and 44 years, first-degree (four patients) or second-degree (three patients) relatives of schizophrenic patients. Schizotaxia was recognized in them on account of neuropsychological and social function impairment. They all consented to risperidone administration, 1-2 mg/day. Duration of risperidone treatment has ranged between 3-7 years. In all subjects, the continuous treatment with risperidone brought about a marked improvement in their cognitive, social, and vocational functioning. Neuropsychological testing after 6-24 months showed significant improvement on such tests as Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Stroop Test. Discontinuation of treatment after 3-4 years did not cause deterioration of functioning.