A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients

Chen, Eric; Hui, Christy Lai Ming; Dunn, Eva Lai-Wah; Miao, May Yin-King; Yeung, Wai-Song; Wong, C.K.; Chan, Wah-Fat; Tang, Wai-Nang

doi:10.1016/j.schres.2005.02.020

Cited by 114 publications

(92 citation statements)

References 17 publications

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“…Our finding that brief periods of oral medication nonadherence led to a return of psychosis is consistent with the previous literature on first-episode schizophrenia (4)(5)(6)(7)28). The present study extended these findings to the early phases of schizophrenia by using welloperationalized definitions of nonadherence that quantified three levels of partial nonadherence.…”

Section: Discussionsupporting

confidence: 92%

“…Üçok et al (6) demonstrated that first-episode schizophrenia patients who experienced a psychotic relapse had a much higher rate of nonadherence (70%) than nonrelapsing patients (25%). Similarly, Chen et al (7) found that the 1-year relapse rates for adherent versus poorly adherent schizophrenia, schizoaffective, and schizophreniform patients were 18% versus 29%, respectively, and the 2-year relapse rates were 29% versus 42%, respectively. The cumulative relapse rate for first-episode patients with good adherence over a 3-year period was 36%, whereas the rate for poorly adherent patients was 57% (7).…”

mentioning

confidence: 85%

“…Similarly, Chen et al (7) found that the 1-year relapse rates for adherent versus poorly adherent schizophrenia, schizoaffective, and schizophreniform patients were 18% versus 29%, respectively, and the 2-year relapse rates were 29% versus 42%, respectively. The cumulative relapse rate for first-episode patients with good adherence over a 3-year period was 36%, whereas the rate for poorly adherent patients was 57% (7). Patients exhibit various levels of medication adherence behavior, often with partial or intermittent adherence, as opposed to complete nonadherence.…”

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confidence: 85%

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Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Subotnik

Nuechterlein²,

Ventura³

et al. 2012

FOC

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Objective-This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients.Method-Three sets of operational criteria for medication nonadherence with differing levels of severity were compared for their ability to predict relapse. Explicit operational criteria are provided with the hope that they will be adopted by others. Psychotic symptoms were prospectively rated on a frequent basis, and systematic criteria were applied using a computer scoring program to identify periods of psychotic symptom return. In addition, a specialized statistical survival analysis method, optimal for examining risk periods and outcomes that can recur during the follow-up assessment, was used.Results-As hypothesized, medication nonadherence robustly predicted a return of psychotic symptoms during the early phase of schizophrenia (hazard ratios=3.7-28.5, depending on the severity of nonadherence). Conclusions-Even brief periods of partial nonadherence lead to greater risk of relapse thanwhat is commonly assumed. Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence.Nonadherence to antipsychotic medication is quite common among schizophrenia patients and is the greatest obstacle to recovery and relapse prevention. This issue is heightened among individuals with a recent onset of schizophrenia who are just beginning to come to terms with having a psychiatric disorder and have not been in treatment long enough to recognize the necessity of adhering to their medication regimen (1). Approximately 50% of patients discontinue antipsychotic medication or have significant nonadherence to their Address correspondence and reprint requests to Dr. Subotnik, University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, 300 UCLA Medical Plaza, Rm. 2240, Los Angeles, CA 90095-6968; ksubotnik@mednet.ucla.edu. HHS Public AccessAuthor manuscript Am J Psychiatry. Author manuscript; available in PMC 2016 October 19. Published in final edited form as: Am J Psychiatry. 2011 March ; 168(3): 286-292. doi:10.1176/appi.ajp.2010.09010087. Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript medication regimen within 1 year of beginning treatment, with rates rising to 75% within 2 years (2). Some evidence indicates that nonadherence is greater in the early course of the disorder (3). The clinical implications of nonadherence among first-episode patients are dramatic. Morken et al. (4) demonstrated an odds ratio of 10.3 for psychotic relapse among nonadherent first-episode patients. In another study of first-episode schizophrenia patients, those who discontinued their medication had an almost fivefold increase in the risk for a first and second relapse (5). Üçok et al. (6) demonstrated that first-episode schizophrenia patients who experienced a psychotic relapse h...

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 85%

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confidence: 85%

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Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Subotnik

Nuechterlein²,

Ventura³

et al. 2012

FOC

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“…Although the CTMT version we used is considered as a test for processing speed , it also measures another process due to the necessity to shift continuously between numbers and letters. It is well known that set-shifting is also often disturbed in schizophrenia (Donohoe and Robertson, 2003;Pantelis et al, 1999) and it has even been identified as a predictor of relapse in first-episode schizophrenia (Chen et al, 2005).…”

Section: Ampakines and Schizophreniamentioning

confidence: 99%

Acute Effects of the Ampakine Farampator on Memory and Information Processing in Healthy Elderly Volunteers

Wezenberg

Verkes

Ruigt³

et al. 2006

Neuropsychopharmacol

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Ampakines act as positive allosteric modulators of AMPA-type glutamate receptors and facilitate hippocampal long-term potentiation (LTP), a mechanism associated with memory storage and consolidation. The present study investigated the acute effects of farampator, 1-(benzofurazan-5-ylcarbonyl) piperidine, on memory and information processes in healthy elderly volunteers. A double-blind, placebocontrolled, randomized, cross-over study was performed in 16 healthy, elderly volunteers (eight male, eight female; mean age 66.1, SD 4.5 years). All subjects received farampator (500 mg) and placebo. Testing took place 1 h after drug intake, which was around T max for farampator. Subjects performed tasks assessing episodic memory (wordlist learning and picture memory), working and short-term memory (N-back, symbol recall) and motor learning (maze task, pursuit rotor). Information processing was assessed with a tangled lines task, the symbol digit substitution test (SDST) and the continuous trail making test (CTMT). Farampator (500 mg) unequivocally improved short-term memory but appeared to impair episodic memory. Furthermore, it tended to decrease the number of switching errors in the CTMT. Drug-induced side effects (SEs) included headache, somnolence and nausea. Subjects with SEs had significantly higher plasma levels of farampator than subjects without SEs. Additional analyses revealed that in the farampator condition the group without SEs showed a significantly superior memory performance relative to the group with SEs. The positive results on short-term memory and the favorable trends in the trail making test (CTMT) are interesting in view of the development of ampakines in the treatment of Alzheimer's disease and schizophrenia.

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“…Cognitive deficits are the single best predictor of functional outcome in schizophrenia (Bozikas et al, 2006;Hofer et al, 2005;Milev et al, 2005). They predict poorer medication (Burton, 2005) and treatment (Prouteau et al, 2004) adherence, reduced adaptive and social skills (Bowie and Harvey, 2005), dysfunctional personality traits (Gurrera et al, 2005), and increased risk of relapse in first-episode patients (Chen et al, 2005). The cognitive dysfunction of schizophrenia appears to involve almost all the known neurotransmitter systems (Tamminga, 2006) and is also be found in probands' non-schizophrenic relatives (Keefe et al, 1994;Sitskoorn et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Pergolide Treatment of Cognitive Deficits Associated with Schizotypal Personality Disorder: Continued Evidence of the Importance of the Dopamine System in the Schizophrenia Spectrum

McClure

Harvey

Goodman

et al. 2010

Neuropsychopharmacol

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Cognitive deficits observed in schizophrenia are also frequently found in individuals with other schizophrenia spectrum disorders, such as schizotypal personality disorder (SPD). Dopamine appears to be a particularly important modulator of cognitive processes such as those impaired in schizophrenia spectrum disorders. In a double-blind, placebo-controlled clinical trial, we administered pergolide, a dopamine agonist targeting D 1 and D 2 receptors, to 25 participants with SPD and assessed the effect of pergolide treatment, as compared with placebo, on neuropsychological performance. We found that the pergolide group showed improvements in visual-spatial working memory, executive functioning, and verbal learning and memory. These results suggest that dopamine agonists may provide benefit for the cognitive abnormalities of schizophrenia spectrum disorders.

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A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients

Cited by 114 publications

References 17 publications

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Risperidone Nonadherence and Return of Positive Symptoms in the Early Course of Schizophrenia

Acute Effects of the Ampakine Farampator on Memory and Information Processing in Healthy Elderly Volunteers

Pergolide Treatment of Cognitive Deficits Associated with Schizotypal Personality Disorder: Continued Evidence of the Importance of the Dopamine System in the Schizophrenia Spectrum

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