The relation of antipsychotic and antidepressant medication with baseline symptoms and symptom progression: A naturalistic study of the North American Prodrome Longitudinal Sample

Abstract

A substantial number of patients who meet criteria for a prodromal syndrome for first psychosis are treated with antipsychotic and/or antidepressant medications. There is suggestive evidence that both classes of medication may reduce prodromal symptoms. This longitudinal study examined the relation of antipsychotic and antidepressant medication with prodromal symptom severity at baseline and 6-month follow-up. Participants met Structured Interview for Prodromal Syndromes (SIPS) criteria for the prodrome, and were evaluated at eight centers as part of the North American Prodrome Longitudinal Study (NAPLS).Symptom ratings (positive, negative, disorganized and general) and data on antipsychotics, SSRIs, and other antidepressant medications were obtained at baseline and 6-month follow-up. Analyses revealed that all symptom dimensions declined in severity over time, but there were differences in the magnitude of the decline as a function of antipsychotic medication. Those never on antipsychotics showed less reduction in positive and disorganized symptoms over time. SSRIs and other antidepressants were not linked with declines in symptom severity. Consistent with findings from small-sample, clinical trials, the present results suggest that atypical antipsychotics may be effective in reducing the severity of attenuated positive symptoms associated with the prodrome to psychotic disorders. Limitations of the present study are noted, including the fact that it is not a randomized trial, and data on duration and dosage of medication and 2-year followup were not available for most participants. The results are discussed in light of the relative risks and benefits of preventive interventions, both medication and cognitive therapies, and the importance of future clinical trials.

Revisiting the therapeutic effect of rTMS on negative symptoms in schizophrenia: A meta-analysis

“…However other studies have found that patients with first-episode schizophrenia may also present with predominantly negative symptoms (Hovington et al, 2012; Malla et al, 2004). Studies have shown that patients with a higher PANSS total score or positive symptom score at baseline had greater reduction in global symptoms or positive symptoms after antipsychotic treatment (Levine and Rabinowitz, 2010; Walker et al, 2009). Our results showed that rTMS, as an add-on treatment, may be more effective for patients with a higher baseline negative symptoms subscale score rather than a higher baseline PANSS total score.…”

Current status specifiers for patients at clinical high risk for psychosis

“…In the NAPLS-1 cohort, some patients received psychotropic medication or psychosocial treatment, either clinically during naturalistic research follow-along or in prospective research trials, as previously described (Cadenhead et al, 2010; Cannon et al, 2008; Walker et al, 2009; Woods et al, 2013). We thus also investigated the extent to which cases converting or meeting progression criteria after having achieved remission could potentially be accounted for by discontinuation of treatment.…”

Endocrine, Lifestyle, and Genetic Factors in the Development of Metabolic Syndrome

“…Weight gain can be a result of reduced resting energy expenditure. Blocking the histamine H1 receptor increases appetite, while serotonin 2C (2-HT 2C ) interaction with antipsychotics stimulates food intake despite satiety (53)(54)(55). A recent study (56) confi rmed that users of tricyclic antidepressants were prone to obesity and dyslipidaemia and it associated low-grade infl ammation with more severe anxiety disorders and depression.…”