The Scottish First Episode Schizophrenia Study V. One-year Follow-up

Abstract

Of 49 schizophrenicpatientsfollowed up 12 monthsafter their first admissionto hospital, onlyabout 45% had experiencedno relapseand had no schizophrenicsymptoms;a poorer outcome was moreoften found in Feighnerpositivethan Feighnernegativeschizophrenic patients. The patients' overall level of unemployment had more than doubled to 51 %. In patients whose acute episodesrespondedto treatment, pimozidetaken once weekly as maintenance therapy was as effective as intramuscularflupenthixol decanoate, but tardive dyskinesiaappeared in two patients receivingweekly pimozide;the repeat psy chometric assessmentat 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relativesstillshowed significantpsychological distress,which correlatedwith patients' schizophrenicsymptoms, and the relatives' socialfunctioningremainedpoorerthan that of a normal community sample.

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

“…Both negative symptoms and age at onset have been linked to treatment resistance (Kolakowska et al 1985;McCreadie et al 1989;Meltzer et al 1997;Robinson et al 1999). Contrary to our expectations, the study by Lally et al (2016) did not find association with negative symptoms, which could be due to the fact that they used the Positive and Negative Syndrome Scale (PANSS) negative subscale that does not incorporate all negative symptoms such as motor retardation and active social avoidance.…”

“…It remains, however, unknown whether these patients are treatment resistant from the illness onset (TRO), or whether they gradually become resistant as illness progresses in the context of multiple episodes, chronic exposure to medication or neurochemical sensitization. We have previously demonstrated that dopamine dysfunction is not evident in treatment-resistant patients (Demjaha et al 2012(Demjaha et al , 2014 and this, together with the evidence linking various underlying neurodevelopmental factors to treatment resistance (McCreadie et al 1989;Robinson et al 1999), may suggest that in this distinct subgroup, dopamine-blocking antipsychotics are ineffective right from the beginning of illness. In support of this, first-episode psychosis (FEP) studies have established that even during the first episode of illness where treatment response to antipsychotic medication tends to be greater; up to one-quarter of patients continue to have persistent symptoms despite adequate treatment (Lieberman et al 1993;Agid et al 2011;Schennach et al 2012).…”

“…Although greater severity of negative symptoms, younger age at onset, poor pre-morbid functioning, male gender and a longer DUP have all been linked to treatment resistance (McCreadie et al 1989;Lieberman et al 1993;Robinson et al 1999), these studies have mostly focused on poor outcome or poor response to antipsychotic treatment, and have not distinguished between different subtypes of treatment resistance, which may account for disparity in results.…”

Longitudinal research on bipolar disorders

“…The complexity and risk of confounding under such con-ditions has encouraged prospective studies of firstepisode patients in early or prodromal phases of illness. Most first-episode studies involve patients diagnosed with early (Jones & Tarrant, 1999;McGorry et al, 2000;Cannon et al, 2001;Gaebel et al, 2001;Hollis 2003), or established schizophrenia (Kane et al, 1982;Biehl et al, 1986;Schubart et al, 1986;McCreadie et al, 1989;Johnstone et al, 1990;Tohen et al, 1990b;1992a;1996;Tohen 1991;Leff et al, 1992;Ram et al, 1992;Ventura et al, 1992;Lieberman et ai, 1993;Bromet et al, 1996;Varma et al, 1996;Craig et al, 1997;Gupta et al, 1997;Lay et al, 1997). There have been far fewer first-episode follow-up studies of patients diagnosed with bipolar disorder (Tohen et al, 1990b(Tohen et al, , 2000aFennig et al, 1996;Strakowski et al, 1998;Conus et al, 2004;Schimmelmann et al, 2005), or other types of psychotic disorders (Pillmann et ai, 2002;Schimmelmann et ai, 2005;Abe et ai, 2006;Emsley et ai, 2006;2007).…”

Diretrizes da Federação Mundial das Sociedades de Psiquiatria Biológica para o tratamento biológico da esquizofrenia. Parte 2: tratamento de longo prazo

“…Apesar de haver poucos estudos sobre os fatores relacionados à manutenção do estado de remissão, as evidências sugerem que os antipsicóticos são altamente eficazes na prevenção de recaídas (APA, 2004). Nos pacientes para os quais os antipsicóticos são prescritos, o risco de recaída em 1 ano varia de 0% a 46%, sendo as taxas de recaída entre os pacientes que pararam de tomar a medicação 5 vezes maior do que naqueles que continuaram o tratamento (Nível A) (Kane et al, 1982;Crow et al, 1986;McCreadie et al, 1989;Robinson et al, 1999b). Os níveis variáveis de recaídas encontradas nesses estudos podem ocorrer em razão das diferenças nos critérios utilizados para a definição da recaída, das diferentes populações de estudo e dos diferentes perío-dos de seguimento e poderiam ser explicados, em parte, pelos diferentes graus de aderência ao tratamento.…”