Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis

Pelayo-Terán, José María; Díaz, Francisco Javier Rodríguez; Pérez-Iglesias, Rocí­o; Suárez-Pinilla, Paula; Tabarés‐Seisdedos, Rafael; León, José de; Crespo‐Facorro, Benedicto

doi:10.1017/s0033291713000330

Cited by 42 publications

(41 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies in adults also reported that PsyNOS patients had better outcomes than patients with schizophrenia (Kendler and Walsh 1995;Harrison et al 2001;Jobe and Harrow 2005;Crespo-Facorro et al 2007;Simonsen et al 2010;Crespo-Facorro et al 2013;Diaz et al 2013;Pelayo-Teran et al 2014). However, even in adults, such comparative studies are sparse, and generally have the same limitations as studies in the child and adolescent population; either small sample sizes or lack of differentiation among the different diagnostic first-episode psychosis subgroups.…”

Section: Discussionmentioning

confidence: 97%

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Vernal

Kapoor

Al-Jadiri

et al. 2015

Journal of Child and Adolescent Psychopharmacology

View full text Add to dashboard Cite

Objectives: The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. Methods: The study was a prospective, naturalistic, inception cohort study of youth £ 19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and £ 24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. Results: Altogether, 130 youth with SCZ-S (n = 42) or PsyNOS (n = 88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4 -2.1 vs. 14.8 -3.2, p = 0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p = 0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0 -0.9 vs. 5.5 -0.8, p = 0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6 -9.2 vs. 36.1 -8.9, p = 0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS £ 40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p = 0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p = 0.97), or nonadherence (29.3% vs. 30.9%, p = 0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p = 0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups ( p = 0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores ( p = 0.012) and more frequently reached higher categorical CGAS group status ( p = 0.021) than SCZ-S patients. Conclusions: Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.

show abstract

Section: Discussionmentioning

confidence: 97%

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Vernal

Kapoor

Al-Jadiri

et al. 2015

Journal of Child and Adolescent Psychopharmacology

View full text Add to dashboard Cite

show abstract

“…For more trait-like symptoms of schizophrenia, such as thought disorder, latent trajectory analysis can determine whether there is any added predictive value of trajectories beyond that of baseline severity. In psychiatry, latent trajectory analyses have been used to evaluate the patterns of symptoms in autism onset (N = 52) (Ozonoff et al, 2011), in disparate types of mood episodes in bipolar disorder (N= 118) (M’Bailara et al, 2013), and in response to antipsychotic medications in first-episode psychosis patients (N = 161) (Pelayo-Teran et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

Symptom trajectories and psychosis onset in a clinical high-risk cohort: The relevance of subthreshold thought disorder

DeVylder

Muchomba

Gill

et al. 2014

Schizophrenia Research

View full text Add to dashboard Cite

Background Prior studies have implicated baseline positive and negative symptoms as predictors of psychosis onset among individuals at clinical high risk (CHR), but none have evaluated latent trajectories of symptoms over time. This study evaluated the dynamic evolution of symptoms leading to psychosis onset in a CHR cohort. Method 100 CHR participants were assessed quarterly for up to 2.5 years. Latent trajectory analysis was used to identify patterns of symptom change. Logistic and proportional hazards models were employed to evaluate the predictive value for psychosis onset of baseline symptoms and symptom trajectories. Results Transition rate to psychosis was 26%. Disorganized communication (i.e., subthreshold thought disorder) presented an increased hazard for psychosis onset, both at baseline (Hazard Ratio (95% CI) = 1.4 (1.1–1.9)) and as a trajectory of high persistent disorganized communication (Hazard Ratio (95% CI) = 2.2 (1.0–4.9)). Interval clinical data did not improve the predictive value of baseline symptoms for psychosis onset. Conclusions High baseline disorganized communication evident at ascertainment tended to persist and lead to psychosis onset, consistent with prior behavioral and speech analysis studies in similar cohorts. Remediation of language dysfunction therefore may be a candidate strategy for preventive intervention.

show abstract

“…A long DUP has been found to be associated with more severe positive and negative symptoms [10][11][12], longer length of first hospitalization [13], poorer remission status and higher risk of relapse and rehospitalisation [8,11,13,14]. Such negative outcomes can lead to further consequences, such as increased burden and expressed emotion in the family [15], reduced compliance to treatment [16,17], lower treatment response rates [18][19][20][21][22], increased risk of depression, suicide and self-harming behaviour [23][24][25], higher risk of violence, aggression and delinquent behaviour [26][27][28] and eventually greater impairment in general functioning, social functioning and quality of life [11,14,29,30].…”

Section: Clinical Relevance and Impact Of Delayed Treatmentmentioning

confidence: 99%

The Psychosis High-Risk State

Rutigliano¹,

Manalo²,

Fusar‐Poli

2016

Key Issues in Mental Health

View full text Add to dashboard Cite

The disabling nature and costly impact of mental disorders, such as schizophrenia, can cause significant burden to both person and society. It is also indicated that the negative outcomes associated with psychosis may, in part, be due to the delayed detection and initiation of treatment. Preventative interventions in several arenas of medicine have advanced; however have only come to the fore in psychiatry in the last two decades. It was long-known that a preclinical phase preceded psychosis, now commonly termed as ultra high-risk (UHR) status.The advent of specialized early intervention services provided the cornerstone in taking a preventative and timely endeavor to maximize the chance of positive outcomes in psychosis.Despite the potential, the current state of the UHR concept lacks consensus in how at-risk individuals should be approached. This chapter aims to provide an overview of how preventative medicine can intersect with psychiatry by focusing on the psychosis high risk state. It describes the current criteria and screening procedures used to prospectively detect UHR individuals, as well as discussing the validity of these tools. Whilst advocating the benefits of focused interventions, this chapter also recognizes current challenges and the controversy that leaves the psychosis high risk state on fertile ground for wavering opinions.The chapter concludes with an exploration and discussion that proposes an improved conceptualization of the high risk state and how this can direct intervention, as well as suggesting future lines of research in this area.2

show abstract

Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis

Cited by 42 publications

References 41 publications

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Symptom trajectories and psychosis onset in a clinical high-risk cohort: The relevance of subthreshold thought disorder

The Psychosis High-Risk State

Contact Info

Product

Resources

About