scholarly journals Randomized Controlled Trial of Clozapine and CBT for First-Episode Psychosis with Enduring Positive Symptoms: A Pilot Study

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
J. Edwards ◽  
J. Cocks ◽  
P. Burnett ◽  
D. Maud ◽  
L. Wong ◽  
...  
Keyword(s):  
Pilot Study ◽  
Negative Symptoms ◽  
Controlled Trial ◽  
Treatment Phase ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Treatment Groups ◽  
Episode Psychosis ◽  
Symptomatic Remission

Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria () were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52%) of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time.

Toxic psychosis? Duration of untreated psychosis, symptomatology and cognitive deterioration in first episode psychosis

2007 ◽  
Vol 24 (4) ◽  
pp. 145-148 ◽  
Author(s):  
Richard Lawoyin ◽  
Keith Gaynor ◽  
Barbara Dooley ◽  
Elizabeth Lawlor ◽  
Mary Clarke ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Cognitive Deterioration ◽  
Duration Of Untreated Psychosis ◽  
Episode Psychosis ◽  
The Relationship ◽  
Linear Regressions ◽  
Positive And Negative Symptoms

AbstractObjectives: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample.Method: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology.Results: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors.Conclusions: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.

Efficacy of amisulpride in treating primary negative symptoms in first-episode psychosis: a pilot study

2006 ◽  
Vol 21 (8) ◽  
pp. 511-517 ◽  
Author(s):  
Brendan P. Murphy ◽  
Antonia H. Stuart ◽  
Darryl Wade ◽  
Sue Cotton ◽  
Patrick D. McGorry
Keyword(s):  
Pilot Study ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis

scholarly journals Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis

2020 ◽  
pp. 1-12
Author(s):  
Miranda Bridgwater ◽  
Peter Bachman ◽  
Brenden Tervo-Clemmens ◽  
Gretchen Haas ◽  
Rebecca Hayes ◽  
...  
Keyword(s):  
Negative Symptom ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
Positive Symptom ◽  
First Episode ◽  
Positive Symptoms ◽  
Symptom Expression ◽  
Age Related ◽  
Episode Psychosis

Abstract Background The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated. Methods Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12–40 years, 1–12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. Results Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood. Conclusions These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain–behavior relationships vary as a function of development.

Do psychosis prodrome onset negative symptoms predict first presentation negative symptoms?

2014 ◽  
Vol 29 (3) ◽  
pp. 153-159 ◽  
Author(s):  
J. Lyne ◽  
L. Renwick ◽  
K. Madigan ◽  
B. O’Donoghue ◽  
M. Bonar ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Treatment Phase ◽  
First Episode Psychosis ◽  
Diagnostic Group ◽  
First Episode ◽  
Regression Analyses ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Psychosis Prodrome ◽  
The Relationship

AbstractBackground:Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear.Objectives:We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment.Methods:Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding.Results:PONS prevalence was 50.3% in the schizophrenia spectrum group (n = 155) and 31.2% in the non-schizophrenia spectrum group (n = 218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ2 = 10.41, P < 0.001) and adjusted (OR = 2.40, 95% CI = 1.11–5.22, P = 0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group.Conclusion:PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.

scholarly journals Developmental Influences on Symptom Expression in Antipsychotic-Naïve First-Episode Psychosis

2020 ◽  
Author(s):  
Miranda Bridgwater ◽  
Peter Bachman ◽  
Brenden Tervo-Clemmens ◽  
Gretchen Haas ◽  
Rebecca Hayes ◽  
...  
Keyword(s):  
Negative Symptom ◽  
Symptom Severity ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Symptom Expression ◽  
Cross Sectional ◽  
Age Related ◽  
Episode Psychosis

AbstractIntroductionThe neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how a person’s age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated.MethodUsing generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals experiencing a first episode of psychosis (N=340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990-2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We also tested for age-associated effects on change in positive or negative symptom severity following baseline assessment, and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development.ResultsIn the cross-sectional and longitudinal data, perceptual positive symptoms significantly decreased with increasing age (F=7.0, p=0.0007; q=0.003) while non-perceptual positive symptoms increased with increasing age (F=4.1, p=0.01, q=0.02). These relationships remained significant when SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p>0.25). Finally, an association between severity of non-perceptual and perceptual symptoms developed with increasing age, with a significant association starting at age 18.ConclusionThese findings suggest that as cognitive maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced, reflecting influences of developmental processes on psychosis expression. Findings underscore how pathological brain-behavior relationships vary as a function of development.

scholarly journals Twenty-Four Week, Randomized, Double-Blind, Placebo-Controlled Trial of Metformin for Antipsychotic-Induced Weight Gain in Patients with First-Episode Psychosis: A Pilot Study

2021 ◽  
Vol 19 (1) ◽  
pp. 137
Author(s):  
Charmaine Tang ◽  
Yi Chian Chua ◽  
Edimansyah Abdin ◽  
Mythily Subramaniam ◽  
Swapna Verma
Keyword(s):  
Weight Gain ◽  
Pilot Study ◽  
Controlled Trial ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Episode Psychosis

Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.

Conceptual disorganization and redistribution of resting state cortical hubs in untreated first episode psychosis: A 7T MRI study

2020 ◽  
Author(s):  
Avyarthana Dey ◽  
Kara Dempster ◽  
Michael Mackinley ◽  
Peter Jeon ◽  
Tushar Das ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Superior Temporal Gyrus ◽  
Brain Regions ◽  
First Episode Psychosis ◽  
Cortical Reorganization ◽  
First Episode ◽  
Formal Thought Disorder ◽  
Whole Brain ◽  
Episode Psychosis ◽  
Positive And Negative Symptoms

Background:Network level dysconnectivity has been studied in positive and negative symptoms of schizophrenia. Conceptual disorganization (CD) is a symptom subtype which predicts impaired real-world functioning in psychosis. Systematic reviews have reported aberrant connectivity in formal thought disorder, a construct related to CD. However, no studies have investigated whole-brain functional correlates of CD in psychosis. We sought to investigate brain regions explaining the severity of CD in patients with first-episode psychosis (FEPs) compared with healthy controls (HCs).Methods:We computed whole-brain binarized degree centrality maps of 31 FEPs, 25 HCs and characterized the patterns of network connectivity in the two groups. In FEPs, we related these findings to the severity of CD. We also studied the effect of positive and negative symptoms on altered network connectivity.Results:Compared to HCs, reduced hubness of a right superior temporal gyrus (rSTG) cluster was observed in the FEPs. In patients exhibiting high CD, increased hubness of a medial superior parietal (mSPL) cluster was observed, compared to patients exhibiting low CD. These two regions were strongly correlated with CD scores but not with other symptom scores.Discussion:Our observations are congruent with previous findings of reduced but not increased hubness. We observed increased hubness of mSPL suggesting that cortical reorganization occurs to provide alternate routes for information transfer.Conclusion:These findings provide insight into the underlying neural processes mediating the presentation of symptoms in untreated FEP. A longitudinal tracking of the symptom course will be useful to assess the mechanisms underlying these compensatory changes.

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