scholarly journals Rates of treatment-resistant schizophrenia from first-episode cohorts: systematic review and meta-analysis

2021 ◽  
pp. 1-6
Author(s):  
Dan Siskind ◽  
Stacy Orr ◽  
Surabhi Sinha ◽  
Ou Yu ◽  
Bhavna Brijball ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
First Episode Psychosis ◽  
Drop Out ◽  
Continuous Treatment ◽  
Sensitivity Analyses ◽  
First Episode ◽  
Treatment Resistant ◽  
Episode Psychosis

Background Treatment-resistant schizophrenia (TRS) is associated with high levels of functional impairment, healthcare usage and societal costs. Cross-sectional studies may overestimate TRS rates because of selection bias. Aims We aimed to quantify TRS rates by using first-episode cohorts to improve resource allocation and clozapine access. Method We undertook a systematic review of TRS rates among people with first-episode psychosis and schizophrenia, with a minimum follow-up of 8 weeks. We searched PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Database of Systematic Reviews, and meta-analysed TRS rates from included studies. Results Twelve studies were included, totalling 11 958 participants; six studies were of high quality. The rate of TRS was 22.8% (95% CI 19.1–27.0%, P < 0.001) among all first-episode cohorts and 24.4% (95% CI 19.5–30.0%, P < 0.001) among first-episode schizophrenia cohorts. Subgroup sensitivity analyses by location of recruitment, TRS definition, study quality, time of data collection and retrospective versus prospective data collection did not lead to statistically significant differences in heterogeneity. In a meta-regression, duration of follow-up and percentage drop-out did not significantly affect the overall TRS rate. Men were 1.57 times more likely to develop TRS than women (95% CI 1.11–2.21, P = 0.010). Conclusions Almost a quarter of people with first-episode psychosis or schizophrenia will develop TRS in the early stages of treatment. When including people with schizophrenia who relapse despite initial response and continuous treatment, rates of TRS may be as high as a third. These high rates of TRS highlight the need for improved access to clozapine and psychosocial supports.

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

2017 ◽  
Vol 47 (11) ◽  
pp. 1981-1989 ◽  
Author(s):  
A. Demjaha ◽  
J. M. Lappin ◽  
D. Stahl ◽  
M. X. Patel ◽  
J. H. MacCabe ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Age At Onset ◽  
Treatment Resistance ◽  
First Episode Psychosis ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Treatment Resistant ◽  
Illness Onset ◽  
Episode Psychosis

BackgroundWe examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.MethodThe study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.ResultsFrom the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.ConclusionsThe striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

scholarly journals Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
Author(s):  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Emma Francis ◽  
Fiona Gaughran ◽  
Anthony S. David ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Hospitalised Patients ◽  
Episode Psychosis ◽  
Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

scholarly journals Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies

2017 ◽  
Vol 211 (6) ◽  
pp. 350-358 ◽  
Author(s):  
John Lally ◽  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Michael Cullinane ◽  
Kieran C. Murphy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
First Episode ◽  
Prevalence Rates ◽  
Recovery Rates ◽  
Pooled Prevalence ◽  
Episode Psychosis ◽  
Remission Rates

BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.

scholarly journals Remission and recovery from first-episode psychosis in adults: A systematic review and meta-analysis of long-term outcome studies

2017 ◽  
Vol 41 (S1) ◽  
pp. s819-s819 ◽  
Author(s):  
J. Lally ◽  
O. Ajnakina ◽  
B. Stubbs ◽  
M. Cullinane ◽  
K.C. Murphy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
First Episode ◽  
Recovery Rates ◽  
Pooled Prevalence ◽  
Episode Psychosis ◽  
Remission Rates

IntroductionRemission and recovery rates for people who have had a first episode psychosis (FEP) remain uncertain.ObjectivesWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies and conducted meta regression analyses to investigate potential moderators.MethodsA systematic literature search of major electronic databases without language restrictions was conducted from database inception until July 1, 2016. Longitudinal studies with follow up greater than 1 year reporting data on remission or recovery rates in FEP were included.ResultsSeventy-nine studies were included representing 19,072 FEP patients (mean age = 26.9 years, male = 59.5%). The pooled rate of remission among 12,301 individuals with FEP was 57.9% (95%CI: 52.7–62.9, Q = 1536.3, P< 0.001, n = 60 studies, mean follow up = 5.5 years). Restricting the analysis to studies, which used the remission in schizophrenia working group (RSWG) criteria (n = 25 studies, n = 6909 patients), the pooled remission rate was 56.9% (95%CI: 48.9–64.5, Q = 656.9). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 37.9% (95%CI: 30.0–46.5, Q = 1450.8, studies = 35, P = 0.006, average follow up = 7.2 years). Recovery rates were higher (P< 0.05) in North America compared to other regions.ConclusionsOur data suggest that remission and recovery rates in FEP may be more favorable than previously thought. We observed stability of recovery rates after the first two years, suggesting that a progressive deteriorating course of illness is not typical. While remission rates have improved over time, recovery rates have not, raising questions about the effectiveness of specialist early intervention services in achieving improved recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Risk factors associated with treatment-resistant schizophrenia in first-episode psychosis

2017 ◽  
Vol Ano 7 ◽  
pp. 8-12
Author(s):  
Ana Beatriz de Oliveira Assis ◽  
Jayse Gimenez Pereira Brandão ◽  
Pedro Otávio Piva Espósito ◽  
Osmar Tessari Junior ◽  
Bruno Berlucci Ortiz
Keyword(s):  
Risk Factors ◽  
First Episode Psychosis ◽  
First Episode ◽  
Treatment Resistant ◽  
Factors Associated ◽  
Syndrome Scale ◽  
Episode Psychosis ◽  
Negative Syndrome

Objetivo: Ainda não está claro quais são os fatores de risco para a esquizofrenia resistente ao tratamento (ERT) em primeiro episódio psicótico (PEP). O objetivo deste trabalho é investigar indicadores de risco para ERT em PEP. Métodos: Foram selecionados 53 pacientes em primeiro episódio psicótico, com diagnóstico de esquizofrenia, que deram entrada à enfermaria de psiquiatria do Hospital das Clínicas Luzia de Pinho Melo entre 2011 e 2015. Ao ser admitido na enfermaria, o paciente era avaliado com a Escala de Sintomas para as Síndromes Positiva e Negativa (Positive and Negative Syndrome Scale – PANSS) e recebia tratamento inicial por 4 semanas. Caso sua resposta fosse inferior a 40% de redução na PANSS, o antipsicótico era trocado, e as escalas eram aplicadas novamente após mais 4 semanas. Após a falha com dois antipsicóticos, em doses plenas, por 4 semanas cada, a clozapina era introduzida, e o paciente era considerado ERT. Uma regressão logística foi aplicada onde sexo, idade de início, tempo de doença não tratada, uso de substâncias, avaliação global do funcionamento inicial e PANSS inicial total foram inseridos como variáveis independentes, e ERT foi inserida como variável dependente. Resultados: Tempo de doença não tratada apresentou significância de p = 0,038 e Exp (B) = 4,29, enquanto que PANSS total apresentou p = 0,012 e Exp (B) = 1,06. Conclusão: Identificar os fatores associados à resistência precoce ao tratamento poderia permitir aos clínicos evitar o atraso na introdução da clozapina e prevenir um pior prognóstico para esses pacientes.

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