Drug-naive Psychotic Patients Research Articles

From folk therapy to evidence-based psychiatry practice: The benefit of evidence-based psychiatry in treatment-naive psychotic patients.

As Taiwan's Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. To evaluate the outcomes of these patients from folk therapy to conventional treatment. The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.

Prefrontal cortical thickness related to negative symptoms in antipsychotic-naive, first-episode psychotic patients

IntroductionA significant cortical thinning has been repeatedly observed in adult-onset first-episode schizophrenia patients compared to healthy controls, mostly in medial and inferior prefrontal cortices. However, it is yet unclear whether all these replicated alterations are related to any particular clinical feature.ObjectivesThis study aimed to investigate differences of cortical thickness in a sample of first-episode, drug-naive psychotic patients and age- and gender-matched healthy controls and explore clinical correlates of these parameters regarding negative symptoms.MethodsHigh-resolution T1-weighted images were acquired from 23 antipsychotic-naive, first-episode psychotic patients and 26 age-matched healthy comparison subjects. Clinical features were measured with the negative subscale of the Positive and Negative Syndrome Scale (PANSS) at baseline and after a 2-month follow-up period.ResultsNo differences were found regarding age or gender when comparing patients and controls. We found a significant cortical thinning in the left medial orbitofrontal cortex and in the right lateral orbitofrontal cortex in patients compared to healthy age- and gender-matched controls. Regarding clinical performance, no correlation was found at baseline between left medial orbitofrontal nor right lateral ortitofrontal cortical thickness and scores of the negative subscale of the PANSS. However, at the 2-month evaluation clinical performances were significantly associated to the left medial orbitofrontal cortical thickness values.ConclusionsCortical thickness alterations in prefontal cortex appear to be present at disease onset and these alterations may relate to clinical outcome. However, our findings must be considered just as exploratory. Larger longitudinal studies may help characterize, replicate and consolidate these findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sexual dysfunction related to typical and atypical antipsychotics in drug naive psychotic patients

IntroductionSexual dysfunction is one of the bothersome adverse drug effects that is profoundly underestimated and infrequently addressed in practice. Studies have shown that 25–60% of patients with schizophrenia treated with antipsychotics report sexual dysfunction. Some studies reported that atypi

Prevalence and risk factors of metabolic syndrome among drug-naive psychotic patients

Objectives The aim of the study was to determine the prevalence and risk factors of metabolic syndrome among drug-naive psychotic patients. Patients and methods The sample consisted of two groups: group I had 65 drug-naive patients recruited from psychiatric outpatient clinics of Zagazig University Hospitals and group II had 65 participants selected randomly from among Zagazig University Hospital visitors. Patients were subjected to a semistructured psychiatric interview, using the DSM-IV criteria for diagnosis. Severity of symptoms was rated using the Positive and Negative Syndrome Scale. Detection of metabolic syndrome was based on the criteria of the International Diabetes Federation. Results The results of the study show that the prevalence of metabolic syndrome among drug-naive psychotic patients was 12% (eight patients). There was also significant correlation between sex and marital status and all metabolic syndrome criteria, between education and triglycerides level, and between age and waist circumference, blood pressure, triglycerides, and high-density lipoprotein levels. Conclusion The current study concluded that prevalence of metabolic syndrome is higher in drug-naive psychotic patients and psychosis is a risk factor for developing metabolic syndrome among drug-naive psychotic patients.

P.3.f.005 Sexual dysfunction in drug naive psychotic patients treated with antipsychotics

P.3.f.005 Sexual dysfunction in drug naive psychotic patients treated with antipsychotics

Plasma orexin A, ghrelin, cholecystokinin, visfatin, leptin and agouti-related protein levels during 6-week olanzapine treatment in first-episode male patients with psychosis

The objective of the study was to investigate the change of body mass index (BMI), waist circumference, lipid profile, leptin, ghrelin, orexin, visfatin, agouti-related protein, and cholecystokinin levels during 6 weeks of olanzapine treatment in newly diagnosed first-episode drug naive, young adult, nonobese male patients with psychosis. Twenty male participants who were all first-episode drug naive psychotic patients without prominent affective signs and symptoms and 22 healthy male controls of similar age were included. BMI, waist circumference, fasting glucose, and lipid profiles were measured, and Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores were obtained at baseline, during the second and sixth week of treatment, and the aforementioned neuropeptide levels were measured at baseline and during the sixth week of treatment. Treatment was associated with significant increases in BMI, waist circumference, serum triglyceride, and low-density lipoprotein levels. BMI levels increased more than 7% in over 75% of the patients. Leptin increased, and ghrelin and orexin decreased significantly with olanzapine treatment, whereas cholecystokinin, visfatin, and agouti-related protein levels did not change significantly. In conclusion, consistent with previous studies, we found increased BMI, leptin and lipids during olanzapine treatment. Association of neuropeptide level changes with symptom improvement might be mediated by the dopaminergic and serotonergic systems.

S35-02 - Pharmacogenetic studies of treatment response in first-episode psychosis

IntroductionAntipsychotic drugs are limited in their efficacy by the relatively poor response of negative and cognitive symptoms of schizophrenia as well as by the substantial variability in response between patients. Although there is a substantial number of pharmacogenetic studies of antipsychotic drug response, relatively few have studied response in first-episode patients. Still fewer have separated effects on positive and negative symptoms, despite the established differences in response to drug treatment between these syndromes.ObjectivesTo identify genetic polymorphisms contributing to individual variability in the response of different symptoms to antipsychotic drug treatment of first-episode psychosis.MethodsFunctional polymorphisms in several candidate genes implicated in antipsychotic drug mechanisms have been investigated in first-episode psychosis patients and assessed for their association with response of different symptom subgroups.ResultsWe have identified the importance of a common functional polymorphism in the 5-HT1A receptor gene on response of negative and depressive symptoms in initially drug-naive psychotic patients; a longer term (one year) study of first-episode subjects demonstrated an association of the 5-HT transporter gene on negative symptom outcome. Despite the discrepancy between these and other reports, most findings are consistent with the conclusion that dopamine D2 and D3 receptor polymorphisms appear to relate to positive symptom response, while negative symptom improvement relates to polymorphisms of genes influencing 5-HT neurotransmission.ConclusionsIdentifying the genetic factors influencing initial symptom response to antipsychotic drugs may provide both an understanding of the underlying neurotransmitter mechanisms and an indication of the clinical utility of genetic testing.

Effect of Antipsychotics on Peptides Involved in Energy Balance in Drug-Naive Psychotic Patients After 1 Year of Treatment

Weight gain has become one of the most common and concerning side effects of antipsychotic treatment. The mechanisms whereby antipsychotics induce weight gain are not known. It has been suggested that peptides related to food intake and energy balance could play a role in weight gain secondary to antipsychotic therapy. To better understand the pathophysiology of antipsychotic-induced weight gain, we studied the effects of 3 antipsychotic drugs (haloperidol, olanzapine, and risperidone) on peptides involved in energy balance (insulin, ghrelin, leptin, adiponectin, visfatin, and resistin) in a population of drug-naive patients with first episode of psychosis.A significant increase in weight (10.16 kg [SD, 8.30 kg]; P < 0.001), body mass index (3.56 kg/m [SD, 2.89 kg/m]; P < 0.001), and fasting insulin (3.93 muU/mL [SD, 3.93 muU/mL]; P = 0.028), leptin (6.76 ng/mL [SD, 7.21 ng/mL]; P < 0.001), and ghrelin (15.47 fmol/mL [SD, 47.90 fmol/mL]; P = 0.009) plasma levels were observed. The increments in insulin and leptin concentrations were highly correlated with the increment in weight and body mass index and seem to be a consequence of the higher fat stores. The unexpected increase in ghrelin levels might be related with the causal mechanism of weight gain induced by antipsychotics. Finally, the 3 antipsychotics had similar effects in all parameters evaluated.

Effect of 5-HT1AReceptor Gene Polymorphism on Negative and Depressive Symptom Response to Antipsychotic Treatment of Drug-Naive Psychotic Patients

The serotonin 5-HT(1A) receptor may modulate some of the negative, cognitive, and affective symptoms of schizophrenia and is a potential target of action of some antipsychotic drugs. A functional polymorphism in the promoter region of the 5-HT(1A) receptor gene is associated with depression and suicidal behavior. The authors sought to determine whether this polymorphism influences symptom response to antipsychotic drug treatment. Sixty-three drug-naive patients with first-episode psychosis who were genotyped for the -1019C/G polymorphism were recruited for this study and received standard care. The Positive and Negative Syndrome Scale and the Calgary Depression Scale were used to monitor symptom changes over 3 months. The polymorphism was associated with, and accounted for much of the variance in, changes in negative and depressive symptoms but not positive symptoms. These findings identify an important genetic factor predicting much of the response in negative and depressive symptoms to antipsychotic drug treatment.

Neuroleptics in progressive structural brain abnormalities in psychiatric illness

Progressive abnormalities have been reported in schizophrenic patients. We did a prospective, longitudinal study of brain structure. 31 drug-naive psychotic patients underwent computed tomography (CT) at first admission to hospital and after 5 years of illness. We obtained written informed consent from all patients. A radiologist masked to the patients’ identities and diagnoses, date of scans, and the nature of the study compared the first and second CT scans. Brain atrophy was assessed on a visual scale, on which 0–1 meant no changes or dubious atrophy and 2–3 meant moderate or severe atrophic changes. After 5 years of illness, we found significant progression of frontal atrophy in 21 schizophrenic patients, compared with nine consecutively included healthy volunteers. We saw progressive frontal atrophy in ten non-schizophrenic patients, but to a lesser degree. During follow-up, schizophrenic patients recieved a median of 172 040 mg (range 19 540-928 450) neuroleptic medication (chlorpromazine equivalents). Seven nonschizophrenic patients received a median of 20 780 mg (range 678-141 596). The only atypical neuroleptic used was clozapine, administered to three patients, always in high doses and in combination with traditional neuroleptics. Patients were thought to have a chronic, non-remittent course of illness if all psychiatric records described a state of permanent psychosis, and if they were psychotic at the time of the reinvestigation. Some patients were described as remitted, but if in long interviews they showed firm delusive systems that seemed to be integrated but not necessarily overt parts of their lives, and if they were judged to be permanently deluded, despite their records, they were classified as non-remittent. This classification was made without knowledge of the results of the CT scans. Nine schizophrenic patients (eight men and one woman) had been continuously psychotic during follow-up. At reinvestigation, non-remittent patients had significantly higher ratings for psychopathology (SANS and SAPS) than remittent patients. Because of the small sample, we did exact tests in a logistic regression analysis with LogXact, adjusted for sex, course of illness, (remission/non-remission), diagnosis, and neuroleptic load. Course of illness and diagnosis had no significant impact on the development of frontal atrophy. Sex was significant (p=0·035) if course of illness was not included into the model, but sex became non-significant (p=0·138) if course of illness was included. Neuroleptic load was significant whether sex was included or not (p=0·013 and 0·0003, respectively). The estimated risk of atrophy increases by 6·4% for each additional 10 g neuroleptic drug. Non-remittent patients received a higher neuroleptic dose than remittent patients, but the model was corrected for this interaction. Association has been shown between frontal atrophy or aplasia and non-respondence to antipsychotic drugs, and neuroleptic side-effects as tardive dyskinesia and akathisia have been associated with wider sulci. These studies do not include neuroleptic load as a possible explanatory factor for the anormalities found. Traditional neuroleptics have been shown to affect brain structure because they enhance the volume of basal ganglia, but the potential impact of neuroleptics, on frontal cortex, for example, is not known. Factors causing progression of brain atrophy have not yet been identified. Our study showed an unexpected effect of

Differences in the EEG profiles of early and late responders to antipsychotic treatment in first-episode, drug-naive psychotic patients

The aim of this study was to search for differences in the EEG of first-episode, drug-naive patients having a schizophrenic syndrome which presented different time courses in response to antipsychotic treatment. Thirteen patients who fulfilled DSM-IV diagnosis for schizophrenia or schizophreniform disorder participated in this study. Before beginning antipsychotic treatment, the EEG was recorded. On the same day psychopathological ratings were assessed using the AMDP system, and again after 7 and 28 days of treatment. The resting EEG (19 leads) was subject to spectral analysis involving power values for six frequency bands. The score for the schizophrenic syndrome was used to divide the patients into two groups: those who displayed a clinically meaningful improvement of this syndrome (reduction of more than 30%) after 7 days of treatment (early responders, ER) and those who showed this improvement after 28 days (late responders, LR). Analysis of variance for repeated measures between ER, LR and their matched controls with the 19 EEG leads yielded highly significant differences for the factor group in the alpha2 and beta2 frequency band. No difference was found between the slow-wave frequency bands. Compared to controls the LR group showed significantly higher alpha2 and beta2 power and, in comparison to the ER group, significantly higher alpha2 power. There were no significant differences between the ER and the control group. These findings point to differences in brain physiology between ER and LR. The implications for diagnosis and treatment are discussed.

Neuroendocrine responsivity to clomipramine and haloperidol challenge tests in drug naive psychotic patients : E. Angelopoulos, M. Markianos, E. Daskalopoulou, J. Tzemos. Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Vas. Sophias 74, Athens 11528, Greece

Neuroendocrine responsivity to clomipramine and haloperidol challenge tests in drug naive psychotic patients : E. Angelopoulos, M. Markianos, E. Daskalopoulou, J. Tzemos. Athens University Medical School, Psychiatric Clinic, Eginition Hospital, Vas. Sophias 74, Athens 11528, Greece

Drug-naive psychotic patients and risperidone treatment : I. Nimatoudis, A. Iacovides, I. Diakogiannis, Ch. Ierodiakonou. 3rd Department of Psychiatry, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece

Drug-naive psychotic patients and risperidone treatment : I. Nimatoudis, A. Iacovides, I. Diakogiannis, Ch. Ierodiakonou. 3rd Department of Psychiatry, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece

Plasma membrane phospholipid and cholesterol distribution of skin fibroblasts from drug-naive patients at the onset of psychosis

Contents of plasma membrane major phospholipids, cholesterol, and cholesteryl esters of fibroblasts from drug-naive psychotic patients were compared with those from normal controls. Total membrane lipids were extracted and individual lipids were separated on high-performance thin-layer chromatography. The contents of lipid bands were quantitated by densitometric scanning and comparing with standards. Contents of total phospholipids as well as phosphatidylserine, phosphatidylinositol and phosphatidylethanolamine were significantly lower in fibroblasts from patients than in those from normal controls ( P<0.001, <0.005, <0.05, <0.05 respectively). Total cholesterol fraction and cholesteryl esters were also significantly lower in fibroblasts from patient ( P <0.005, <0.001 respectively). These changes were not related to differences in age or sex. These data support the hypothesis that schizophrenia is associated with disordered membrane lipid metabolism, and that this predates the onset of psychosis.