Significant Improvement In Psychopathology Research Articles

Outcomes for young people in out of home care accessing tiered mental health services in Sydney, Australia.

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8-17years accessing mental health services across SWSLHD from January 2020-December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.

Lurasidone Augmentation of Clozapine in Refractory Schizophrenia: A Case Series.

Clozapine represents the criterion standard therapy for patients with treatment-resistant schizophrenia. Unfortunately, a significant percentage of such patients are also partial responders to clozapine. Consequently, several augmentation strategies have been proposed with various and sometimes controversial efficacy. Among these add-on treatments, lurasidone has been recently introduced and could represent a potential option, especially for the additional positive effect on cognitive symptoms. This case series aims to determine possible advantages of lurasidone augmentation in four patients treated with clozapine, who were diagnosed with treatment-resistant schizophrenia. Positive and Negative Syndrome Scales were used to evaluate psychopathology, the Udvalg for Kliniske Undersøgelser scale for tolerability and safety. All patients achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported. Our observation suggests that lurasidone can lead to clinically significant improvements in psychopathology with a good tolerability profile when added to clozapine.

Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.

Avoidant/restrictive food intake disorder (ARFID) is a recently named condition to classify patients who present with restricted nutritional intake without body image distortion or fear of weight gain. We sought to compare treatment outcomes of patients with ARFID in a family-centered partial hospital program (PHP) to those with other eating disorders (ED). A retrospective chart review of 130 patients 7-17 years of age admitted to the program from 2008 to 2012 was performed. Intake and discharge data included: length of stay; percentage median body mass index (%MBMI); and scores on the Children's Eating Attitudes Test (ChEAT) and Revised Children's Manifest Anxiety Scale (RCMAS). Between and within group effects were measured for intake and discharge data. Patients with ARFID spent significantly fewer weeks in program than those with anorexia nervosa (AN) and experienced a similar increase in %MBMI as patients with AN and other specified/unspecified feeding and eating disorders. All patients exhibited significant improvements in psychopathology over the course of treatment as measured by scores on the ChEAT and RCMAS. Our findings suggest that patients with ARFID can be successfully treated in the same PHP as patients with other ED, with comparable improvements in weight and psychopathology over a shorter time period. Results are limited to patients with ARFID who exhibit an acute onset of severe food restriction. Future research should incorporate measures relevant to the diagnosis of ARFID and explore how patients with different ARFID subtypes may respond to various treatments.

Fostering Resilience while Waiting for Psychotherapy: Evaluation of a Group Intervention in an Outpatient Care Setting

Background: High untreated prevalence of mental disorders and long waiting lists for psychotherapy at the same time call for innovative intervention concepts. The positive brief intervention "Personal Model of Resilience" 1 is offered as group training and evaluated for the first time in a naturalistic clinical setting. Method: In a pre-post-design data from 84 wait-list patients are analysed via intention-to-treat (n=84) and completer analysis at 6-week-follow-up (n=54). Results: Repeated measures ANOVAs demonstrate significant improvements in psychopathology, incongruence and self-esteem. Effect sizes range from d=0.30-0.49 at follow-up. Intention-to-treat analyses support these results with significant improvements for all evaluation instruments. Discussion: The "Personal Model of Resilience" is a promising intervention module that may be offered to patients while waiting for psychotherapy.

EPA-0235 – Effectiveness of long-acting injectable antipsychotics (pplai and rlai) in the treatment of delusional disorder with non-prominent hallucinations

Recent meta-analysis in schizophrenia report that patients treated with long-acting injectable antipsychotics (LAI) show a significant improvement in hallucinations. However, little evidence supports their efficacy in non-prominent hallucinations in delusional disorder (DD) patients. To examine treatment effectiveness of LAI antipsychotics (PPLAI and RLAI) with other oral antipsychotics in DD with non-prominent hallucinations. A prospective and observational study was carried out by including 60 consecutive cases of DD outpatients, as part of the DEVCODEL Study. All patients were followed up for at least 6 months. Outcome variables: Scores in PANSS, HRSD-17 items, PSP for functionality, and C-SSRS for suicide. To investigate whether differences between treatment groups were biased by confounding variables, scores in assessment scales at 6 months served as dependent variables, and hallucinatory and treatment groups were included as between-subject factors when analysis of covariance (ANCOVA) was applied. 24(40%) patients had non-prominent hallucinations. Although not statistically significant, when uncorrected for influencing factors, DD patients receiving PPLAI or RLAI (n=27;45.5%) were less frequently treated with antidepressants (32%vs.68%) and showed lower suicidality (44.4%vs.55.6%). Patients treated with PPLAI or RLAI had lower scores in psychotic symptoms and suicidal ideation intensity, and higher functionality. After adjustment, patients with non-prominent hallucinations receiving PPLAI or RLAI showed a tendency of improvement in functionality, lower scores in PANSS positive (p=0.003) and negative (p=0.047) subscales, and suicidal ideation severity (p<0.001) compared to those treated with oral antipsychotics. Non-prominent hallucinatory patients treated with PPLAI or RLAI showed a significant improvement in psychopathology and suicidal ideation.

Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics in Patients Over Age 40

To compare longer-term safety and effectiveness of the 4 most commonly used atypical antipsychotics (aripiprazole, olanzapine, quetiapine, and risperidone) in 332 patients, aged > 40 years, having psychosis associated with schizophrenia, mood disorders, posttraumatic stress disorder, or dementia, diagnosed using DSM-IV-TR criteria. We used equipoise-stratified randomization (a hybrid of complete randomization and clinician's choice methods) that allowed patients or their treating psychiatrists to exclude 1 or 2 of the study atypical antipsychotics due to past experience or anticipated risk. Patients were followed for up to 2 years, with assessments at baseline, 6 weeks, 12 weeks, and every 12 weeks thereafter. Medications were administered employing open-label design and flexible dosages, but with blind raters. The study was conducted from October 2005 to October 2010. Primary metabolic markers (body mass index, blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), percentage of patients who stay on the randomly assigned atypical antipsychotic for at least 6 months, psychopathology, percentage of patients who develop metabolic syndrome, and percentage of patients who develop serious and nonserious adverse events. Because of a high incidence of serious adverse events, quetiapine was discontinued midway through the trial. There were significant differences among patients willing to be randomized to different atypical antipsychotics (P < .01), suggesting that treating clinicians tended to exclude olanzapine and prefer aripiprazole as one of the possible choices in patients with metabolic problems. Yet, the atypical antipsychotic groups did not differ in longitudinal changes in metabolic parameters or on most other outcome measures. Overall results suggested a high discontinuation rate (median duration 26 weeks prior to discontinuation), lack of significant improvement in psychopathology, and high cumulative incidence of metabolic syndrome (36.5% in 1 year) and of serious (23.7%) and nonserious (50.8%) adverse events for all atypical antipsychotics in the study. Employing a study design that closely mimicked clinical practice, we found a lack of effectiveness and a high incidence of side effects with 4 commonly prescribed atypical antipsychotics across diagnostic groups in patients over age 40, with relatively few differences among the drugs. Caution in the use of these drugs is warranted in middle-aged and older patients. ClinicalTrials.gov identifier: NCT00245206.

Yoga Therapy as an Adjunctive Treatment for Schizophrenia: A Randomized, Controlled Pilot Study

There has been limited study of therapeutic yoga as a complementary treatment for schizophrenia. This study investigates the effects of a Yoga Therapy program on symptomatology and quality of life in adults with schizophrenia in a state psychiatric facility. In a randomized, controlled pilot study, 18 clinically stable patients (12 men and 6 women) with schizophrenia (mean age=42±13.5) were randomized to an 8-week Yoga Therapy program (YT) and a Waitlist group (WL). YT intervention included yoga postures, breathing exercises, and relaxation. At baseline and at 8 weeks, symptomatology was measured using the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy outcomes were measured with the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF). The YT group obtained significant improvements in positive and negative symptoms of schizophrenia symptoms compared to WL, including PANSS scores on positive syndrome (t=-2.64, p=0.02), negative syndrome (t=-3.04, p<0.01), general psychopathology (t=-3.74, p<0.00), activation (t=-2.29, p<0.04), paranoia (t=-2.89, p<0.01), and depression subscales (t=-2.62, p<0.02). PANSS total scores also decreased for the YT group (t=-4.54, p<0.00). YT had improved perceived quality of life in physical (t=2.38, p<0.04) and psychologic domains (t=2.88, p<0.01). Adults with schizophrenia being treated in a state psychiatric facility who participated in an 8-week therapeutic yoga program showed significant improvements in psychopathology and quality of life compared with controls. The findings of this study need to be confirmed in larger, more sufficiently powered studies with active control groups.

Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: A case–control study with a 2-year follow-up

Aim: The aim of the present study was to evaluate the effect of assertive community treatment (ACT) in the Tønder Region, South Jutland, where the first Danish ACT team was established to treat patients with severe and persistent mental illness (SMI). Methods: The study compares outcome over a 2-year period between recipients of ACT and standard community mental healthcare. Results: The study included 86 cases and 88 controls. At the time of recruitment, the cases and the controls did not differ significantly in demographic details and eligibility criteria. At the 2-year follow-up, the ACT patients showed a significant reduction in admissions, bed days and day hospital days, and a significant increase in the number of consultations compared with the controls. Adherence to outpatient services was higher in the ACT group. No significant improvements in psychopathology were found after 2 years, but a significant improvement in met needs and fewer unmet needs, indicating better functioning, occurred. Clients’ satisfaction with care (Client Satisfaction Questionnaire, CSQ) was significantly higher among ACT patients than among controls. Conclusion: The treatment of these patients in this ACT service has yielded promising results, suggesting that ACT treatment may be a useful intervention for SMI patients. However, large, rigorous, randomized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies.

ACT Tailored for Ethnocultural Communities of Metropolitan Toronto

ACT Tailored for Ethnocultural Communities of Metropolitan Toronto

Paliperidone for schizophrenia

The efficacy, safety, pharmacology, pharmacokinetics, drug-drug interactions, and administration of paliperidone for schizophrenia are reviewed. Paliperidone is a benzisoxazole derivative and the principal active metabolite of risperidone. Representative of most oxidative metabolites, paliperidone is less lipophilic than risperidone. Like other atypical antipsychotics, paliperidone has a greater affinity for serotonin type 2A- receptor blockade relative to dopamine type 2-receptor blockade. Paliperidone's advanced-generation osmotic release delivery system allows for the avoidance of dosage adjustment when initiating therapy and may decrease the frequency of antido-paminergic effects that would occur with an immediate-release formulation. The pharmacologic actions of paliperidone are similar to other high potency atypical antipsychotics. The receptor-binding profile of paliperidone most closely resembles that of risperidone and ziprasidone. Paliperidone differs from risperidone and most other antipsychotics by its relatively low extent of enzymatic metabolism. A limited number of investigations have demonstrated the ability of paliperidone to produce significant improvements in psychopathology, functioning, and relapse in patients with schizophrenia when compared with placebo. Paliperidone appears to have a similar adverse-effect profile compared to risperidone, except for an increased rate of hyperprolactinemia. The recommended dose of paliperidone for the treatment of adults with schizophrenia is 6 mg every morning. Paliperidone does not offer any clear advantage over other atypical antipsychotics with a similar receptor-binding profile, such as risperidone and ziprasidone. Nevertheless, a few investigations have demonstrated the ability of paliperidone to produce significant improvements in psychopathology, functioning, and relapse when compared with placebo. Based on limited studies, the frequency of adverse effects, except for hyperprolactinemia, appears to favor paliperidone over risperidone.

Positive Childhood Experiences

Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder. Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from personality disorder were determined using survival and proportional hazard regression analyses. Positive achievement experiences and positive interpersonal relationships during childhood or adolescence were significantly associated with remission from avoidant and schizo-typal personality disorders. The greater the number of positive experiences and the broader the developmental period they spanned, the better the prognosis of these personality disorders. The prognosis of certain personality disorders is better in patients whose developmental histories include positive experiences. Early treatment designed to foster personal strengths and competencies and to develop interpersonal skills might benefit young patients diagnosed with personality disorders.

Risperidone augmentation of clozapine

Atypical antipsychotics are frequently used as augmentation agents in clozapine-resistant schizophrenic patients. Risperidone (RIS) is the one most studied as a clozapine (CLZ) adjunct. The aim of this study is to critically review all published studies regarding the efficacy and safety of RIS as an adjunctive agent in CLZ-resistant schizophrenic or schizoaffective patients. A MEDLINE search from January 1988 to June 2005 was conducted. Identified papers were examined against several clinical, pharmacological and methodological parameters. A total of 15 studies were found (2 randomized controlled trials, 3 open-label trials (OTs) and 8 case-studies (CSs)) comprising 86 schizophrenic or schizoaffective patients (mean age 38.4 years). Mean CLZ dosage during the combined treatment was 474.2 mg/day. Plasma CLZ levels were assessed in 62 patients (72.1%). RIS was added at a mean dosage of 4.6 mg/day for a mean of 7.9 weeks. Significant improvement in psychopathology was reported for 37 patients (43%). A lower RIS dosage and a longer duration of the trial seemed to be associated with a better outcome. Main side effects reported were: extrapyramidal symptoms or akathisia (9.3%), sedation (7%) and hypersalivation (5.8%). Existing evidence encourages the use of RIS as an adjunctive agent in CLZ-resistant schizophrenic or schizoaffective patients.

Atypical Antipsychotics in Elderly Patients with Dementia or Schizophrenia: Review of Recent Literature

Atypical antipsychotics have become a common pharmacologic option for the treatment of various psychiatric and behavioral symptoms in older adults, although these medications have been officially approved by the U.S. Food and Drug Administration for use only in schizophrenia and bipolar disorder. Despite the widespread use of these agents, there is a relative shortage of rigorously conducted trials. This review focuses on recently published randomized, blinded, controlled trials involving the use of atypical antipsychotics in elderly patients with dementia (n = 9) or schizophrenia (n = 3), with some discussion of published large, open-label studies and a few unpublished controlled trials. In general, the studies of patients with dementia reported modest efficacy of atypical antipsychotics when compared to placebo and conventional antipsychotics. In addition, an advantage in terms of motor side effects was consistently noted with atypical antipsychotics when compared to conventional antipsychotics. The studies have also shown, however, a greater risk of mortality and adverse cerebrovascular events with several of these agents than with placebo in individuals with dementia. There are insufficient data comparing atypical antipsychotics to one another. In the trials involving elderly persons with schizophrenia, atypical antipsychotics were associated with significant improvements in psychopathology; differences in efficacy among atypical antipsychotics were unclear. A careful consideration of the risk-benefit ratio of atypical antipsychotics, as well as that of available alternative treatments, is needed for each individual elderly patient. Clinical judgment, caution, and consent should be the watchwords in this area of psychopharmacology.

Safety of Clozapine in 2 Successive Pregnancies

Dear Editor: With the introduction of atypical antipsychotics, it was predicted that the incidence of hyperprolactinemia-induced infertility problems would decrease. However, the use of atypical antipsychotics during pregnancy is an area with more questions than answers. We present a case wherein clozapine therapy was continued successfully over 2 consecutive pregnancies. case Report MK, aged 25 years and a housewife of rural background, was premorbidly well adjusted, with a family history of depression. She had an acute-onset 7-year continuous illness precipitated by the death of her father. The illness was characterized by auditory hallucinations (that is, commenting and commanding), tac tile hallucinations, passivity phenomenon, aggression, negative symptoms, and disturbed biofunctions. There was no history suggestive of depression or mania, substance abuse, or head injury. During this period, treatment tolerance or resistance was seen with various antipsychotics (that is, chlorpromazine, haloperidol, trifluperazine, and risperidone). Hence, clozapine was initiated after baseline investigations up to 400 mg daily. With 8 months of treatment, significant improvement in psychopathology and functioning occurred, with associated weight gain of 10 kg. Over the next 3 years, clozapine was gradually reduced to 200 mg daily with no reemergence of positive symptoms but persistence of negative symptoms. MK was married in early 2001 and continued to take clozapine. She was informed about the risk of congenital malformations with antipsychotics and was advised to use contraception. However, she conceived after 6 months of marriage and continued with the pregnancy and with clozapine. Venereal Disease Research Laboratory Slide Test (VDRL), HIV, and hepatitis B surface antigen titers were negative during the first trimester, and there was no evidence of congenital malformations during antenatal ultrasonography on repeat occasions. Hemoglobin was 9.6 gram percent at the 10th week of pregnancy; folic acid and iron supplements were initiated at 10 and 16 weeks, respectively. Pregnancy-induced hypertension (PIH) was detected at the 38th week and was monitored. At the beginning of the 39th week, a 3-kg boy was delivered by episiotomy, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. The postnatal period was uneventful, with normal developmental growth until age 20 months. Eight months after the first delivery, the patient reconceived and continued the pregnancy while on clozapine 100 mg daily. PIH occurred at 30 weeks and was managed with methyldopate hydrochloride 1500 mg daily. At 39 weeks, a 2.8-kg girl in breech presentation was delivered by elective cesarean section. …

Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods

Background: Tardive dyskinesia (TD) is a potentially persistent and disabling abnormal involuntary movement disorder. The aim of this 8-month study was to determine if olanzapine treatment could lead to a significant and persistent reduction in preexisting TD. Methods: Eligible schizophrenia patients met restricted Research Diagnosis criteria of TD requiring, in part, a rating of at least moderate severity (score≥3) in one or more of seven body regions on the Abnormal Involuntary Movement Scale (AIMS). Patients received olanzapine, 5–20 mg/day, for 8 months. During this period, they underwent one to two dose reduction periods under blinded conditions. Concurrent changes in TD, psychopathology, parkinsonism and akathisia were assessed with the AIMS, the Positive and Negative Syndrome Scale (PANSS), and the Simpson-Angus and Barnes Akathisia Scales, respectively. Results: A significant reduction in mean AIMS total score was demonstrated at endpoint ( n=92; p<0.001) as well as at each visit ( p<0.001) and as early as Week 1 on olanzapine. Approximately 70% of patients no longer met the restricted Research Diagnostic criteria for persistent TD (RD-TD) after 8 months of treatment. No statistically significant rebound worsening of TD was found during either blinded drug reduction period. Significant improvement in psychopathology ( p=0.001) and parkinsonism ( p<0.001) was observed. Conclusions: Improvement in the severity of preexisting TD was achieved with olanzapine and persisted throughout the 8-month study and during each dose reduction period. Overall improvement in clinical status suggests that olanzapine may be effective for the long-term management of schizophrenia patients with preexisting TD.