Treatment Of First-episode Schizophrenia Research Articles

S-51. Symposium: Treatment of first episodeschizophrenia

S-51. Symposium: Treatment of first episodeschizophrenia

The neuropsychological basis of competence to consent in first-episode schizophrenia: A pilot metacognitive study

This study was designed to explore the neuropsychological basis of competence to consent to treatment in first-episode schizophrenia by evaluating its differential and joint links with cognitive versus metacognitive performance. Twenty-one first-episode patients were assessed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback) and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "ventured" sort received a bonus of 10 cents if correct but an equal penalty if wrong. Compromised capacity to consent was more strongly related to deficits at the metacognitive level than to cognitive deficits per se. Moreover, prediction of competence to consent significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures but not the other way around. These preliminary results suggest that metacognition plays a fundamental role in capacity to consent, which might be at least equally important for decision-making competence as cognitive deficits per se.

Pharmacogenetics of treatment in first-episode schizophrenia: D3 and 5-HT2C receptor polymorphisms separately associate with positive and negative symptom response

We have been studying the pharmacogenetic correlates of side effects and early response to antipsychotic treatment in a series of Chinese Han first-episode drug-naïve patients with schizophrenia. Here, we report the association of three functional polymorphisms of receptor genes on initial symptom severity and outcome in these patients. We studied the dopamine D3 receptor ser9gly, the dopamine D2 receptor Taq IA and the 5-HT2C receptor promoter −759C/T polymorphisms in 117 patients who had symptoms assessed by Positive and Negative Syndrome Scale (PANSS) on admission and following 10-week antipsychotic treatment, primarily with risperidone or chlorpromazine. The D2 polymorphism was found not to be significantly associated with baseline levels or changes in total PANSS in these patients. The D3 genotype is associated with the change in total PANSS ( p<0.01), an effect reflecting positive and general (each p<0.01) but not negative symptom improvement. However, symptom improvement at 10 weeks strongly correlates with total PANSS score on admission, in which the greater improvement is seen with the more severe initial symptom score. The D3 genotype is also related to severity on admission, i.e. to total baseline PANSS ( p<0.05), including baseline PANSS score as a covariate, the association of the genotype to change over 10 weeks remains significant for total PANSS ( p<0.05) and for positive and general, but not negative, symptom scores. The 5-HT2C promoter polymorphism was also associated with improvement in PANSS ( p<0.05), but reflecting effects on negative and general, but not positive, symptom scores. This polymorphism was not associated with PANSS score on admission, although after controlling for the effect of this parameter on 10-week outcome, a stronger association with change in total PANSS ( p<0.01) was apparent, again reflecting improvements in negative and general symptoms but not changes in positive symptoms.

Prolactin levels in risperidone treatment of first-episode schizophrenia

OBJECTS: To evaluate the risperidone effect on prolactin (PRL) levels and to analyse the relation between PRL change and treatment response in first-episode schizophrenia patients.METHOD: Patients with a first-episode of schizophrenia who were consecutively admitted for hospitalisation participated in a longitudinal follow-up study that included clinical evaluation (PANSS) and PRL assessment. All patients were treated under open conditions with risperidone.RESULTS: Risperidone in an average dose lower than 4 mg significantly improved both positive and negative symptoms. Co-operating responders undergoing maintenance therapy showed a mild trend towards further long-term improvement. At the end of acute treatment the average elevation of PRL levels almost doubled the baseline value. There was a trend among responders to return to their initial values during long-term therapy. Three-quarters of the subjects had hyperprolactinaemia at the end of acute treatment (44 days), and after 1 year about one-quarter had hyperprolactinaemia. No significant correlation between PRL change and PANSS score change was found.CONCLUSION: There is a considerable variation of PRL elevation among subjects. In some patients the development of tolerance of the PRL-elevating effect was observed. Risperidone-induced changes of PRL levels may not be associated with treatment response.

Genetics of symptom severity and response to treatment in first-episode schizophrenia: Association with 5-HT2C, D3 and D2 polymorphisms

Genetics of symptom severity and response to treatment in first-episode schizophrenia: Association with 5-HT2C, D3 and D2 polymorphisms

Pharmacological management of first-episode schizophrenia and related nonaffective psychoses.

Schizophrenia is a severe mental illness characterised by abnormalities of thought and perception that affects 1-2% of the population. Patients who experience a first episode of schizophrenia should be treated early and optimally with antipsychotic agents to lessen the morbidity of the initial episode and possibly improve the course of the illness. Positive psychotic symptoms remit in the majority of patients who are treated with adequate trials of antipsychotic medications, but most relapse within 1 year. Non-adherence is strongly related to the likelihood of recurrence of symptoms. Innovative programmes that integrate early intervention, psychosocial treatments and atypical antipsychotic pharmacotherapy show promise in improving outcomes. The available research supports the use of antipsychotic medications early in the first-episode of schizophrenia and for at least 1 year after remission of positive symptoms. Antidepressants, benzodiazepines and mood stabilisers have roles in the acute and maintenance phases of treatment for some patients. Atypical antipsychotics represent a great advance in the treatment of first-episode schizophrenia with strong evidence for greater tolerability with equal or better therapeutic efficacy. Future research will further define their roles in treatment and hopefully identify targets for prevention of first-episode schizophrenia.

Basal ganglia volumes in first-episode schizophrenia and healthy comparison subjects

Background: Previous studies suggest that dysfunction of cortico-striato-pallido-thalamic (CSPT) circuitry may be involved in the pathophysiology of schizophrenia but also show that basal ganglia structure is highly plastic and may be influenced by antipsychotic treatments. Controversy remains about whether basal ganglia pathology can be detected in vivo among treatment-naı̈ve patients. We conducted a magnetic resonance imaging (MRI) study to examine basal ganglia structures and the limbic forebrain in first episode schizophrenia and healthy comparison subjects. Methods: Fifty-one patients with first-episode schizophrenia and 28 healthy comparison subjects participated in the study. A high-resolution, special contrast (white matter nulling) MRI sequence was used to measure the caudate nucleus, nucleus accumbens, putamen, and subcommissural limbic forebrain. Results: Volumes of the basal ganglia regions of interest (adjusted for total brain volume and age) did not differ significantly between the groups. Age correlated significantly with caudate and putamen volumes bilaterally in the healthy comparison group, but not among patients. Conclusions: The findings suggest that there are no volumetric abnormalities in basal ganglia before treatment in first-episode schizophrenia. The lack of a negative correlation between age and striatal volume among patients may implicate illness-associated factors that alter normal age-related changes in basal ganglia size.

Negative symptom resolution and improvements in specific cognitive deficits after acute treatment in first-episode schizophrenia

Patients with first-episode schizophrenia show significant cognitive impairments even at this early phase of their illness. Antipsychotic medication improves clinical symptomatology, but the effectiveness of this treatment on neuropsychological deficits remains unclear. We investigated clinical symptom and neuropsychological performance change in 34 unmedicated first-episode psychotic patients (17 males, 17 females) from the time prior to treatment until 33.6±11.3 days after treatment initiation at which time patients demonstrated meaningful recovery from psychosis. Twenty-four matched healthy subjects were also studied. Performance in most neuropsychological functions (language skills, attention, nonverbal learning and reasoning, motor speed) remained stable for the group as a whole. However, reduction in negative symptoms was significantly correlated with performance increases in verbal fluency and attention. Higher negative symptom recovery was associated with improvement of cognitive performance to levels approaching those of healthy subjects, whereas low or no negative symptom improvement was associated with stable or decreased cognitive performance. Reduction in positive symptoms was not associated with change in cognitive abilities. These findings suggest a linkage between early, treatment-induced improvements in negative symptoms and reductions in distinct cognitive deficits.

P02.240 Are conventional antipsychotics the only option for the treatment of first episode schizophrenia?

P02.240 Are conventional antipsychotics the only option for the treatment of first episode schizophrenia?

W06.04 Long-term treatment of first episode schizophrenia: New strategies, prodromal symptoms and biological basis of relapse

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Diagnosis, Neurobiology, and Treatment of First-episode Schizophrenia

Early detection, intervention, and treatment infirst-episode schizophrenia is becoming increasingly recognized as offering many patients thepossibility of improvedprognosis and quality of life. However, there are many obstacles to early detection treatment, specificaly, common signs leading to early detection are often misleading resulting in identification problems, and many common prodromal diagnoses suggest otherpotential illnesses. Because afirst-episode schizophrenia diagnosis is difficult, it is imperative that awareness be increased about warning signs among primary care clinicians, families, and school systems. In addition to psychoeducationalprograms, the new atypical antipsychotics offer the best hope to date for improved long-term outcome.

Diagnosis, neurobiology, and treatment of first-episode schizophrenia

Early detection, intervention, and treatment in first-episode schizophrenia is becoming increasingly recognized as offering many patients the possibility of improved prognosis and quality of life. However, there are many obstacles to early detection treatment, specifically, common signs leading to early detection are often misleading, resulting in identification problems, and many common prodromal diagnoses suggest other potential illnesses. Because a first-episode schizophrenia diagnosis is difficult, it is imperative that awareness be increased about warning signs among primary care clinicians, families, and school systems. In addition to psychoeducational programs, the new atypical antipsychotics offer the best hope to date for improved long-term outcome.

P-12-1 - Minimum effective doses of SSRIs

To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects.We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months.Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI (P < .0001), waist circumference (P = 0.0006) and triglycerides (P = 0.03) and decrease in HDL (P = 0.005), while systolic (P = 0.7) and diastolic blood pressure (P = 0.8), LDL (P = 0.1), cholesterol (P = 0.3), and glucose (P = 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides (P = .008). The only significant predictor of BMI increase was non-substance abuse (P = .002).The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.

71. - Atypical antipsychotic medication in the treatment of first episode schizophrenia

71. - Atypical antipsychotic medication in the treatment of first episode schizophrenia