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Antipsychotic Treatment in People at Clinical High Risk for Psychosis A Narrative Review of Suggestions for Clinical Practice
No full textPurpose: The “early intervention” paradigm in psychiatry holds significant
promise for preventing psychosis. Recent evidence showed that individuals at
clinical high risk for psychosis (CHR-P) with antipsychotic (AP) prescription
at baseline have higher psychosis transition rates compared with those without
AP, although the underlying cause remains unclear. In this article, we reviewed
international guidelines on early intervention in CHR-P people, paying specific
attention to clinical recommendations on AP treatment. Then, we comment on
these suggestions in the light of recent empirical evidence examining AP prescription in CHR-P populations within “real-world” clinical settings.
Methods: This search was conducted on PubMed/MEDLINE, PsycINFO,
EMBASE, and Google, looking for both “Guidelines AND CHR-P OR
UHR OR Early Psychosis.”
Results: International guidelines generally recommend not using AP as
first-line treatment, but only when psychosocial interventions have failed.
CHR-P people with AP drug showed high prevalence rates and had more
severe clinical picture at entry. Is this a “warning signal” for potentially
higher psychosis transition risk? Is it a direct AP iatrogenic effect? Is it possible to detect specific CHR-P subgroup that may benefit from AP? These
are the questions that this article seeks to explore.
Conclusions: The current framework for identifying CHR-P subjects has
defined psychometric criteria mainly based on positive symptoms. In our
opinion, this is reductive, especially for evaluating therapeutic outcomes
and prognosis. A more comprehensive assessment considering quality of life,
psychiatric comorbidity, persistent negative symptoms, subjective experience of CHR-P psychopathology, and social/personal recovery is thus needed
Short‐term disengagement from early intervention service for first‐episode psychosis: findings from the “Parma Early Psychosis” program.
Full text linktors
of engagement is crucial to maximize mental healthcare interventions in first-episode psychosis (FEP). No Italian study
on this topic has been reported to date. Thus, the aims of this investigation were: (1) to examine short-term disengagement
rate in an Italian population of FEP patients treated within an EIP service across a 1-year follow-up period, and (b) to assess
the most relevant predictors of disengagement in the first year of treatment.
Methods All participants were young FEP help-seeking patients, aged 12–35 years, enrolled within the “Parma Early Psychosis”
(Pr-EP) protocol. At baseline, they completed the Positive And Negative Syndrome Scale (PANSS), the Health of
the Nation Outcome Scale (HoNOS) and the Global Assessment of Functioning (GAF) scale. Univariate and multivariate
Cox regression analyses were used.
Results 496 FEP individuals were enrolled in this research. Across the follow-up, a 16.5% prevalence of short-term disengagement
was found. Particularly robust predictors of service disengagement were poor baseline treatment non-adherence,
living with parents and the presence of brief psychotic disorder or schizophreniform disorder at entry.
Conclusion About 16% of FEP patients disengaged the Pr-EP program within the first year of treatment. A solution to reduce
disengagement and/or to favor re-engagement of these subjects might be to remain on EIP program caseloads allowing the
option for low-intensity support and monitoring, also via remote technology
Is depressed mood clinically relevant at the onset of schizophrenia? A longitudinal study.
Full text linkAim: Depressed mood (DM) in schizophrenia is often associated with suicide risk and poor outcomes. However, it is generally overlooked in clinical practice, especially in First Episode Schizophrenia (FES). The aims
of this investigation were: (1) to calculate baseline prevalence of FES patients with relevant DM, (2) to longitudinally monitor DM severity levels over a 12-month follow-up, and (3) to investigate their associations with
clinical data and the specific treatment components of an “Early Intervention in Psychosis” (EIP) program.
Material and Methods: The Positive and Negative Syndrome Scale (PANSS) was completed by all FES participant. Individuals with a baseline PANSS “Depression” item subscore of ≥ 5 were classified as having relevant depressed mood (FES/DM+). Chi-square and Mann-Whitney tests were used for inter-group comparisons. A linear regression analysis was also performed.
Results: Fifty-three (33.3%) participants were in the FES/DM+ subgroup. Relevant DM at baseline was associated with female gender and a higher PANSS “Positive Symptoms” score. Across the follow-up, FES individuals improved their DM severity levels. This was significantly related to a longitudinal decrease in PANSS
“Positive Symptoms” levels.
Conclusions: DM is relatively frequent in FES, already at the recruitment in EIP services. However, its severity decreases overtime within specialized EIP programs
Longitudinal evaluation on negative symptoms in young people at Ultra‐High Risk (UHR) of psychosis: results from a 2‐year follow‐up study in a real‐world care setting
No full textNegative Symptoms (NS) severely affect real-world functioning also in young people at UHR for developing psychosis.
However, longitudinal research on beneficial effects of specialized treatments for NS in UHR people is still relatively scarce
and inconclusive, especially in real-world care settings. The aims of the present research were: (1) to evaluate the longitudinal
stability of NS levels in young UHR subjects treated within a specialized “Early Intervention in Psychosis” (EIP) program
across a 2-year follow-up period, and (2) to investigate any relevant association of NS changes with the specific treatment
components offered within the EIP program. One hundred UHR individuals (aged 12–25 years) completed the Positive And
Negative Syndrome Scale (PANSS). A multiple linear regression analysis was conducted to examine significant associations
between longitudinal changes in NS severity levels and the EIP treatment components. Across the follow-up, a significant
decrease in NS clinical severity was observed. This reduction was associated with the intensity of individual psychotherapy
sessions provided in the first year of treatment, a shorter duration of untreated illness at entry and the 2-year longitudinal
decrease in positive symptom levels. In conclusion, NS are relevant in UHR people, but decrease over time together with
the delivery of specialized EIP interventions. Specifically, our results showed that individual psychotherapy may reduce the
clinical severity of NS at least during the first year of treatment
Depressed mood in first episode psychosis: findings from the “Parma-Early Psychosis” program.
No full textObjective
Depressed mood (DM) is relatively frequent in psychosis and significantly associated with
suicidal behavior and poorer prognosis. However, it is often under-recognized and under-
treated, especially at the illness onset. The aims of this research were: (1) to longitudinally
assess DM levels in young subjects with First Episode Psychosis (FEP) over a 2-year
follow-up period, and (2) to explore any relevant association of DM with clinical features and
the specialized intervention components of an Italian “Early Intervention in Psychosis” (EIP)
program, both at baseline and along the follow-up.
Methods
The Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning
(GAF) were completed by 266 FEP individuals (aged 12-53 years). Regression analyses
with DM as the dependent measure and sociodemographic, psychopathological and treatment
characteristics as independent parameters were also performed (both at baseline and
along the follow-up).
Results
Relevant DM (i.e. PANSS “Depression” item subscore of ≥ 5) descreased over time and
showed longitudinally stable associations with PANSS “Negative Symptoms” and “Positive
Symptoms” scores. Along the follow-up, reduction in DM levels was also related to higher
antidepressant dose at entry and lower antipsychotic dose prescribed at the end of our research
(i.e. after 24 months of follow-up).
Conclusions
Relevant DM is experienced in FEP and in the first specialist contact within specialized EIP
programs. However, DM severity levels tends to decrease overtime, together with general
improvements in psychosis psychopathology and with antidepressant prescription at entry
DEPRESSIVE FEATURES IN INDIVIDUALS WITH FIRST EPISODE PSYCHOSIS: PSYCHOPATHOLOGICAL AND TREATMENT CONSIDERATIONS FROM A 2-YEAR FOLLOW-UP STUDY
Full text linkObjective: Comorbid depression is quite common in early psychosis and
specifically related to suicidal behavior and poor long-term outcomes. However,
Depressive Symptoms (DS) are often neglected in both research and treatment,
especially at the psychosis onset. The goals of this investigation were: (a) to
longitudinally explore DS levels in patients with First Episode Psychosis (FEP)
during 24 months of follow-up, and (b) to investigate the associations of DS with
psychopathology and intervention components of an “Early Intervention in Psychosis”
(EIP) program across the follow-up period.
Method: The Global Assessment of Functioning (GAF) and the Positive And
Negative Syndrome Scale (PANSS) were completed by 266 FEP subjects. A linear
regression analysis with DS as the dependent parameter and psychopathological and
treatment characteristics as independent variables was performed (both at baseline and
across the follow-up period).
Results: DS had enduring associations with PANSS “Positive Symptoms” and
“Negative Symptoms” subscores. During the investigation, FEP subjects significantly
improved their DS severity levels. This was related to the number of individual
psychotherapy meetings supplied within the EIP protocol, as well as to a higher
antidepressant dose and a lower antipsychotic dose prescribed during the follow-up.
Conclusions: DS are quite prominent in FEP, even at the recruitment time in EIP
services. Nevertheless, DS severity tends to diminish overtime, especially with the
provision of specialized EIP treatments
Rates and predictors of service disengagement in adolescents with first episode psychosis: results from the 2‐year follow‐up of the Pr‐EP program.
Full text linkService disengagement is a major concern for “Early Intervention in Psychosis” (EIP). Indeed, understanding predictors of engagement is important for the efectiveness of mental health interventions, to improve outcome and quality of life, also in adolescents with frst episode psychosis (FEP). No specifc European investigation on this topic in adolescence has been reported in the literature to date. The aim of this study was to investigate service disengagement rate and predictors in an Italian sample of FEP adolescents treated within an EIP program during a 2-year follow-up period. All participants were adolescents help-seekers (aged 12–18 years) enrolled in the “Parma Early Psychosis” (Pr-EP) program. At baseline, they completed the Positive and Negative Syndrome Scale (PANSS) and the global Assessment of Functioning (GAF) scale. Univariate and multivariate Cox regression analyses were performed. 71 FEP adolescents were recruited in this research. During the 2 years of our follow-up, a 25.4% prevalence rate of service disengagement was found. Particularly robust predictors of disengagement were lower baseline acceptance of psychosocial interventions, substance abuse at entry, and lower baseline PANSS “Disorganization” factor score. Approximately, 1/4 of our FEP adolescents disengaged from the Pr-EP program during the frst 2 years of treatment. A possible solution to decrease disengagement and to favor re-engagement of these young individuals might be to provide the option of low-intensity monitoring and support, also via remote technology
Persistent negative symptoms in young people at clinical high risk of psychosis treated with an Italian early intervention program: a longitudinal study
Full text linkNegative symptoms in CHR-P people are generally not responsive to treatments and commonly related to poorer functional
outcome. However, less research attention has been dedicated to Persistent Negative Symptoms (PNS), defined as clinically
stable negative symptoms of moderate severity evident for at least 6 months. This study aims to (a) determine the prevalence
of PNS in a sample of young people at CHR-P; (b) investigate any association of PNS with functioning and clinical features;
(c) examine longitudinal course of PNS across 2 years of follow-up and changes in PNS severity levels with specialized
treatments. One Hundred Eighty CHR-P participants were recruited and were divided into CHR-P/PNS + and CHR-P/PNS−
subgroups. The clinical assessments were based on the PANSS and the GAF and were conducted at baseline and every
12 months during the follow-up. Twenty four participants showed PNS at entry. Of them, 21 concluded the 2-year followup
period. At baseline, the CHR-P/PNS + participants showed more educational and employment deficits, and more social
and functioning impairment. During the follow-up, the CHR-P/PNS + subgroup had a significant longitudinal decrease in
negative symptoms, which was specifically related to antidepressant treatment. CHR-P/PNS + subjects also showed a higher
incidence of new hospitalization and a lower functional recovery over time. Our findings support that the persistence of
negative symptoms in CHR-P people is longitudinally related to worse daily functioning and more severe clinical conditions
that are at higher risk of hospitalization and are less responsive to specialized treatments
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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