Is disorganized schizophrenia a predictor of treatment resistance? Evidence from an observational study

Ortiz, Bruno Bertolucci; Filho, Gerardo Maria de Araújo; Gadelha, Ary; Medeiros, Daiane; Bressan, Rodrigo A.

doi:10.1590/1516-4446-2013-1190

Cited by 16 publications

(7 citation statements)

References 14 publications

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“…Nevertheless, lower mortality rates have been found in CLZ users compared to all other antipsychotics and compared to former CLZ users and to users of other antipsychotics , suggesting long‐term good physical tolerability of CLZ. Another factor possibly explaining our results is that patient characteristics independent of disease stage may partially explain CLZ treatment response: Some research hints that factors such as abundant negative symptoms, a longer duration of untreated psychosis , young age at onset , and disorganized subtype of SCZ might predict TRS early in the disease.…”

Section: Discussionmentioning

confidence: 96%

Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis

Okhuijsen-Pfeifer

Huijsman

Hasan

et al. 2018

Acta Psychiatr Scand

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ObjectiveNo consensus exists on whether clozapine should be prescribed in early stages of psychosis. This systematic review and meta‐analysis therefore focus on the use of clozapine as first‐line or second‐line treatment in non‐treatment‐resistant patients.MethodsArticles were eligible if they investigated clozapine compared to another antipsychotic as a first‐ or second‐line treatment in non‐treatment‐resistant schizophrenia spectrum disorders (SCZ) patients and provided data on treatment response. We performed random‐effects meta‐analyses.ResultsFifteen articles were eligible for the systematic review (N = 314 subjects on clozapine and N = 800 on other antipsychotics). Our meta‐analysis comparing clozapine to a miscellaneous group of antipsychotics revealed a significant benefit of clozapine (Hedges’ g = 0.220, P = 0.026, 95% CI = 0.026–0.414), with no evidence of heterogeneity. In addition, a sensitivity analysis revealed a significant benefit of clozapine over risperidone (Hedges’ g = 0.274, P = 0.030, 95% CI = 0.027–0.521).ConclusionThe few eligible trials on this topic suggest that clozapine may be more effective than other antipsychotics when used as first‐ or second‐line treatment. Only large clinical trials may comprehensively probe disease stage‐dependent superiority of clozapine and investigate overall tolerability.

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Section: Discussionmentioning

confidence: 96%

Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis

Okhuijsen-Pfeifer

Huijsman

Hasan

et al. 2018

Acta Psychiatr Scand

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“…Previous studies investigating risk factors for treatment resistance (TR) have utilized clozapine prescription rates as a proxy measure of TR (Nielsen et al 2012 b ; Stroup et al 2014; Schneider et al 2015); however, given the under-utilization of clozapine in clinical practice, such studies do not measure all people with TR. Although, a few potential risk factors for TR, such as poor premorbid functioning, living in less urban areas, co-morbid personality disorder, longer duration of untreated psychosis (DUP), greater severity of negative symptoms, and a younger age of illness onset have been suggested (Vanelle et al 1994; Meltzer, 1997; Schennach et al 2012; Ortiz et al 2013; Frank et al 2015; Martin & Mowry, 2016; Wimberley et al 2016), the predictive value of specific clinical and demographic factors on TR in first-episode schizophrenia has not yet been widely investigated (Lin et al 2008). Further, while there is a large literature investigating predictors of treatment response and remission from illness onset (Menezes et al 2006; Carbon & Correll, 2014), TR has not been examined longitudinally as an outcome measure in first-episode psychosis (FEP).…”

Section: Introductionmentioning

confidence: 99%

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

et al. 2016

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BackgroundClozapine remains the only evidence-based antipsychotic for treatment-resistant schizophrenia (TRS). The ability to predict which patients with their first onset of schizophrenia would subsequently meet criteria for treatment resistance (TR) could help to diminish the severe functional disability which may ensue if TR is not recognized and correctly treated.MethodThis is a 5-year longitudinal assessment of clinical outcomes in a cohort of 246 first-episode schizophrenia spectrum patients recruited as part of the NIHR Genetics and Psychosis (GAP) study conducted in South London from 2005 to 2010. We examined the relationship between baseline demographic and clinical measures and the emergence of TR. TR status was determined from a review of electronic case records. We assessed for associations with early-, and late-onset TR, and non-TR, and differences between those TR patients treated with clozapine and those who were not.ResultsSeventy per cent (n = 56) of TR patients, and 23% of the total study population (n = 246) were treatment resistant from illness onset. Those who met criteria for TR during the first 5 years of illness were more likely to have an early age of first contact for psychosis (<20 years) [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.25–4.94] compared to those with non-TR. The relationship between an early age of first contact (<20 years) and TR was significant in patients of Black ethnicity (OR 3.71, 95% CI 1.44–9.56); and patients of male gender (OR 3.13 95% CI 1.35–7.23).ConclusionsFor the majority of the TR group, antipsychotic TR is present from illness onset, necessitating increased consideration for the earlier use of clozapine.

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“…A study assessing the relationship between symptom dimensions and functioning also found that disorganized symptoms had the highest effect on functioning and prevented patients from achieving remission (Ortiz et al 2015). Furthermore, in a study assessing treatment response of disorganized schizophrenia inpatients, it was found that these patients were more treatment-resistant in comparison with paranoid schizophrenia inpatients and had more severe PANSS scores (Ortiz et al 2013). Thus, the Arabic MINI-Mod-K and PANSS can capture this important feature in the Arab schizophrenia patients and thus be a reliable measure to diagnose and properly assess this group of patients.…”

Section: Predictors Of Panss Total and Subscales Scoresmentioning

confidence: 99%

Cross-Validation of the Arabic Mini International Neuropsychiatric Interview, Module K, for Diagnosis of Schizophrenia and the Arabic Positive and Negative Syndrome Scale

Chamali

Ghuloum

Sheehan

et al. 2019

J Psychopathol Behav Assess

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The Mini International Neuropsychiatric Interview, version 6, module K (MINI6-Mod-K) is a diagnostic tool to confirm schizophrenia; whereas the Positive and Negative Syndrome Scale in Schizophrenia (PANSS) is a scale to assess psychotic symptoms severity. The objective of this study was to cross-validate the diagnostic questions (categorical) from the Arabic MINI6-Mod-K with the corresponding items' scores (dimensional) from Arabic PANSS. Arab subjects (N = 101) were recruited from the Psychiatry Hospital in Qatar. MINI6-Mod-K was used to confirm schizophrenia diagnosis, and PANSS was administered to assess psychopathology by an independent rater. The most common symptoms according to MINI6-Mod-K were the delusions and hallucinations but the PANSS items scores ≥2.5 captured more positive responses on all the diagnostic features of schizophrenia. The cutoff PANSS scores that significantly distinguished between the presence or absence of schizophrenia features on MINI6-Mod-K were mostly between 2.5 and 3.5. Multivariate linear regression showed that negative symptoms and disorganized/catatonic behaviors independently contributed to the PANSS score on positive symptoms subscale. However, none of the symptom questions in the MINI6-Mod-K were significant predictors of the PANSS negative score. Our results showed that there is very good cross-validation between the diagnostic questions of Arabic MINI6-Mod-K and the corresponding positive cutoff scores in Arabic PANSS.

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Is disorganized schizophrenia a predictor of treatment resistance? Evidence from an observational study

Cited by 16 publications

References 14 publications

Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis

Clozapine as a first‐ or second‐line treatment in schizophrenia: a systematic review and meta‐analysis

Two distinct patterns of treatment resistance: clinical predictors of treatment resistance in first-episode schizophrenia spectrum psychoses

Cross-Validation of the Arabic Mini International Neuropsychiatric Interview, Module K, for Diagnosis of Schizophrenia and the Arabic Positive and Negative Syndrome Scale

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