Acute effects of treatment for prodromal symptoms for people
                        putatively in a late initial prodromal state of psychosis

Ruhrmann, Stephan; Bechdolf, Andreas; Kühn, Kai‐Uwe; Wagner, Michael; Schultze‐Lutter, Frauke; Janssen, Birgit; Maurer, Kurt; Häfner, Heinz; Gäebel, Wolfgang; Möller, Hans‐Jürgen; Maier, Wolfgang; Klosterkötter, Joachim

doi:10.1192/bjp.191.51.s88

Cited by 126 publications

(109 citation statements)

References 31 publications

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“…Extrapyramidal symptoms did not differ between groups. Ruhrmann et al (2007) used a somewhat different approach in their study comparing a supportive needs-focused intervention with and without amisulpride in 124 individuals with putative prodromal symptoms. Rather than evaluating conversion rates, their main outcome criterion was the improvement in various prodromal symptoms including Attenuated Positive Symptoms (APS), Brief Limited Intermittent Psychotic Symptoms (BLIPS), and Basic Symptoms (BS).…”

Section: Pharmacological Interventionsmentioning

confidence: 98%

“…The main side effect of amisulpride was a non-dose-dependent increase in prolactin levels. Ruhrmann et al (2007) make the point that patients with prodromal signs or symptoms should not only be managed to reduce the risk of conversion to psychosis but also to treat their subjective suffering.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…In this context it is important to note that in three of the antipsychotic trials (McGorry et al 2002;Ruhrmann et al 2007;Yung et al 2011) antipsychotics were combined with a psychotherapeutic intervention.…”

Section: Psychosocial Interventionsmentioning

confidence: 99%

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Managing the Prodrome of Schizophrenia

Fleischhacker

Simma

2012

Handbook of Experimental Pharmacology

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It is a well-known fact that managing schizophrenia patients as early as possible has a positive impact on the psychopathological and psychosocial outcomes of the disorder. Identifying people at risk for this serious disorder before its outbreak has become a major research aim in the past decade. Consequently, the intuitive notion that intervening at this early stage, before a diagnosis of schizophrenia is established, could be a preventive measure has been scientifically studied. In this context, a number of interventions, both pharmacological and psychosocial, have been evaluated in prospective controlled clinical trials. Amisulpride, olanzapine, risperidone, omega-3 fatty acids, and antidepressants have been compared to placebo or other control interventions and have been found somewhat helpful. With the exception of omega-3 fatty acids, however, the original positive findings were not maintained in follow-up studies. In addition, the rates of conversion to psychosis, although generally lower in the experimental treatment groups, were also reasonably low in the control groups. Similar findings have been established in psychotherapy trials.All evidence taken together makes it difficult to justify specific interventions at the prodromal stage of schizophrenia from the perspective of preventing or delaying the onset of the disorder. On the other hand, as many of the affected individuals suffer considerably, symptomatic treatment certainly is called for even though the evidence whether it should be pharmacological or psychosocial is not yet available.

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Section: Pharmacological Interventionsmentioning

confidence: 98%

Section: Pharmacological Interventionsmentioning

confidence: 99%

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Managing the Prodrome of Schizophrenia

Fleischhacker

Simma

2012

Handbook of Experimental Pharmacology

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“…Studies have suggested that young people in particular are prone to neuroleptic side effects (Fraguas et al, 2008) whilst long term use carries the possible risk of brain shrinkage (Ziermans et al, 2011). Indeed significant side effects have been noted in several At-Risk Mental State trials thus far, such as weight gain (McGlashan et al, 2006, and increased prolactin levels resulting in high study drop out (Ruhrmann et al, 2007). Although it is relatively easy to highlight the sideeffects and potential negatives of medication use, limited attention has been directed towards the use of psychological therapies that have also been utilised as a form of psychosis prevention.…”

Section: The Risks Of Being Labelled 'At-risk'mentioning

confidence: 99%

‘I’m not insane, my mother had me tested’: the risk and benefits of being labelled ‘at-risk’ for psychosis

Welsh

Brown

2013

Health, Risk & Society

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Brown, S. (2013) I'm not insane, my mother had me tested' : the risk and benets of being labelled 'at-risk' for psychosis. ', Health, risk and society., 15 (8). pp. 648-662. Further information on publisher's website:http://dx.doi.org/10. 1080/13698575.2013.848846 Publisher's copyright statement:Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. These findings indicate that there are indeed personal benefits for screening for psychosis risk in young people, despite the 'undesirability' of identification reported in other areas of health.The benefits observed may reflect genuine differences in adolescent mental health or the methodological constraints of this exploratory study. Nevertheless, the results contribute to the understanding and on-going debate of screening for illness in potential 'at-risk'populations.

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“…The main outcome variable was prevention of conversion into manifest schizophrenia. Four RCTs in people with prodromal symptoms assessing the efficacy of new-generation antipsychotics (NGAs) suggest that the use of NGAs (amisulpride, olanzapine, and risperidone) in UHR individuals may delay the onset of frank psychosis, ameliorate subthreshold psychotic symptoms, and improve functioning [12][13][14][15], although three of the trials failed to demonstrate statistical significance on the main outcome variable. These trials involved a relatively small number of subjects.…”

Section: Early Intervention At the Prodromal Stagementioning

confidence: 99%

Pharmacological Treatment of Schizophrenia:

Fleischhacker

Miyamoto

2016

CNPT

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In the past decade, four main topics have shaped research and clinical practice. 1) In randomized controlled trials, researchers have investigated whether treating prodromal symptoms of schizophrenia helps to reduce the conversion risk to full-blown schizophrenia. Results are ambiguous and the discussion on whether or not an intervention at the stage is justified is ongoing. 2) Following the enhanced understanding of the pathophysiology of schizophrenia, also with respect to specific symptom domains, pharmacological targets beyond D 2 receptor antagonism have been explored. Much work and enthusiasm has revolved around nicotinergic and glutamatergic compounds, so far with mostly discouraging results. 3) Several new-generation antipsychotics have become available as long-acting formulations. All of them have demonstrated a significant positive impact on relapse rates in placebo controlled studies. Whether these compounds also have advantages over first-generation depots and/or oral antipsychotics is still debated. The development of an inhalable antipsychotic has complemented the treatment options for the management of acutely agitated patients. 4) Lastly, attempts from various perspectives, including genetics and neuroimaging, have investigated whether it is possible to predict treatment response and drug safety. Although some look promising, they have not yet reached a stage in which they can be applied to everyday clinical practice. What has become clear, though, is that early non response predicts late non response, leading to the recommendation to switch antipsychotics much earlier than stated in most treatment guidelines.

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Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis

Abstract: Coadministration of amisulpride yielded a marked symptomatic benefit. Effects require confirmation by a placebo-controlled study.

Cited by 126 publications

References 31 publications

Managing the Prodrome of Schizophrenia

Managing the Prodrome of Schizophrenia

‘I’m not insane, my mother had me tested’: the risk and benefits of being labelled ‘at-risk’ for psychosis

Pharmacological Treatment of Schizophrenia:

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