Duration of untreated prodromal symptoms in a Chinese sample at a high risk for psychosis: demographic, clinical, and outcome

Zhang, Tianhong; Xu, Li-Hua; Tang, Yingying; Cui, Huiru; Wei, Yanyan; Wang, Junjie; Tang, Xiaochen; Li, Chunbo; Wang, Jijun

doi:10.1017/s0033291717002707

Cited by 20 publications

(30 citation statements)

References 38 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study also revealed that long periods of DUPrS and CHR state are significant predictors for poorer recovery. Together with our previous findings (Zhang et al, 2018b, 2018d), this evidence highlights the importance of reducing DUPrS to decrease future functional impairment in populations at the premorbid phase of psychosis. However, the major finding from this study adds a new message to remind clinicians that although shortening DUP is important, it is still necessary to pay attention in choosing appropriate, evidence-based treatments, instead of carelessly initiating AP treatment in CHR populations.…”

Section: Discussionsupporting

confidence: 86%

“…For the same reason, we avoided including terms for the interactions among the predictors such as DUP and DUPrS. We evaluated our published papers (Zhang et al, 2014, 2017, 2018b, 2019) on psychosis and poor outcome prediction in CHR samples. As a result, seven predictors were selected including (1) age, (2) drop GAF score (GAF score baseline from highest in the past year), (3) total score of positive symptoms, (4) total score of negative symptoms, (5) DUPrS, (6) CHR_Duration and (7) CHR_AP vs FEP_AP.…”

Section: Timeline Criteria and Outcome Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis?

Zhang

Wei

et al. 2020

Aust N Z J Psychiatry

Self Cite

View full text Add to dashboard Cite

Objective: Antipsychotic drugs are widely used for treating patients with first episode of psychosis, targeting threshold psychotic symptoms. The clinical high risk of psychosis is characterized as subthreshold psychotic symptoms and it is unclear whether they can also benefit from antipsychotic drugs treatment. This study attempted to determine whether initiating antipsychotic drugs treatment in the clinical high risk of psychosis phase was superior to initiating antipsychotic drugs treatment in the first episode of psychosis phase, after the 2-year symptomatic and functional outcomes. Method: Drawing on 517 individuals with clinical high risk of psychosis from the ShangHai At Risk for Psychosis program, we identified 105 patients who converted to first episode of psychosis within the following 2 years. Patients who initiated antipsychotic drugs while at clinical high risk of psychosis (CHR_AP; n = 70) were compared with those who initiated antipsychotic drugs during a first episode of psychosis (FEP_AP; n = 35). Summary scores on positive symptoms and the global function scores at baseline and at 2 months, 1 year and 2 years of follow-up were analyzed to evaluate outcomes. Results: The CHR_AP and FEP_AP groups were not different in the severity of positive symptoms and functioning at baseline. However, the CHR_AP group exhibited significantly more serious negative symptoms and total symptoms than the FEP_AP group. Both groups exhibited a significant reduction in positive symptoms and function ( p < 0.001). Repeated-measures analysis of variance revealed group by time interaction for symptomatic ( F = 3.196, df = 3, p = 0.024) and functional scores ( F = 7.306, df = 3, p < 0.001). The FEP_AP group showed higher remission rates than the CHR_AP group (χ2 = 22.270, p < 0.001). Compared to initiating antipsychotic drug treatments in the clinical high risk of psychosis state, initiating antipsychotic drugs treatments in the first episode of psychosis state predicted remission in a regression model for FEP_AP (odds ratio = 5.567, 95% confidence interval = [1.783, 17.383], p = 0.003). Conclusion: For clinical high risk of psychosis, antipsychotic drugs might be not the first choice in terms of long-term remission, which is more reasonable to use at the first episode of psychosis phase.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Timeline Criteria and Outcome Definitionsmentioning

confidence: 99%

When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis?

Zhang

Wei

et al. 2020

Aust N Z J Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

“…Emerging evidence has highlighted that subthreshold symptoms in CHR-P participants may confer a similar relationship with clinical and functional outcomes as in FEP [ 6 ]. Specifically, studies in CHR-P participants that meet Ultra High-Risk (UHR) criteria have examined the question of whether longer DUR increases the likelihood for transition to psychosis, but findings have been inconclusive [ 7 – 9 ]. In addition, preliminary evidence from clinical samples indicate that poorer global functioning is related to increased DUR [ 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, studies in CHR-P participants that meet Ultra High-Risk (UHR) criteria have examined the question of whether longer DUR increases the likelihood for transition to psychosis, but findings have been inconclusive [ 7 – 9 ]. In addition, preliminary evidence from clinical samples indicate that poorer global functioning is related to increased DUR [ 6 , 9 , 10 ]. Thus, lower functioning has been linked to longer duration of UHR symptoms [ 6 , 9 ] as well as attenuated negative symptoms [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Duration of basic and attenuated-psychotic symptoms in individuals at clinical high risk for psychosis: pattern of symptom onset and effects of duration on functioning and cognition

et al. 2021

View full text Add to dashboard Cite

Introduction Duration of risk symptoms (DUR) in people at clinical high risk for psychosis (CHR-P) has been related to poorer clinical outcomes, such as reduced functioning, but it is currently unclear how different symptoms emerge as well as their link with cognitive deficits. To address these questions, we examined the duration of basic symptoms (BS) and attenuated psychotic symptoms (APS) in a sample of CHR-P participants to test the hypothesis that BS precede the manifestation of APS. As a secondary objective, we investigated the relationship between DUR, functioning and neuropsychological deficits. Methods Data from 134 CHR-P participants were assessed with the Comprehensive Assessment of At-Risk Mental State and the Schizophrenia Proneness Interview, Adult Version. Global, role and social functioning and neurocognition were assessed and compared to a sample of healthy controls (n = 57). Results In CHR-P participants who reported both APS and BS, onset of BS and APS was not significantly related. When divided into short and long BS duration (</> 8 years), CHR-P participants with a longer duration of BS showed evidence for an onset of BS preceding APS (n = 8, p = 0.003). However, in the short BS duration group, APS showed evidence of preceding BS (n = 56, p = 0.020). Finally, there were no significant effects of DUR on cognition or functioning measures. Conclusion The present findings do not support the view that APS constitute a secondary phenomenon to BS. Moreover, our data could also not confirm that DUR has a significant effect on functioning and cognitive deficits. These findings are discussed in the context of current theories regarding emerging psychosis and the importance of DUR.

show abstract

“…4 In our previous reports, we demonstrated that the shorter the untreated period of prodromal symptoms, the better the recovery of general functions was. 5,6 In addition, the plasticity of cognitive function and brain function in pre-morbid phase CHR individuals is better than in postmorbid phase patients with the first episode of psychosis. This indicates that, although early cognitive impairment 7,8 or neurobiological changes 9,10 already exist, they are reversible.…”

Section: Introductionmentioning

confidence: 99%

<p>Real-World Effectiveness and Safety of Antipsychotics in Individuals at Clinical High-Risk for Psychosis: Study Protocol for a Prospective Observational Study (ShangHai at Risk for Psychosis-Phase 2)</p>

Gan

et al. 2019

NDT

Self Cite

View full text Add to dashboard Cite

Background: The clinical high-risk (CHR) state is identified as a critical period for early prevention and intervention during the development of psychosis and early treatment may reduce the risk of conversion to psychosis. However, it remains controversial whether antipsychotics are effective in CHR populations. Limited previous randomised controlled trials of antipsychotic treatment of CHR individuals indicated possible short-term efficacy on psychotic symptoms with unclear long-term effects. To answer this question, it is necessary to establish a high-quality real-world cohort study with large sample size to explore the effectiveness and safety of antipsychotics in CHR individuals. Methods: We plan to consecutively recruit 600 CHR individuals from Shanghai Mental Health Centre in the ongoing SHARP-2 (ShangHai At Risk for Psychosis-Phase 2) project between 2019 and 2022. At baseline, participants will be assessed by the Structured Interview for Prodromal Syndromes, the MATRICS Consensus Cognitive Battery, demographic information, and clinical medication history. They will be followed up in a naturalistic way in which the research team will not prescribe antipsychotics or provide pharmacological consultation. First, CHR participants and their families will be trained to record their medication daily and self-evaluate symptoms through smart-phone applicationbased assessment and report their information weekly. Second, telephone calls will be arranged monthly so that the researchers are informed about the participants' symptoms, medications and daily functions. Third, face-to-face interviews will be conducted annually for repeating assessment of baseline. The primary outcomes will include conversion to psychosis and functional outcome (scored with less than 60 in the Global Assessment of Function) at the end of the follow-up period. Conclusion: The current study will improve our knowledge on the effectiveness and safety of the use of antipsychotics at the prodromal phase, and will eventually facilitate optimisation of individualised interventions for psychosis prevention and treatment.

show abstract

Duration of untreated prodromal symptoms in a Chinese sample at a high risk for psychosis: demographic, clinical, and outcome

Cited by 20 publications

References 38 publications

When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis?

When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis?

Duration of basic and attenuated-psychotic symptoms in individuals at clinical high risk for psychosis: pattern of symptom onset and effects of duration on functioning and cognition

<p>Real-World Effectiveness and Safety of Antipsychotics in Individuals at Clinical High-Risk for Psychosis: Study Protocol for a Prospective Observational Study (ShangHai at Risk for Psychosis-Phase 2)</p>

Contact Info

Product

Resources

About