Early treatment resistance in a Latin-American cohort of patients with schizophrenia

Mena, Cristián; González-Valderrama, Alfonso; Iruretagoyena, Bárbara; Undurraga, Juan; Crossley, Nicolás

doi:10.1016/j.schres.2018.02.056

Cited by 13 publications

(9 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent studies have shown that there are 2 distinct types of treatment resistance [21][22][23]: the majority of patients with treatment-resistant schizophrenia present "early resistance" or "treatment resistance from the illness onset" not "late resistance" or "delayed-onset treatment resistance". As only patients who responded to an antipsychotic and achieved positive symptom remission were included in this analysis (i.e., the former population were excluded), the findings shed light on how treatment resistance evolves in schizophrenia.…”

Section: Discussionmentioning

confidence: 99%

Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia

Takeuchi

Siu

Remington

et al. 2018

Neuropsychopharmacol.

128

View full text Add to dashboard Cite

Although some studies have suggested that relapse may be associated with antipsychotic treatment resistance in schizophrenia, the number and quality of studies is limited. The current analysis included patients with a diagnosis of first-episode schizophrenia or schizoaffective disorder who met the following criteria: (1) referral to the First-Episode Psychosis Program between 2003 and (2) treatment with an oral second-generation antipsychotic according to a standardized treatment algorithm; (3) positive symptom remission; (4) subsequent relapse (i.e., second episode) in association with non-adherence; and (5) reintroduction of antipsychotic treatment with the same agent used to achieve response in the first episode. The following outcomes were used as an index of antipsychotic treatment response: changes in the brief psychiatric rating scale (BPRS) total and positive symptom scores and number of patients who achieved positive symptom remission and 20 and 50% response. A total of 130 patients were included in the analyses. Although all patients took the same antipsychotic in both episodes, there were significant episode-by-time interactions for all outcomes of antipsychotic treatment response over 1 year in favor of the first episode compared to the second episode (50% response rate: 48.7 vs. 10.4% at week 7; 88.2 vs. 27.8% at week 27, respectively). Although antipsychotic doses in the second episode were significantly higher than those in the first episode, results remained unchanged after adjusting for antipsychotic dose. The present findings suggest that antipsychotic treatment response is reduced or delayed in the face of relapse following effective treatment of the first episode of schizophrenia.

show abstract

Section: Discussionmentioning

confidence: 99%

Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia

Takeuchi

Siu

Remington

et al. 2018

Neuropsychopharmacol.

128

View full text Add to dashboard Cite

show abstract

“…Latino population with psychosis seem to have a specific higher risk for developing a MS and other cardiovascular complications, compared to other international psychotic populations, which is not shared with the Latino population in the community. Whether this risk comes from a cultural factor related to illness or a genetic predisposition to metabolic adverse effects of obesogenic antipsychotics highly prescribed in this studied population ( (Mena, Gonzalez-Valderrama, Iruretagoyena, Undurraga, & Crossley, 2018), is a question that needs to be addressed. This highlights the need to intervene early in this population with initiatives such as Iphys's HeAL (healthy active lives) statement.…”

Section: Where Do We Stand Compared To Other Countries?mentioning

confidence: 99%

High prevalence of metabolic alterations in Latin American patients at initial stages of psychosis

Iruretagoyena

Castañeda²,

Undurraga

et al. 2019

Early Intervention Psych

Self Cite

View full text Add to dashboard Cite

Aim Studies conducted in the United States have highlighted a higher prevalence of metabolic alterations (MA) in Latino population and Latino psychotic patients. Metabolic risk in psychosis is known to be present from initial stages of the disease. To better characterize this population, we explored the prevalence of MA and metabolic syndrome (MS) in early psychosis patients in a Latin American country. Methods Transversal, observational study comparing the prevalence of MA and MS in patients with early psychosis from an outpatient program in Chile (n = 148) with a community representative sample from the 2009‐2010 National Health Survey (n = 568). ANOVA and regression analysis were performed obtaining odds ratio for MA and MS. Results The prevalence of MS was 44.7% in patients compared to 11.4% in the community sample (odds ratio [OR] 5.28, confidence interval [CI] 95% 3.07‐9.08; P‐value <0.001). There was no effect of gender. Subgroup analyses showed no significant association of MS with clozapine/olanzapine use, treatment duration or tobacco use. There was an association between treatment duration and hypertriglyceridemia (P = 0.024; OR 1.02, CI 95% 1.00‐1.04) and obesity (P = 0.007; OR 5.93, CI 95% 1.82‐20.22). Clozapine/olanzapine use was associated with hyperglycaemia (P = 0.007; OR 6.04, CI 95% 1.63‐22.38) and high low density lipoprotein (P = 0.033 ANOVA; OR 5.28, CI 95% 1.14‐24.37). Conclusion Latino psychotic patients have a high risk of MA and MS at initial stages of the disease which is not entirely explained by the higher risk in the whole Latino population, is irrespective of gender, and does not seem to be entirely a response to atypical antipsychotic use.

show abstract

“…MRI, neuropsychological assessments). To date, we have conducted studies on metabolic syndrome and healthy lifestyle 7 , neuroimaging 8 , treatment resistance 9 , social determinants of mental health 10 , epidemiology 11 , and public policies 6 , among other topics. This case report describes the potential benefits and associated challenges of conducting research in the context of a clinical practice in Latin America that works with vulnerable populations who have difficulties with decisional capacity.…”

Section: Case Studymentioning

confidence: 99%

Consent, decisional capacity and guardianship in mental health research

Undurraga

Negussie²,

Wendler³

2022

Wellcome Open Res

Self Cite

View full text Add to dashboard Cite

Background: Research with adults who cannot give informed consent has important social value. However, enrolling adults who cannot consent in research raises significant ethical concerns. Methods: To evaluate how researchers in low and middle-income countries (LMICs) can assess individuals’ decisional capacity, and the conditions under which it is appropriate to include and the conditions under which it is appropriate to exclude individuals who lack decisional capacity. Results: In LMICs, where resources may be limited, implementing protections for adults with decisional incapacity can be especially challenging. Recognition of the ethical concerns, and awareness of the circumstances and available resources, offers the means to protect these vulnerable participants. Conclusions: Researchers in low and middle-income countries should be aware of steps they can take to ensure appropriate protections for subjects with decisional impairments while conducting clinical trials on methods to improve their clinical care.

show abstract

Early treatment resistance in a Latin-American cohort of patients with schizophrenia

Cited by 13 publications

References 38 publications

Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia

Does relapse contribute to treatment resistance? Antipsychotic response in first- vs. second-episode schizophrenia

High prevalence of metabolic alterations in Latin American patients at initial stages of psychosis

Consent, decisional capacity and guardianship in mental health research

Contact Info

Product

Resources

About