First-episode psychosis in treatment-resistant schizophrenia: a cross-sectional study of a long-term follow-up cohort

Kanahara, Nobuhisa; Yamanaka, Hiroshi; Suzuki, Tomotaka; Takase, Masayuki; Iyo, Masaomi

doi:10.1186/s12888-018-1853-1

Cited by 9 publications

(8 citation statements)

References 18 publications

(21 reference statements)

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“…This finding is consistent with previous studies that have identified premorbid social functioning as predictive of poor outcomes in schizophrenia and also TRP. 32 Furthermore, lower premorbid IQ (estimated from the National Adult Reading Test) was associated with an increased risk of TRP in multivariate regression analysis (odds ratio 0.98, 95% CI = 0.96–0.99) and was identified by the conditional inference forest model as predictive. These premorbid factors have been implicated in other studies of poor outcomes in schizophrenia 10,33 and warrant further investigation for their role in treatment resistance.…”

Section: Discussionmentioning

confidence: 97%

Clinical indicators of treatment-resistant psychosis

et al. 2019

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BackgroundAround 30% of individuals with schizophrenia remain symptomatic and significantly impaired despite antipsychotic treatment and are considered to be treatment resistant. Clinicians are currently unable to predict which patients are at higher risk of treatment resistance.AimsTo determine whether genetic liability for schizophrenia and/or clinical characteristics measurable at illness onset can prospectively indicate a higher risk of treatment-resistant psychosis (TRP).MethodIn 1070 individuals with schizophrenia or related psychotic disorders, schizophrenia polygenic risk scores (PRS) and large copy number variations (CNVs) were assessed for enrichment in TRP. Regression and machine-learning approaches were used to investigate the association of phenotypes related to demographics, family history, premorbid factors and illness onset with TRP.ResultsYounger age at onset (odds ratio 0.94, P = 7.79 × 10−13) and poor premorbid social adjustment (odds ratio 1.64, P = 2.41 × 10−4) increased risk of TRP in univariate regression analyses. These factors remained associated in multivariate regression analyses, which also found lower premorbid IQ (odds ratio 0.98, P = 7.76 × 10−3), younger father's age at birth (odds ratio 0.97, P = 0.015) and cannabis use (odds ratio 1.60, P = 0.025) increased the risk of TRP. Machine-learning approaches found age at onset to be the most important predictor and also identified premorbid IQ and poor social adjustment as predictors of TRP, mirroring findings from regression analyses. Genetic liability for schizophrenia was not associated with TRP.ConclusionsPeople with an earlier age at onset of psychosis and poor premorbid functioning are more likely to be treatment resistant. The genetic architecture of susceptibility to schizophrenia may be distinct from that of treatment outcomes.

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Section: Discussionmentioning

confidence: 97%

Clinical indicators of treatment-resistant psychosis

et al. 2019

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“…Therefore, the refractory process TRS patients experience during their long-term disease course cannot be explained only by the subtle autistic traits observed in future TRS patients. However, some longitudinal studies suggested that future TRS patients could have a more difficult clinical course after their first episode of psychosis compared to that of non-TRS patients ( Demjaha et al, 2017 ; Kanahara et al, 2018 ; Lally et al, 2016 ). It is uncertain how the subtle autistic traits identified in TRS patients could affect their severe psychotic symptoms as part of the TRS etiology.…”

Section: Discussionmentioning

confidence: 99%

Autistic traits and cognitive profiles of treatment-resistant schizophrenia

Nakata

Kanahara

Kimura

et al. 2020

Schizophrenia Research: Cognition

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The complex pathophysiology of treatment-resistant schizophrenia (TRS) includes severe positive symptoms but also other symptom domains. The overlapping psychological profiles of schizophrenia and autistic spectrum disorder (ASD) are not established. We compared TRS patients (n = 30) with schizophrenia patients in remission (RemSZ, n = 28) and ASD patients (n = 28), focusing on both neurodevelopmental aspects and general and social cognitive impairments. The TRS group performed the worst on general neurocognition (measured by the MATRICS Consensus Cognitive Battery) and social cognition (measured by the theory of mind and emotional expression). The RemSZ group performed the best among the three groups. Regarding autistic traits, all measurements by the Autism-Spectrum Quotient/Autism Screening Questionnaire/Pervasive Developmental Disorder Assessment Rating Scale showed that (1) the ASD patients had the highest autistic traits (2) the TRS patients' scores were less severe than the ASD group's, but (3) the overall trends placed the TRS group between the ASD and the RemSZ group. These findings indicate that TRS patients and remitted patients could have distinctive neurodevelopmental and cognitive profiles. Further, the degrees of social cognitive dysfunction and autistic traits in TRS patients could be close to those of ASD patients, suggesting similarities between TRS and ASD.

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“…A total of 7.4% of the patients were treated with clozapine at 2 years follow‐up. This proportion seems low considering that the rate of resistance to AP treatment among patients with schizophrenia is approximately one‐third of that among patients with FEP (Kanahara et al, 2018), and this resistance is present in a high proportion (84%) of patients from illness onset (Demjaha et al, 2017). Unfortunately, there is still a delay between the diagnosis of resistant psychosis treatment and the starting with clozapine treatment (Doyle et al, 2017; Thien and O'Donoghue, 2019).…”

Section: Discussionmentioning

confidence: 99%

Early intervention services, patterns of prescription and rates of discontinuation of antipsychotic treatment in first‐episode psychosis

Catalán

García

Sánchez-Alonso

et al. 2020

Early Intervention Psych

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Aims Non‐compliance is still an important problem in psychotic patients. Although antipsychotic (AP) treatment leads to a decrease in psychotic relapses, there are no clear recommendations about how long treatment should be maintained after first‐episode psychosis (FEP) and no indication of the rates and causes of treatment withdrawal in this group. Methods We evaluated a large sample of patients with FEP for 2 years to compare the time to all‐cause treatment discontinuation of AP drugs and the time to the first relapse. We collected the sociodemographic and psychopathological characteristics of the sample. The number of relapses was also recorded. Results A total of 310 FEP patients were assessed across seven early intervention teams (mean age = 30.2 years; SD = 11.2). The most prevalent diagnosis at baseline was psychotic disorder not otherwise specified (36.1%), and the most commonly used APs were risperidone (26.5%) and olanzapine (18.7%). A lack of efficacy was the most frequent reason for the withdrawal of the first AP prescribed, followed by non‐compliance. There were no differences in the relapse rates between different APs. Patients treated with long‐acting injectable (LAI) APs presented less disengagement from services than patients treated with oral APs. Conclusions Although there were no differences between the different APs in terms of relapse rates, LAIs had higher retention rates than oral APs in early intervention services. Compliance is still an important issue in Psychiatry, so clinicians should use different strategies to encourage it, such as the use of LAI treatments.

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First-episode psychosis in treatment-resistant schizophrenia: a cross-sectional study of a long-term follow-up cohort

Cited by 9 publications

References 18 publications

Clinical indicators of treatment-resistant psychosis

Clinical indicators of treatment-resistant psychosis

Autistic traits and cognitive profiles of treatment-resistant schizophrenia

Early intervention services, patterns of prescription and rates of discontinuation of antipsychotic treatment in first‐episode psychosis

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