Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment

Cognitive deficits are prominent features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on multiple outcomes.npj Schizophrenia (2017) 3:20 ; doi:10.1038/s41537-017-0021-9 INTRODUCTIONDuring the last two decades there have been a surge of studies into the putative prodromal phase of psychosis commonly termed "the ultra-high risk state for psychosis" (UHR) or "the clinical high risk state". This way of prospectively identifying individuals at heightened risk for psychosis serves as the foundation for intervention studies aimed at avoiding, ameliorating, or delaying progression to psychosis. Furthermore, initiating appropriate treatment as early as possible has the potential of improving both the clinical and functional heterogeneous outcome 1 of UHR individuals. 2 Cognitive deficits are prominent features of the UHR state that have received increased attention in the research field. The most recent meta-analysis on the subject found an overall impairment in neurocognition compared with healthy controls to have an effect size of Hedges' g = −0.34, 95% CI: −0.43 to −0.26, with the greatest impairments found in the domains of visual and verbal memory. 3 Moreover, evidence indicates that neurocognitive functioning can be predictive of transition to psychosis, as poorer neurocognitive functioning in the domains of verbal fluency, verbal and visual memory, an...

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“…74, 75 Studies were included irrespective of whether they included a control group or not. Both RCTs and cohort studies were included.…”

Section: Methodsmentioning

confidence: 99%

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

Glenthøj

Hjorthøj

Kristensen³

et al. 2017

npj Schizophr

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“…Amisulpride was the treatment of choice for late prodromal patients in a randomized German study:66 treatment markedly enhanced the benefits of psychosocial interventions 67. There is one small study of amisulpride in first episode patients which demonstrated that after 6 months the negative symptoms and quality of life of the patients had improved 68…”

Section: Amisulpride In First Episode Schizophreniamentioning

confidence: 99%

Update on the management of symptoms in schizophrenia: focus on amisulpride

Mortimer¹

2009

NDT

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Amisulpride is an atypical antipsychotic drug with a unique receptor pharmacology which is dose dependent. It is a standard treatment in dysthymia as well as in psychosis. Amisulpride is efficacious, effective and well tolerated in positive symptoms of schizophrenia: there is extensive evidence that it treats negative symptoms when given in low doses, although relative lack of EPS and an antidepressant effect may contribute. In first-episode patients amisulpride is an option, although there is little comparative work available. Amisulpride has the best evidence as an effective adjunct to clozapine treatment. Regarding intellectual function, amisulpride appears cognitive sparing but the clinical relevance of this remains obscure. There is evidence that amisulpride can improve social function but again there is little comparative work to demonstrate any particular advantages. Regarding the current conventional versus atypical antipsychotic controversy, amisulpride did better in switching studies and meta-analyses than in the single large pragmatic randomized trial reported to date. It is a versatile drug, and may offer advantages over other atypical antipsychotic drugs in the treatment of negative and depressive symptoms, and tolerability advantages such as the avoidance of weight gain. Essentially it rests with the treating clinician to employ a rational psychopharmacological approach towards the individual patient: there will be few circumstances in which amisulpride will not be a likely contender as a treatment choice.

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“…Research suggests that the basal ganglia may be implicated in this neurological constitutional vulnerability, as UHR individuals show impaired neural development and neurocognitive deficits related to basal ganglia function 8,11 . Additionally, Mittal and colleagues have used observer ratings to show that movement abnormalities, closely linked to basal ganglia function, could successfully classify UHR individuals likely to convert to psychosis 8,12 . Another at risk group, nonclinical psychosis individuals who report having a psychotic-like experience at least once a year, show dyskinesia during a finger force stability task 5,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis

Dean

Teulings

Caligiuri

et al. 2013

JoVE

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Growing evidence suggests that movement abnormalities are a core feature of psychosis. One marker of movement abnormality, dyskinesia, is a result of impaired neuromodulation of dopamine in fronto-striatal pathways. The traditional methods for identifying movement abnormalities include observer-based reports and force stability gauges. The drawbacks of these methods are long training times for raters, experimenter bias, large site differences in instrumental apparatus, and suboptimal reliability. Taking these drawbacks into account has guided the development of better standardized and more efficient procedures to examine movement abnormalities through handwriting analysis software and tablet. Individuals at risk for psychosis showed significantly more dysfluent pen movements (a proximal measure for dyskinesia) in a handwriting task. Handwriting kinematics offers a great advance over previous methods of assessing dyskinesia, which could clearly be beneficial for understanding the etiology of psychosis.

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Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment

Abstract: The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.

Cited by 59 publications

References 27 publications

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

Update on the management of symptoms in schizophrenia: focus on amisulpride

Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis

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Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment

Abstract: The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.

Cited by 59 publications

References 27 publications

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

Update on the management of symptoms in schizophrenia: focus on amisulpride

Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Na&#239;ve Adolescents at High Risk for Psychosis

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Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis