Predictors of clinical remission following a first episode of non-affective psychosis: Sociodemographics, premorbid and clinical variables

Diaz, I. Espiño; Pelayo-Terán, José María; Pérez-Iglesias, Rocí­o; Mata, Ignacio; Tabarés‐Seisdedos, Rafael; Suárez-Pinilla, Paula; Vázquez‐Barquero, José Luís; Crespo‐Facorro, Benedicto

doi:10.1016/j.psychres.2012.10.011

Cited by 36 publications

(26 citation statements)

References 45 publications

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“…Studies in adults also reported that PsyNOS patients had better outcomes than patients with schizophrenia (Kendler and Walsh 1995;Harrison et al 2001;Jobe and Harrow 2005;Crespo-Facorro et al 2007;Simonsen et al 2010;Crespo-Facorro et al 2013;Diaz et al 2013;Pelayo-Teran et al 2014). However, even in adults, such comparative studies are sparse, and generally have the same limitations as studies in the child and adolescent population; either small sample sizes or lack of differentiation among the different diagnostic first-episode psychosis subgroups.…”

Section: Discussionmentioning

confidence: 97%

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Vernal

Kapoor

Al-Jadiri

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Objectives: The purpose of this study was to assess differences in the outcomes of youth with schizophrenia-spectrum disorders (SCZ-S) and psychotic disorder not otherwise specified (PsyNOS) during early antipsychotic treatment. Methods: The study was a prospective, naturalistic, inception cohort study of youth £ 19 years old with SCZ-S (schizophrenia, schizoaffective disorder, schizophreniform disorder) or PsyNOS (PsyNOS, brief psychotic disorder) and £ 24 months of lifetime antipsychotic treatment receiving clinician's choice antipsychotic treatment. Baseline demographic, illness and treatment variables, and effectiveness outcomes were compared at 12 weeks last-observation-carried-forward across SCZ-S and PsyNOS patients, adjusting for significantly different baseline variables. Results: Altogether, 130 youth with SCZ-S (n = 42) or PsyNOS (n = 88), mostly antipsychotic naïve (76.9%), were prescribed risperidone (47.7%), olanzapine (19.2%), aripiprazole (14.6%), quetiapine (11.5%), or ziprasidone (6.9%). Compared with those with PsyNOS, SCZ-S youth were older (16.4 -2.1 vs. 14.8 -3.2, p = 0.0040), and less likely to be Caucasian (19.1% vs. 42.5%, p = 0.009). At baseline, SCZ-S patients had significantly higher Clinical Global Impressions-Severity (CGI-S) scores (6.0 -0.9 vs. 5.5 -0.8, p = 0.0018) and lower Children's Global Assessment Scale (CGAS) scores (29.6 -9.2 vs. 36.1 -8.9, p = 0.0002) and were more likely to be in the severely ill CGAS group (i.e., CGAS £ 40). SCZ-S and PsyNOS patients did not differ regarding all-cause discontinuation (40.5 vs. 40.3%. p = 0.49), discontinuation because of adverse effects (12.2% vs. 12.4%, p = 0.97), or nonadherence (29.3% vs. 30.9%, p = 0.88), but somewhat more SCZ-S patients discontinued treatment for inefficacy (19.5% vs. 7.4%, p = 0.063). CGI-S and CGAS scores improved significantly in both diagnostic groups ( p = 0.0001, each). Adjusting for baseline differences, PsyNOS patients experienced significantly better CGI-I improvement (CGI-I) scores ( p = 0.012) and more frequently reached higher categorical CGAS group status ( p = 0.021) than SCZ-S patients. Conclusions: Both youth with SCZ-S and those with PsyNOS experienced significant improvements with clinician's choice antipsychotic treatment. However, treatment discontinuation was common within 12 weeks, with greater inefficacy-related discontinuation in the SCZ-S group, whereas CGI-I and CGAS score-based improvements were greater in the PsyNOS group.

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Section: Discussionmentioning

confidence: 97%

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Vernal

Kapoor

Al-Jadiri

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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“…Rates of remission vary widely in different studies and most of them do not provide duration criteria [173]. As an example, after a 1-year follow-up, only 31% of the initial subjects enrolled in the PAFIP program achieved remission [174], in particular due to persistence of negative symptoms or to relapse in the last 6 months, which seem to be related to duration of untreated psychosis and premorbid functioning. Remission is closely related to functional recovery, although symptomatic remission rates tend to exceed functional recovery rates [173].…”

Section: Other Keystone Aspects In the Treatment Of First-episode Indmentioning

confidence: 99%

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Crespo‐Facorro

Pelayo-Terán²,

Son³

2016

Neurol Ther

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Implementing the most suitable treatment strategies and making appropriate clinical decisions about individuals with a first episode of psychosis (FEP) is a complex and crucial task, with relevant impact in illness outcome. Treatment approaches in the early stages should go beyond choosing the right antipsychotic drug and should also address tractable factors influencing the risk of relapse. Effectiveness and likely metabolic and endocrine disturbances differ among second-generation antipsychotics (SGAs) and should guide the choice of the first-line treatment. Clinicians should be aware of the high risk of cardiovascular morbidity and mortality in schizophrenia patients, and therefore monitoring weight and metabolic changes across time is mandatory. Behavioral and counseling interventions might be partly effective in reducing weight gain and metabolic disturbances. Ziprasidone and aripiprazole have been described to be least commonly associated with weight gain or metabolic changes. In addition, some of the SGAs (risperidone, amisulpride, and paliperidone) have been associated with a significant increase of plasma prolactin levels. Overall, in cases of FEP, there should be a clear recommendation of using lower doses of the antipsychotic medication. If no or minimal clinical improvement is found after 2 weeks of treatment, such patients may benefit from a change or augmentation of treatment. Clinicians should provide accurate information to patients and relatives about the high risk of relapse if antipsychotics are discontinued, even if patients have been symptom free and functionally recovered on antipsychotic treatment for a lengthy period of time.

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“…Following this study, it is now important to understand factors associated with the outcome. In FES, frequently reported predictors of remission (severity and duration criteria) for maintenance treatment include shorter duration of untreated psychosis (DUP), lower negative symptoms at baseline, enhanced premorbid functioning and early response (AlAqeel & Margolese, 2012;Díaz et al, 2013;Fraguas et al, 2014;Gaebel et al, 2014;Simonsen et al, 2010;Veru, Jordan, Joober, Malla, & Iyer, 2016). Moreover, length of symptomatic remission is a strong predictor of social and occupational functioning in FES, which highlights the importance of promptly achieving and maintaining symptomatic remission (Jordan et al, 2014).…”

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confidence: 99%

Predictors of remission during acute treatment of first‐episode schizophrenia patients involuntarily hospitalized and treated with algorithm‐based pharmacotherapy: Secondary analysis of an observational study

Yoshimura

Sakamoto

Sato

et al. 2017

Early Intervention Psych

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Predictors of clinical remission following a first episode of non-affective psychosis: Sociodemographics, premorbid and clinical variables

Cited by 36 publications

References 45 publications

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Outcome of Youth with Early-Phase Schizophrenia-Spectrum Disorders and Psychosis Not Otherwise Specified Treated with Second-Generation Antipsychotics: 12 Week Results from a Prospective, Naturalistic Cohort Study

Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review

Predictors of remission during acute treatment of first‐episode schizophrenia patients involuntarily hospitalized and treated with algorithm‐based pharmacotherapy: Secondary analysis of an observational study

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