Psychopathology and treatment responsiveness of patients with first-episode schizophrenia

Abstract

One hundred and four male patients hospitalized for the first time with the diagnosis of first-episode schizophrenia were comprehensively assessed on admission and discharge. Psychopathology, treatment response, and remission rates were evaluated (based on the Positive and Negative Syndrome Scale (PANSS), severity of symptoms only). On admission, the most frequently observed symptoms were lack of judgment and insight (87.6%), suspiciousness/feelings of persecution (82.3%), delusions (77%), poor attention (70%), disturbance of volition (65.4%), conceptual disorganization (64.7%), and active social avoidance (64%). Except for delusions and hallucinations, the positive items of the PANSS correlated significantly with negative symptoms, and conceptual disorganization correlated with the greatest number of negative symptoms. Individual negative symptoms were present in about half the patients. At discharge, the most frequent symptoms were again lack of judgment and insight (in 55.7%), and for negative symptoms they were blunted affect (22.1%), emotional withdrawal (21.2%), and passive/apathetic social withdrawal (19.5%). The positive symptoms of suspiciousness/feelings of persecution and grandiosity persisted in 20.6% of patients. On average, all symptoms were significantly reduced 44 days after admission. The negative symptoms improved less, compared with the positive ones. At discharge there was a high rate of responders (response defined as minimal 30% reduction of total PANSS): 73% and 74% of patients fulfilled the criteria for remission. On admission, the responders (n = 76) had significantly higher scores of most symptoms, both positive and negative ones than nonresponders (n = 28).

Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

“…Although psychoeducation is broadly used to characterize a range of approaches of educational intervention for patients with schizophrenia, there are several features common to the effective ones, including structural components, philosophical perspectives, and the goals and content of the programs. First, their common structural components are that the programs are designed and led by health professionals; they are mainly medium term, lasting between 9 months and 2 years; they are an integral part of the patient’s treatment plan, along with medication and other psychiatric treatments; they may be delivered to single or multiple participants at the patient’s home or in a clinical setting; and they mainly include both the patient and his/her family members during the intervention sessions 47. Second, the philosophical perspectives of these interventions are common in their emphasis on the present situation and improving the future while avoiding delving into the past and placing blame 48.…”

“…With our current understanding of the molecular, functional, and pathophysiological nature of schizophrenia, new pharmacological and treatment approaches targeting specific stages of pathogenesis and groups of symptoms of the illness may prevent illness progression at different stages and offer the possibility of personalized treatments based on an individual’s characteristics and illness condition 47. When applied to clinical treatment, their ability to overcome the pitfalls of current treatment modalities in improving the cognitive and functional abilities of different groups of patients with schizophrenia and its subtypes should be examined.…”

Treatment effect with paliperidone palmitate compared with oral antipsychotics in patients with recent‐onset versus more chronic schizophrenia and a history of criminal justice system involvement

“…Evidence suggests that treatment response tends to diminish with each successive psychotic episode and that most functional deterioration occurs within 5 years of onset 1, 7. Nevertheless, these patients are particularly vulnerable to incomplete treatment because early in their illness they have poor insight into their illness and their need for continuous, effective treatment 8, 9. As a result, these patients are often nonadherent to medication regimens,10, 11 thus increasing their risk of relapse and rehospitalization 1…”

Treatment Response in First-episode Schizophrenia

“…Generally, first-episode patients feature lower levels of negative symptoms compared to multiple episode patients which has been associated to a more favourable response pattern 8). However, there are also conflicting reports from authors finding higher levels of psychopathology, including negative symptoms, to be associated with response in FES patients 50). In terms of positive symptoms there are several authors finding a higher level of positive symptoms associated with better response 10,46).…”