The Basel early‐detection‐of‐psychosis (FEPSY)‐study – design and preliminary results

Abstract

early-detection-of-psychosis (FEPSY)-study -design and preliminary results.Objective: Early detection and therapy of schizophrenic psychoses have become broadly accepted aims in psychiatry, recently even in very early stages of the disorder when clear diagnostic criteria are not yet fulfilled. However, reliable and widely applicable methods do not yet exist. This study aims at contributing to the improvement of the early assessment of psychosis. Method: Individuals potentially at risk are identified by a newly developed stepwise screening procedure. Identified subjects are then examined extensively and followed-up for at least 5 years to detect actual transition to psychosis. Results: Of 50 subjects who have been followed up for 1-5 years by now, 16 have progressed to frank psychosis, 12 of them during the first 12 months of follow-up. Conclusion: At this stage, our approach seems to be promising for the early detection of psychosis. Further results from this ongoing study will hopefully permit us to optimize the assessment procedure.A. Significant outcomes • Early detection of psychosis and of at risk mental states is possible in a stepwise enrichment strategy using a screening procedure. • This approach is feasible for specialised early detection centres with well trained psychiatrists and the capacity to perform broad information and awareness campaigns. • In the usual clinical setting a major aim of early detection remains the early diagnosis of frank psychosis which is obviously still underdiagnosed and the differential diagnosis of these disorders. Limitations• At this stage of the ongoing study, only preliminary data are available.• Sample size is still small, and follow-up is ongoing.• Definite conclusions and recommendations can only be made after completion of the study.

The Effects of Antipsychotics on the Brain: What Have We Learnt from Structural Imaging of Schizophrenia? – A Systematic Review

“…Most neuroimaging studies of schizophrenia to date have not included the examination of non-medicated patients, making conclusions about medication effects on neuroimaging measures difficult. Investigation of subjects at the onset of the disease avoids potential confounders such as antipsychotic treatment [62][63][64][65]. A clinical high-risk status for psychosis (at risk mental state, ARMS) is associated with a set of neurofunctional abnormalities that are qualitatively similar to those observed in patients with the disorder [66].…”

Negative symptoms in neuroleptic-naïve patients with first-episode psychosis correlate with QEEG parameters

“…In a next step, we will therefore investigate this question in individuals in an at-risk mental state for psychosis. In these individuals EEG might contribute to the identification of those, who are in the prodromal phase of schizophrenia with purely negative symptoms (Riecher-Rossler et al, 2007).…”

“…The multi-domain assessment approach used in this study covers psychopathological, neuropsychological, neurophysiological, and neuroimaging investigations. The study design and preliminary results of the study have been described in detail elsewhere (Riecher-Rossler et al, 2007).…”

‘At-risk’ for psychosis research: where are we heading?

“…The lack of research interest in negative symptoms is surprising since these symptoms are described as part of the prodrome Häfner et al 1999) and social isolation/withdrawal has been shown to be a more common presenting symptom in at-risk samples than attenuated positive symptoms (Lencz et al 2004;Iyer et al 2008). Moreover, higher levels of negative symptoms at baseline, such as anhedonia, asociality and withdrawal, have been shown to predict transition to psychotic disorder Mason et al 2004;Riecher-Rössler et al 2007;Velthorst et al 2009;Piskulic et al 2012). The problem here is that, once again, the primary outcome is the development of (arbitrarily defined) psychosis, and negative symptoms are viewed as predictors.…”