What is the evidence for antipsychotic medication and alternative psychosocial interventions for people with acute, non-affective psychosis?

Jauhar, Sameer; Lawrie, Stephen M.

doi:10.1016/s2215-0366(21)00293-5

Cited by 8 publications

(5 citation statements)

References 61 publications

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“…These cognition findings must be considered within the context of the full risk: benefit profile of withholding or prescribing antipsychotics in the early stages of psychosis treatment, including symptomatology, functioning, physical and metabolic health, brain health outcomes, in addition to patient-driven personal recovery goals [ 55 ]. The STAGES study is one of the few placebo-controlled studies to examine the risks and benefits of antipsychotic treatment in FEP [ 56 ]. We have previously reported that the placebo group had comparable functioning (primary outcome), symptomatology, quality of life, adverse events and physical and metabolic outcomes to the group receiving antipsychotic medication [ 25 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial

Allott¹,

Yuen²,

Baldwin³

et al. 2023

Transl Psychiatry

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The drivers of cognitive change following first-episode psychosis remain poorly understood. Evidence regarding the role of antipsychotic medication is primarily based on naturalistic studies or clinical trials without a placebo arm, making it difficult to disentangle illness from medication effects. A secondary analysis of a randomised, triple-blind, placebo-controlled trial, where antipsychotic-naive patients with first-episode psychotic disorder were allocated to receive risperidone/paliperidone or matched placebo plus intensive psychosocial therapy for 6 months was conducted. A healthy control group was also recruited. A cognitive battery was administered at baseline and 6 months. Intention-to-treat analysis involved 76 patients (antipsychotic medication group: 37; 18.6Mage [2.9] years; 21 women; placebo group: 39; 18.3Mage [2.7]; 22 women); and 42 healthy controls (19.2Mage [3.0] years; 28 women). Cognitive performance predominantly remained stable (working memory, verbal fluency) or improved (attention, processing speed, cognitive control), with no group-by-time interaction evident. However, a significant group-by-time interaction was observed for immediate recall (p = 0.023), verbal learning (p = 0.024) and delayed recall (p = 0.005). The medication group declined whereas the placebo group improved on each measure (immediate recall: p = 0.024; ηp2 = 0.062; verbal learning: p = 0.015; ηp2 = 0.072 both medium effects; delayed recall: p = 0.001; ηp2 = 0.123 large effect). The rate of change for the placebo and healthy control groups was similar. Per protocol analysis (placebo n = 16, medication n = 11) produced similar findings. Risperidone/paliperidone may worsen verbal learning and memory in the early months of psychosis treatment. Replication of this finding and examination of various antipsychotic agents are needed in confirmatory trials. Antipsychotic effects should be considered in longitudinal studies of cognition in psychosis.Trial registration: Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/; ACTRN12607000608460).

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Section: Discussionmentioning

confidence: 99%

Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial

Allott¹,

Yuen²,

Baldwin³

et al. 2023

Transl Psychiatry

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“…For example, a targeted approach, employing antipsychotics when psychotic episodes occur rather than open-ended prophylactic treatment, has been suggested by several commentators as a substitute for ongoing maintenance treatment, although the evidence is mixed (M. Davidson, 2018). Another example is psychological therapies that target concerns that are of high priority to patients, such as insomnia, worry, decision making, or coping with voices (Freeman et al, 2019) or other intensive psychosocial treatments and psychiatric rehabilitation, such as CBT, group programs, or employment support, delivered without or with minimal antipsychotic medication, have been found to be effective for some people with psychosis (Cooper et al, 2020;Francey et al, 2010Francey et al, , 2020Jauhar & Lawrie, 2022).…”

Section: Respect For Autonomymentioning

confidence: 99%

“…Davidson, 2018). Another example is psychological therapies that target concerns that are of high priority to patients, such as insomnia, worry, decision making, or coping with voices (Freeman et al, 2019) or other intensive psychosocial treatments and psychiatric rehabilitation, such as CBT, group programs, or employment support, delivered without or with minimal antipsychotic medication, have been found to be effective for some people with psychosis (Cooper et al, 2020; Francey et al, 2010, 2020; Jauhar & Lawrie, 2022).…”

Section: Respect For Autonomymentioning

confidence: 99%

An ethics analysis of antipsychotic dose reduction and discontinuation: Principles for supporting recovery from psychosis.

Allott,

Pert,

Rattray

et al. 2024

Psychiatric Rehabilitation Journal

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“…These problems have been linked to serious health complications and may make it harder for patients to stay on OLZ therapy. [4][5][6][7] Research done on people with schizophrenia and schizoaffective disorder in the past showed that combining an opioid antagonist and an antipsychotic medicine can help people lose weight. 8 It has been demonstrated that the new opioid system modulator Samidorphan (SAM) acts in vivo as a µ-opioid antagonist.…”

Section: Introductionmentioning

confidence: 99%

A Novel Bioanalytical Method for Simultaneous Determination of Olanzapine and Samidorphan in Human Plasma Using RP-HPLC

Pavani¹,

Narender²,

Prasanth³

et al. 2023

Ind. J. Pharm. Edu. Res.

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Background: Schizophrenia patients are given with a combined medication of Olanzapine (OLA) and Samidorphan (SAM). A sensitive bioanalytical RP-HPLC technique has to be needed to analyse these drugs in biological samples, hence we have been developed a method for simultaneous determination of OLA and SAM in human plasma. Materials and Methods: The separation was conducted on a Zorbax SB-C 18 column (250 mm x 4.6 mm, 5μ) and an isocratic mobile phase of 10 mM ammonium acetate and acetonitrile (60:40% v/v) at 0.8 mL/min. The quetiapine was employed as Internal Standard (IS). Plasma was treated with phosphoric acid, and then extracted using a HLB cartridge. RP-HPLC coupled with a PDA detector was used for measurement. Results: The SAM, OLA, and IS peaks were appeared at 3.894, 9.572, and 2.318 min, respectively. The method has been found to be sensitive up to 2.25 µg/mL for SAM and 1.00 µg/mL for OLA in human plasma matrix. The method was validated for accuracy, precision, recovery, stability and matrix effect. Solid Phase Extraction (SPE) provided clean samples with good and constant mean recovery: 93.32% for SAM, 97.62% for OLA, and 92.78% for IS. The method was linear over 2.25-90 µg/mL and 1-40 µg/mL with R 2 ≥0.99 for both analytes, respectively. Three-month stability investigations were carried out at-20°C, 8°C, and room temperature. Conclusion: The developed method was found to be sensitive, accurate, and repeatable, hence it could be applied for routine analysis of these drugs in biological samples.

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What is the evidence for antipsychotic medication and alternative psychosocial interventions for people with acute, non-affective psychosis?

Cited by 8 publications

References 61 publications

Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial

Effects of risperidone/paliperidone versus placebo on cognitive functioning over the first 6 months of treatment for psychotic disorder: secondary analysis of a triple-blind randomised clinical trial

An ethics analysis of antipsychotic dose reduction and discontinuation: Principles for supporting recovery from psychosis.

A Novel Bioanalytical Method for Simultaneous Determination of Olanzapine and Samidorphan in Human Plasma Using RP-HPLC

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