No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Background. People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. Methods. NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants (N=15) received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges g was used to examine effects over time. Results. 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S g=.44; Heathy Eating Index-2015 g=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable. Conclusion. Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration.

No / Background: Cognitive deficits are a core symptom of schizophrenia, severely debilitating and untreated by current medication. However, to date there is limited research focusing on the precise nature of the cognitive disturbances at first episode in ethnic populations. Improved understanding of this will allow improved approaches to therapy. The aim of this study was to investigate cognitive function with a first episode of psychosis South Asian patients. Methods: Twenty South Asian first episode psychosis patients and 15 healthy South Asian matched controls were recruited. All were second generation South Asian people living in the UK. Subjects who took part in the study completed the Positive and Negative Syndrome Scale (patient group), the Wechsler Test of Adult Reading and a battery of neuropsychological assessments to assess specific domains of cognition of relevance to Measurement and Treatment Research to Improve Cognition in Schizophrenia using the Cambridge Neuropsychological Test Automated Battery (CANTAB) (all groups). Results: Results show that first episode patients performed significantly worse than controls across all cognitive domains tested using CANTAB. Significant impairments were found in tests of visual and spatial memory, executive function, working memory, spatial planning and attention. Importantly, a number of cognitive performance indices (visual memory, spatial memory, executive function) were positively correlated with the severity of negative symptoms. Conclusion: We demonstrate that first episode South Asian patients display significant and specific cognitive deficits with evidence to support an association between negative symptoms and certain cognitive domains at first episode in this patient population.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Contemporary research has confirmed the presence of cognitive deficits as a core feature of schizophrenia that has a definite and adverse impact on functional outcome. Cognitive functioning can be improved by psychopharmacological intervention, with evidence supporting the superiority of second generation antipsychotics over their first generation predecessors. Despite evidence that cognitive impairment contributes to medication non-adherence and that depot antipsychotics are able to enhance treatment compliance whilst decreasing relapse rates, depot preparations remain less frequently prescribed than their oral counterparts, especially in patients with first episode psychosis (FEP). The aims of this study were primarily to investigate cognitive deficits in patients with FEP, and to then describe the response of these impairments to treatment with a very low dose flupenthixol decanoate. This was a prospective, non-randomized, single arm, open-label, longitudinal study of 58 participants with FEP treated according to a fixed protocol over a period of 12 months. There was a wash-out phase of up to seven days during which all psychotropic medications were discontinued. There was an initial treatment period of one week with oral flupenthixol 1mg/day, after which flupenthixol decanoate was initiated at 10mg intramuscular depot injection every fortnight. Dose increases, in cases of poor or inadequate response, were allowed at 6-weekly intervals and in increments of 10mg per injection, up to a maximum of 30mg per fortnight. The principal findings of the study were as follows: The majority of participants were markedly ill, with significant cognitive impairment at baseline. There was a discrepancy between subjectively reported, and objectively measured, cognitive impairment. The majority of the participants responded to, and achieved remission, on a very low dose of flupenthixol decanoate (22.48 ± 0.47mg/month). The majority of symptomatic and cognitive improvement occurred between baseline and three months, with response leveling out at six months. Social cognition did not improve significantly over time, whereas functional outcome and quality of life did improve with treatment. Flupenthixol decanoate was well tolerated and side-effects were of a mild and transient nature. This study reconfirms that the majority of individuals with FEP experience significant cognitive impairment at baseline. It also suggests that these impairments can be successfully treated with a very low dose of flupenthixol decanoate. The use of depot flupenthixol decanoate ensures sustained treatment delivery, thereby decreasing the risk for relapse. This holds the promise of improved long-term functional outcome for those suffering with psychotic illness. / AFRIKAANSE OPSOMMING: Onlangse navorsing het kognitiewe inkorting identifiseer as een van die kern simptoomkomplekse van skisofrenie, met toenemende bewyse vir die duidelike en ongunstige impak hiervan op funksionele uitkoms. Kognitiewe funksionering kan deur psigofarmakologiese ingrepe verbeter word. Onlangse literatuur toon dat die tweede generasie antipsigotika relatief meer effektief is as hulle eerste generasie voorgangers. Ondanks bewyse vir die negatiewe impak van kognitiewe inkorting op behandelingsinskiklikheid, én data wat daarop wys dat die gebruik van langwerkende intramuskulere (depot) antipsigotika inskiklikheid verbeter en periodes van simptoom-terugval voorkom, word dié preparate steeds minder gereeld as hulle orale eweknieë voorgeskryf, veral by pasiënte met 'n eerste episode psigose (FEP). Die doel van hierdie studie was om kognitiewe probleme by pasiënte met FEP te beskryf, en ook om die respons hiervan op behandeling met 'n baie lae dosis flupentiksol dekanoaat, te ondersoek. Die studie was 'n prospektiewe, nie-ewekansige, enkel middel, oop studie van 58 deelnemers met FEP, wat oor „n tydperk van 12 maande volgens 'n spesifieke protokol behandel is. Daar was 'n uitwas periode van 7 dae, waartydens alle psigotrope medikasie gestaak is. Hierna is behandeling met orale flupentiksol 1mg/dag begin vir een week, waarna flupentiksol dekanoaat geinisieer is teen 10mg intramuskulêr elke 2de week. Dosisverhogings, in geval van onvoldoende respons, was toelaatbaar met 6-weeklikse tussenposes, in inkremente van 10mg per inspuiting, tot 'n maksimum van 30mg elke 2de week. Die vernaamste bevindinge van die studie was soos volg: Die meerderheid van die deelnemers was ernstig siek, met beduidende kognitiewe inkorting tydens basislyn evaluasie. Daar was 'n verskil tussen subjektief-gerapporteerde en objektief-meetbare kognitiewe inkorting. Die meerderheid van die deelnemers het goed reageer op behandeling en het ook remissie op 'n baie lae dosis flupentiksol dekanoaat (22.48 ± 0.47mg/maand), bereik. Die meerderheid van simptomatiese en kognitiewe verbetering het plaasgevind binne die eerste 3 maande, met afplatting in die tempo en hoeveelheid van verbetering vanaf 6 maande. Sosiale kognisie het nie beduidend gedurende die studieperiode verbeter nie. Funksionele uitkoms en lewenskwailiteit van deelnemers het ook met behandeling verbeter. Flupentiksol dekanoaat is goed verdra en die newe-effekte, indien dit teenwoordig was, was van ligte graad en verbygaande aard. Hierdie studie herbevestig dat individue met FEP beduidende kognitiewe inkorting by basislyn ervaar, maar dat hierdie inkortings effektief met 'n baie lae dosis van flupentiksol dekanoaat behandel kan word. Die gebruik van depot flupentiksol is 'n suksesvolle manier om volgehoue behandeling te verseker en sodoende die risiko vir terugvalle te verminder. Dit verstewig dus die hoop op beter langtermyn funksionering vir persone met psigotiese siektes.

BACKGROUND: There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS: Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS: Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS: The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

Thesis (PhD)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Prospective, longitudinal clinical studies in first-episode schizophrenia have become relatively commonplace over the past two decades or more and have provided a wealth of useful information regarding the clinical presentation, treatment, course and outcome of the illness. However, there remain several unanswered questions. The majority of the studies have been conducted in upper income countries using often costly medication with heterogeneous samples. While the overall outcome of patients showed some progress, there is room for improvement yet. The overall aim of the dissertation was to study the clinical, biological and functional aspects of outcome in first episode schizophrenia in a resource constrained setting. We conducted a prospective, non-comparative, longitudinal study over 12 months assessing the efficacy and tolerability of a cost effective, long-acting injectable antipsychotic (LAI; flupenthixol decanoate) combined with an assertive monitoring program (AMP) among first-episode schizophrenia patients. Efficacy was measured by examining rates of response, remission and relapse, as well as quality of life and social and occupational functioning. Tolerability of our intervention was assessed by measuring extrapyramidal symptoms, and weight and metabolic changes. We also examined the evolution of treatment refractoriness by studying the rates of non-response, and other associated predictor and outcome features. We found high rates of acceptance and adherence to the LAI and AMP. Seventy percent of our patients completed the 12 months of treatment. Treatment response was achieved by 82% of the participants and 60% achieved remission. Although 19% of our patients relapsed, the majority of the relapses were mild and did not require hospitalisation. Patients experienced significant quality of life and social and occupational functioning improvements. We found mild rates of extrapyramidal effects, present in only a third of our cohort. The majority of the extrapyramidal effects were treated with anticholinergics or propranolol. Only 3% of our patients developed transient dyskinesia over the duration of the study. However, our cohort gained considerable weight, with statistically significant increases in BMI (p< .0001) and waist circumference (p=0.0006). Our cohort also experienced significant deleterious changes to their lipid profiles. Of particular concern was the increase in triglycerides (p=0.03) and a significant decrease in high density lipoprotein (p=0.005) leading to a 91% increase in the triglyceride/high density lipoprotein ratio. With regards to emerging treatment refractoriness, 12% of our patients met our pre-defined criteria for non-response. Non-responders were younger and at baseline showed more prominent disorganised symptoms, poorer social and occupational functioning, poorer quality of life for psychological, social and environmental domains, more prominent neurological soft signs (NSS), and lower BMI. At endpoint the non-responders were characterised by higher levels of symptomatology in all domains; poorer functional outcome, poorer quality of life and greater cognitive impairments. They also had more prominent NSS and a lower BMI. The strongest predictors of non-response were prominent baseline NSS and poor early (7 weeks) treatment response. In conclusion, the combination of an LAI with an AMP may be an effective and safe intervention in firstepisode schizophrenia, and may be particularly suitable for resource-constrained settings. The risk of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics and low-potency first-generation antipsychotics. Ensuring effective treatment for first episode schizophrenia patients is a global problem, and likely to be under-recognised in LMICs. / AFRIKAANSE OPSOMMING: Oor die afgelope twee dekades het toenemend meer longitudinale kliniese studies, wat eerste episode skisofrenie bestudeer, die lig gesien. Die studies het ‘n magdom van waardevolle inligtng oor die kliniese voorkoms, behandeling, verloop en uitkomste van die siekte opgelewer. Die meerderheid van die studies is egter in hoë inkomste ontwikkelde lande gedoen met pasiënte wat duur medikasie gebruik en hoofsaaklik in heterogene steekproewe. Alhoewel dit blyk uit hierdie studies dat daar oor die algemeen vordering gemaak word ten opsigte van die behandeling van pasiënte is daar steeds ‘n gebrek aan voldoende inligting oor die onderwerp veral in minder gegoede, ontwikkelende lande. Die oorhoofse doel van hierdie proefskrif is om binne ‘n hulpbron beperkte konteks die kliniese, biologiese en funksionele aspekte van pasiënt -uitkomste in eerste episode skisofrenie te ondersoek. Ons het ‘n longitudinale studie gedoen waarin ons die effektiwiteit en toleransie van ‘n enkele antipsigotiese medikasie vir 12 maande nagevors het. Die medikasie wat ons ondersoek het, is flupenthixol decanoate en word deur ‘n inspuiting gegee en die medikasie word dan geleidelik deur die liggaam geabsorbeer. As deel van die behandeling het ons pasiënte ook streng gemonitor. Ons het die effektiwiteit van die behandeling gemeet nagelang van hoe pasiënte reageer op die behandeling, hoeveel pasiënte in remissie gaan en terugval, en ook pasiënte se kwaliteit van lewe en hulle sosiale en beroepsfunksionering. Ons het toleransie gemeet nagelang van pasiënte se gewig en metaboliese verandering sowel as die voorkoms van medikasie geïnduseerde newe-effekte. Verder het ons pasiënte wat nie op medikasie gereageer het nie ondersoek sowel as die aspekte wat moontlik hiernee verband hou. Ons het bevind dat die meerderheid van pasiënte hulle medikasie getrou geneem het en ook die streng monitering aanvaar het. Sewentig persent van die pasiënte het hulle 12 maande behandeling voltooi, 82% het op die medikasie gereageer en 60% het in remissie ingegaan. Alhoewel 19% van die pasiënte teruggeval het, was dit nie so ernstig dat ons hulle moes hospitaliseer nie. Pasiënte het beduidende verbetering ten opsigte van hulle kwaliteit van lewe en sosiale en beroepsfunksionering getoon. Ons het slegs ‘n gematigde mate van medikasie geïnduseerde newe-effekte opgemerk en alleenlik by ‘n derde van die kohort. In die meerderheid van gevalle het ons die newe-effekte met anticholinergics of propranolol behandel. Slegs 3% van die pasiënte het gedurende die verloop van 12 maande die kondisie transient dyskinesia ontwikkel. Ongelukkig het ons kohort geweldig baie gewig opgetel en die toename in pasiënte se BMI (p< .0001) en middellyf omtrek (p=0.0006) was statisties beduidend. Ons het ook bevind dat veranderinge in ons kohort se lipied profiele kommerwekkend is veral as in ag geneem word dat die toename in trigliseriede (p = 0,03) en die beduidende afname in die hoë digtheid lipoproteïen (p = 0,005) gelei het tot ‘n 91% verhoging in trigliseriede: hoë digtheid lipoproteïen verhouding.

Psychosis encompasses a constellation of symptoms that have far-reaching social, physical and functional consequences for sufferers. One of the key clinical concerns in the management of psychotic illnesses is the risk of suicide, which is greatest in the early stages of psychosis. Hopelessness is consistently associated with risk for suicide but as a concept it is not well defined and is not specific enough to be of use in prediction of suicide. Future-directed thinking, particularly regarding positive future events, constitutes an aspect of hopelessness that is closely associated with risk for suicide. This study employed the Future Thinking Task to investigate whether future-directed thinking in first episode psychosis is significantly different from that of matched controls in performance or content, and to clarify the nature of its association with suicide risk in this patient group. In addition, the association of future-directed thinking with the negative symptoms of psychosis was investigated. The results showed that individuals with psychosis were impaired in future-directed thinking globally, particularly with respect to the coming year. Specific deficits were shown in the domains of relations with other people and personal development and understanding. Associations were shown between future-directed thinking and suicide, and reduced positive future-directed thinking was shown to be strongly associated with increased severity of negative symptoms. The results suggest avenues for novel interventions to improve hopelessness, suicide risk and the severity of negative symptoms in psychotic illness, and thereby improve functional outcomes.

Cognitive deficit is now considered to be a core feature of schizophrenia, which significantly influences psychosocial functioning in individuals with this illness. The aim of this study is to analyze the cognitive performance during the first year after the first episode of the illness and cognition related to psychosocial functioning. A total of 28 people hospitalized after the first psychotic episode of schizophrenia F20 according to ICD-10 participated in our study and underwent measurements of cognitive functions by the international MCCB battery. They were also evaluated by the PANSS (Scale of positive and negative symptoms) and PSP (range of personal and social performance). After one year from the first measurement for re-examination, 20 patients made an appearance. In 75% of the sample (n = 28), a cognitive deficit below 1.5 standard deviations below the normative average, i.e. below 35 T-score, was detected, at least in one of the measured domains. Speed of processing was the most impaired domain (T < 35), Reasoning and problem solving was the least attenuated domain (T > 40). The resulting analysis (paired t-test) showed a significant improvement one year after first-episode schizophrenia in domains Speed of processing (p = 0,018) and Reasoning and problem solving (p = 0,023). The...

BACKGROUND: Idiopathic psychotic disorders, which include schizophrenia, schizoaffective and bipolar disorder with psychosis, are debilitating disorders affecting about 3% of the world’s population. Neurodevelopmental and neurodegenerative hypotheses have been proposed in psychosis, but the literature is mixed in regards to whether psychosis pathogenesis involves one or both of these processes. Since the visual system matures early in development, studying visual pathway abnormalities stratified by disease onset may further inform our understanding of psychosis pathogenesis. OBJECTIVE: The objective of this thesis is to determine whether disease onset, independent of illness duration, has a differential effect on visual cortical abnormalities in psychosis. We examined visual cortical measures for thickness, surface area, and volume using a pseudo-longitudinal study design of first episode psychosis-schizophrenia (FEP-SZ), FEP-non-schizophrenia (FEP-NSZ), early onset psychosis (EOP, <15 years of age), adult onset psychosis (OP, >15 and <30 years of age), and late onset psychosis (LOP, >30 years of age) groups. Relationships between visual cortical metrics and clinical or functional outcomes were performed. METHODS: The FEP sample (n= 102) included healthy controls (n= 44), FEP-SZ (n= 36), and FEP-NSZ (n= 22). The chronic psychosis data included healthy controls (n= 311) and psychosis probands (n=510). Psychosis probands was stratified by disease onset: EOP (n=213), OP (n=257), and LOP (n=40). Propensity matching was performed to match healthy controls (HC) according to age, sex and race. Linear regression models were performed comparing the means of visual cortical measures between groups. Partial Spearman correlations controlling for confounding factors were performed between visual cortical regions and clinical data. For FEP, clinical outcomes were assessed using Clinical Global Impression scale (CGI), Scale of Positive Symptoms (SAPS), and Scale of Negative Symptoms (SANS). For onset groups, clinical and functional outcomes were assessed using Positive and Negative Syndrome Scale (PANSS), Montgomery–Åsberg Depression Rating Scale (MADRS), Brief Assessment of Cognition (BACS), Wecshler Memory Scale (WMS) spatial span, anti-saccade error rates, dot expectancy pattern test, emotion recognition test, and Birchwood Social Functioning Scale (SFS). Multiple comparisons were performed using the Benjamini-Hochberg procedure. RESULTS: FEP-SZ was associated with smaller V1 and V2 areas, higher MT area and lower MT thickness compared to HCs. Lower MT thickness was associated with worse negative symptoms. Compared to HC, patients with chronic psychosis had lower V1, V2, and MT areas, as well as smaller MT thickness. V1 and V2 area and MT thickness were lower in the EOP group in comparison to matched HC. OP and LOP had a thinner MT region compared to matched HC. Of particular note, it was observed that EOP had greater area differences as compared to thickness reductions in the LOP group. Increased hallucinations and delusions were associated with a thinner MT region in the EOP group. CONCLUSION: When stratified by disease onset, FEP, EOP, OP, and LOP appear to have different pathogenic mechanisms and the severity of visual cortex neuroanatomical abnormalities are dependent on when the disease onset occurs. EOP occurs earlier in neurodevelopment resulting in greater severity in symptom and visual cortical measures as compared to OP. On the contrary, LOP appears to have a neurodegenerative mechanism which is evidenced by accelerated visual cortical thinning. / 2022-06-01T00:00:00Z

Indiana University-Purdue University Indianapolis (IUPUI) / Aim: Early psychosis has been identified as period during which rapid identification and treatment can lead to significant improvement in clinical and functional outcomes. Despite increased research, no studies have examined early psychosis in Veteran populations. It is unknown whether Veterans differ from non-Veterans at this stage of the disorder, and if the treatments offered to non-Veterans are appropriate to implement in Veteran Affairs Medical Centers. Given differences that appear between Veterans and non-Veterans in chronic psychosis, additional work is necessary to determine the best way to approach specialized treatment for Veterans experiencing early psychosis. Methods: The current study is a secondary analysis of assessment batteries collected at a community-based early intervention program and at a local Veteran Affairs Medical Center. Assessment results were compared for Veterans’ and non-Veterans’ background characteristics, symptoms, and neurocognitive deficits. Results: Significant differences were found between the two samples on age of illness onset, marital status, education level, positive symptoms of psychosis, and neurocognitive functioning. Logistic regression analyses identified age of onset as a potential underlying factor. Conclusions: While some aspects of illness presentation appear similar between Veterans and non-Veterans, there are important differences between these populations. Pre-existing treatment interventions, such as Social Skills Training, cognitive remediation approaches and cognitive behavior therapy for psychosis may be appropriate to implement with Veterans. Others– such as family based interventions or supported employment services – may need to be tailored to maximize the benefit for Veterans.