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FC4B PHARMACOTHERAPY STUDIES FOR THE PSYCHOSIS PRODROME
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Schizophrenia Research 86 (2006)
– The involvement of family members or significant others in the intervention, including family communications styles, psychoeducation and relapse prevention work – Functional recovery, as this has been noted to be poor in people with bipolar disorder, and there is evidence that outcome is better if this is addressed early. This paper will address the specific challenges and opportunities for early intervention presented by young people with bipolar disorder. In addition, a psychological intervention designed specifically for work with young people with bipolar disorder will be described, with emphasis on preliminary findings from a trial currently being conducted.
Symposium 21: Efficacy of pharmacological and psychological treatments in early intervention strategies Chair: R.A. Gafoor FC4A 12 WEEK RANDOMISED BLINDED TRIAL OF QUETIAPINE VERSUS RISPERIDONE: RELATIVE ANTIPSYCHOTIC EFFICACIES AND SIDE EFFECTS R.A. Gafoor *, T. Craig, P. Power, R. Kerwin, P. McGuire. Institute of Psychiatry, London, United Kingdom Presenting author contact: [email protected] Introduction: Patients in their first episode are believed to be both more sensitive to both the therapeutic and adverse effects of antipsychotic medication than chronic patients. The main objectives of the study were to examine the response to treatment in terms of both efficacy and side effects in 72 patients meeting ICD-10 criteria for a first episode of schizophreniform psychosis over 12 weeks. Methodology: All patients were treated with low doses of an atypical antipsychotic and were assessed with the PANSS, Clinical Global Impression scale (CGI), Global Assessment of Functioning scale (GAF), Simpson Angus and the ANNSERS (side effects) rating scales. Results: There was no statistically significant difference in response to medication on the PANSS, CGI and GAF scales although patients on risperidone had a higher degree of sexual dysfunction and parkinsonian side effects. Sexual dysfunction was more common in the risperidone treated group (p = 0.024) than in the group treated with quetiapine. There was a trend towards Parkinsonian side effects being more common in the risperidone treated group (p = 0.080) than in the group treated with quetiapine. There were no differences in weight gain between subjects randomized to either medication group. The mean daily dose of quetiapine was 375 mg and for risperidone was 2.72 mg. Discussion: Quetiapine and risperidone were equally efficacious in reducing psychotic symptoms in patients in their first episode of a schizophreniform psychosis. Risperidone was significantly associated with sexual dysfunction and showed a trend towards greater parkinsonian side effects.
Abstracts FC4B PHARMACOTHERAPY STUDIES FOR THE PSYCHOSIS PRODROME S.W. Woods *, Th.H. McGlashan. Yale School of Medicine, New Haven, CT, United States Presenting author contact: [email protected] Introduction: Pharmacologic intervention in the presumed prodromal phase of schizophrenia can be controversial because some of the patients would be prescribed medications based on an identification as prodromal that was in error (false positives). In such an inherently ambiguous practice situation, it is even more important than usual that outcome studies provide evidence relating to risks and benefits associated with intervention so that practice can become evidencebased. This talk will review evidence from available prospective studies of psychotropic medication in prodromal (ultra high risk) patients. Method: Prospective studies were defined as randomized trials or uncontrolled trials that followed a planned, prospective protocol. The published literature was reviewed, as were abstracts from recent relevant society meetings. Results: Only one randomized, placebo-controlled study is available (Woods et al Biological Psychiatry 2003; 54: 453; McGlashan et al American Journal of Psychiatry in press), which compared placebo to olanzapine. Randomized open label data are available for risperidone, from a study where risperidone was coadministered with CBT (McGorry et al Archives of General Psychiatry 2002; 59: 921), and emerging data are available from an open label randomized design for amisulpride. Open label uncontrolled data are available for risperidone and aripiprazole. Results generally are supportive of efficacy in these antipsychotic studies. Open label uncontrolled data are also available for glycine and lithium. Discussion: Although evidence to date is generally supportive of antipsychotic efficacy in prodromal patients, several important caveats must be stressed. Studies in general have featured small samples, and only one is placebo-controlled. Adverse effect reporting should also be emphasized. Larger scale, placebo-controlled studies are critically needed to provide better evidence to inform practice. The possibility should not be overlooked that other medications without antipsychotic properties in chronic patients could be effective in prodromal patients. FC4C FAMILY WORK IN A FIRST EPISODE PROGRAM: OUTCOME AT THREE YEARS J. Addington1 *, D. Addington2 . 1 University of Toronto, Toronto, Canada, 2 University of Calgary, Calgary, Canada Presenting author contact: [email protected] Objectives: At the initial presentation to a first-episode of psychosis program family members were clearly experiencing distress and difficulties. The purpose of the study was to assess the effectiveness of individualized family intervention integrated within a comprehensive treatment program for first episode psychosis. Method: Participants were the family members of individuals who had presented with a first episode of psychosis. Family members were assessed with the Psychological General Well-Being Scale and the Experience of Caregiving Inventory (ECI). These assessments occurred 6, 12, 24 and 36 months after beginning the program. Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use.
Schizophrenia Research 86 (2006)
– The involvement of family members or significant others in the intervention, including family communications styles, psychoeducation and relapse prevention work – Functional recovery, as this has been noted to be poor in people with bipolar disorder, and there is evidence that outcome is better if this is addressed early. This paper will address the specific challenges and opportunities for early intervention presented by young people with bipolar disorder. In addition, a psychological intervention designed specifically for work with young people with bipolar disorder will be described, with emphasis on preliminary findings from a trial currently being conducted.
Symposium 21: Efficacy of pharmacological and psychological treatments in early intervention strategies Chair: R.A. Gafoor FC4A 12 WEEK RANDOMISED BLINDED TRIAL OF QUETIAPINE VERSUS RISPERIDONE: RELATIVE ANTIPSYCHOTIC EFFICACIES AND SIDE EFFECTS R.A. Gafoor *, T. Craig, P. Power, R. Kerwin, P. McGuire. Institute of Psychiatry, London, United Kingdom Presenting author contact: [email protected] Introduction: Patients in their first episode are believed to be both more sensitive to both the therapeutic and adverse effects of antipsychotic medication than chronic patients. The main objectives of the study were to examine the response to treatment in terms of both efficacy and side effects in 72 patients meeting ICD-10 criteria for a first episode of schizophreniform psychosis over 12 weeks. Methodology: All patients were treated with low doses of an atypical antipsychotic and were assessed with the PANSS, Clinical Global Impression scale (CGI), Global Assessment of Functioning scale (GAF), Simpson Angus and the ANNSERS (side effects) rating scales. Results: There was no statistically significant difference in response to medication on the PANSS, CGI and GAF scales although patients on risperidone had a higher degree of sexual dysfunction and parkinsonian side effects. Sexual dysfunction was more common in the risperidone treated group (p = 0.024) than in the group treated with quetiapine. There was a trend towards Parkinsonian side effects being more common in the risperidone treated group (p = 0.080) than in the group treated with quetiapine. There were no differences in weight gain between subjects randomized to either medication group. The mean daily dose of quetiapine was 375 mg and for risperidone was 2.72 mg. Discussion: Quetiapine and risperidone were equally efficacious in reducing psychotic symptoms in patients in their first episode of a schizophreniform psychosis. Risperidone was significantly associated with sexual dysfunction and showed a trend towards greater parkinsonian side effects.
Abstracts FC4B PHARMACOTHERAPY STUDIES FOR THE PSYCHOSIS PRODROME S.W. Woods *, Th.H. McGlashan. Yale School of Medicine, New Haven, CT, United States Presenting author contact: [email protected] Introduction: Pharmacologic intervention in the presumed prodromal phase of schizophrenia can be controversial because some of the patients would be prescribed medications based on an identification as prodromal that was in error (false positives). In such an inherently ambiguous practice situation, it is even more important than usual that outcome studies provide evidence relating to risks and benefits associated with intervention so that practice can become evidencebased. This talk will review evidence from available prospective studies of psychotropic medication in prodromal (ultra high risk) patients. Method: Prospective studies were defined as randomized trials or uncontrolled trials that followed a planned, prospective protocol. The published literature was reviewed, as were abstracts from recent relevant society meetings. Results: Only one randomized, placebo-controlled study is available (Woods et al Biological Psychiatry 2003; 54: 453; McGlashan et al American Journal of Psychiatry in press), which compared placebo to olanzapine. Randomized open label data are available for risperidone, from a study where risperidone was coadministered with CBT (McGorry et al Archives of General Psychiatry 2002; 59: 921), and emerging data are available from an open label randomized design for amisulpride. Open label uncontrolled data are available for risperidone and aripiprazole. Results generally are supportive of efficacy in these antipsychotic studies. Open label uncontrolled data are also available for glycine and lithium. Discussion: Although evidence to date is generally supportive of antipsychotic efficacy in prodromal patients, several important caveats must be stressed. Studies in general have featured small samples, and only one is placebo-controlled. Adverse effect reporting should also be emphasized. Larger scale, placebo-controlled studies are critically needed to provide better evidence to inform practice. The possibility should not be overlooked that other medications without antipsychotic properties in chronic patients could be effective in prodromal patients. FC4C FAMILY WORK IN A FIRST EPISODE PROGRAM: OUTCOME AT THREE YEARS J. Addington1 *, D. Addington2 . 1 University of Toronto, Toronto, Canada, 2 University of Calgary, Calgary, Canada Presenting author contact: [email protected] Objectives: At the initial presentation to a first-episode of psychosis program family members were clearly experiencing distress and difficulties. The purpose of the study was to assess the effectiveness of individualized family intervention integrated within a comprehensive treatment program for first episode psychosis. Method: Participants were the family members of individuals who had presented with a first episode of psychosis. Family members were assessed with the Psychological General Well-Being Scale and the Experience of Caregiving Inventory (ECI). These assessments occurred 6, 12, 24 and 36 months after beginning the program. Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use.