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EARLY RESPONSE TO ANTIPSYCHOTICS AS A MARKER OF TREATMENT RESPONSE OF PSYCHOSIS
180
Abstracts
EARLY RESPONSE TO ANTIPSYCHOTICS AS A MARKER OF TREATMENT RESPONSE OF PSYCHOSIS Jose Maria Pelayo-Teran, Rocio Perez-Iglesias, Ignacio Mata, Teresa Moreno-Calle, Jose Manuel Rodriguez-Sánchez, Maria Luz RamirezBonilla, Jose Luis Vazquez-Barquero, Benedicto Crespo-Facorro CIBERSAM. Psychiatry Research Unit.University Hospital Marques de Valdecilla. Santander, Cantabria, Spain Background: An increasing amount of evidence has grown in detecting early markers as predictor of antipsychotics response. Early markers may be used in usual clinical practice in order to identify those patients who require an early switch to a more effective treatment. Although previous studies have reported models based in non-response rates during the first weeks of treatment, the optimal thresholds and the time point at which early response should be assessed varied considerably. Additionally, most of the samples studied comprised chronic and previously treated patients. We aimed to identify the optimal thresholds of response to antipsychotics in the first four weeks of treatment that best predicts subsequent non-response at six week point in never treated first episode psychosis patients. Methods: Data were obtained from 174 consecutive patients with a first episode of schizophrenia-spectrum disorders admitted to treatment in a multicomponent treatment program in which antipsychotic treatment was randomly assigned to haloperidol, olanzapine or risperidone followed-up weekly during the first four week of treatment and an end point at six week. The non-response criterion was a less than 40% BPRS reduction from baseline. We used 10%, 20% and 30% thresholds in BPRS and in the psychotic, disorganized and negative dimensions of the SANS-SAPS in the first four weeks of follow-up and diagnosis, age of onset, duration of untreated psychosis (DUP) as possible predictors of non-response. Those variables that were initially associated with the response (assessed with a chi square o a student's T analysis) were introduced in a logistic regression analysis (backward: wald method). Receiver-Operator Curves (ROC) were used to predict non-response by the early response in BPRS in the four first weeks in order to establish the best point to assess the early response and the threshold with a best accuracy. Results: The model obtained in the logistic regression was statistically significant (R2:0.479; Chi Square: 68,252; p < 0.001) and classified correctly 80% of the patients. The variables included in the model were the thresholds of 30% in BPRS at week 3 and 4 and the disorganized dimension at week 3 and DUP. ROC curves showed significant Areas Under the Curve (AUC) for the response in BPRS in weeks 1 (AUC:0.655; p = 0.001), 2 (0,740; p < 0.001), 3 (0.802) and 4 (0.840), but only at week 3 it was possible to establish a threshold with adequate sensibility and specificity (Threshold of 31.91% of BPRS at week 3, Sensibility: 0.78, Specificity: 0.76, Youden's Index:0.54) Discussion: Our data suggest that early response can be used as an accurate predictor of subsequent response-non response. However, response at first two weeks seem to have low specificity, being the third week the optimal point for assessing the early response and the improvement of 31.91% in BPRS the most accurate threshold.
doi:10.1016/j.schres.2010.02.219
Oral Presentations ORAL PRESENTATION 4 – PATHWAYS TO PSYCHOSIS AND FACTORS IN CHILDHOOD Chairperson: Celso Arango Tuesday, 13 April, 2010 - 1:30 pm - 3:30 pm VOICE HEARING IN CHILDHOOD: RESULTS OF A 5-YEAR FOLLOW-UP STUDY Agna A. Bartels-Velthuis1, Gerard Van de Willige1, Jack A. Jenner1, Jim Van Os2,3, Durk Wiersma1 1 University Medical Center Groningen Groningen Netherlands; 2 Maastricht University Maastricht Netherlands; 3Institute of Psychiatry London United Kingdom Background: Subclinical psychotic experiences are prevalent in both adults and children. Very often they are not associated with a psychiatric disorder and mostly they will disappear over time. Experiencing traumatic events is considered to contribute to the development of auditory hallucinations. In a 5-year follow-up study of a case-control sample of voice-hearing children (aged 7 and 8 years), we studied the new incidence and (dis)continuity of voice-hearing, the association between voice-hearing and (problem) behaviour, and negative/traumatic life events. Methods: From the baseline (T1) case-control sample (n = 694), 337 children were interviewed (T2). Continuing voice-hearing children were compared with discontinuing children. New voice-hearing children were compared with control children. · Voice-hearing was again assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS; Jenner & Van de Willige, 2002). · Behaviour problems were again assessed with the Child Behaviour Checklist (CBCL; Achenbach, 1991). · Measures of negative/traumatic events were: 1) 25 negative events and the experienced distress, in the past two years; 2) number of negative events and the experienced impact, in three periods of life: at 0-5, 6-11 and 12/13 years of age; 3) six traumatic events, lifetime. Results: In the T2 sample, voice-hearing at T1 was evenly divided: 170 voice-hearers and 167 controls. Twenty-four percent (n = 40) of the voice-hearers at baseline continued hearing voices. The 5-year new incidence was 9% (n = 15). Continuing voice-hearing children · had in 40% of the cases the highest scores on the T1 severity index of voice hearing · had more thought and attention problems at T1 · had more often a lower school level at T2 · showed more rule-braking behaviour at T2. Within the continuation group (18 boys/22 girls), girls compared with boys · were more anxious and suffered more because of the voices at T1 · more often had somatic complaints at T2 Both continuing voice-hearing children and new voice-hearers · were more often religiously-affiliated · had more somatic complaints, were more anxious/depressed and had more thought problems · reported more (distress of) negative life events, a higher impact of negative life events in the periods 0-5, 6-11 and 12/13 years of age, and had experienced more traumatic life events lifetime. Discussion: Thus far we can conclude that · the 5-year incidence rate of 12/13 years old voice-hearing children is 9% · the continuation rate after five years is 24% · there is an association between voice-hearing and somatic complaints, anxiety/depression and thought problems · experiencing negative and traumatic life events is associated with continuity and new incidence of voice-hearing. doi:10.1016/j.schres.2010.02.220
Abstracts
EARLY RESPONSE TO ANTIPSYCHOTICS AS A MARKER OF TREATMENT RESPONSE OF PSYCHOSIS Jose Maria Pelayo-Teran, Rocio Perez-Iglesias, Ignacio Mata, Teresa Moreno-Calle, Jose Manuel Rodriguez-Sánchez, Maria Luz RamirezBonilla, Jose Luis Vazquez-Barquero, Benedicto Crespo-Facorro CIBERSAM. Psychiatry Research Unit.University Hospital Marques de Valdecilla. Santander, Cantabria, Spain Background: An increasing amount of evidence has grown in detecting early markers as predictor of antipsychotics response. Early markers may be used in usual clinical practice in order to identify those patients who require an early switch to a more effective treatment. Although previous studies have reported models based in non-response rates during the first weeks of treatment, the optimal thresholds and the time point at which early response should be assessed varied considerably. Additionally, most of the samples studied comprised chronic and previously treated patients. We aimed to identify the optimal thresholds of response to antipsychotics in the first four weeks of treatment that best predicts subsequent non-response at six week point in never treated first episode psychosis patients. Methods: Data were obtained from 174 consecutive patients with a first episode of schizophrenia-spectrum disorders admitted to treatment in a multicomponent treatment program in which antipsychotic treatment was randomly assigned to haloperidol, olanzapine or risperidone followed-up weekly during the first four week of treatment and an end point at six week. The non-response criterion was a less than 40% BPRS reduction from baseline. We used 10%, 20% and 30% thresholds in BPRS and in the psychotic, disorganized and negative dimensions of the SANS-SAPS in the first four weeks of follow-up and diagnosis, age of onset, duration of untreated psychosis (DUP) as possible predictors of non-response. Those variables that were initially associated with the response (assessed with a chi square o a student's T analysis) were introduced in a logistic regression analysis (backward: wald method). Receiver-Operator Curves (ROC) were used to predict non-response by the early response in BPRS in the four first weeks in order to establish the best point to assess the early response and the threshold with a best accuracy. Results: The model obtained in the logistic regression was statistically significant (R2:0.479; Chi Square: 68,252; p < 0.001) and classified correctly 80% of the patients. The variables included in the model were the thresholds of 30% in BPRS at week 3 and 4 and the disorganized dimension at week 3 and DUP. ROC curves showed significant Areas Under the Curve (AUC) for the response in BPRS in weeks 1 (AUC:0.655; p = 0.001), 2 (0,740; p < 0.001), 3 (0.802) and 4 (0.840), but only at week 3 it was possible to establish a threshold with adequate sensibility and specificity (Threshold of 31.91% of BPRS at week 3, Sensibility: 0.78, Specificity: 0.76, Youden's Index:0.54) Discussion: Our data suggest that early response can be used as an accurate predictor of subsequent response-non response. However, response at first two weeks seem to have low specificity, being the third week the optimal point for assessing the early response and the improvement of 31.91% in BPRS the most accurate threshold.
doi:10.1016/j.schres.2010.02.219
Oral Presentations ORAL PRESENTATION 4 – PATHWAYS TO PSYCHOSIS AND FACTORS IN CHILDHOOD Chairperson: Celso Arango Tuesday, 13 April, 2010 - 1:30 pm - 3:30 pm VOICE HEARING IN CHILDHOOD: RESULTS OF A 5-YEAR FOLLOW-UP STUDY Agna A. Bartels-Velthuis1, Gerard Van de Willige1, Jack A. Jenner1, Jim Van Os2,3, Durk Wiersma1 1 University Medical Center Groningen Groningen Netherlands; 2 Maastricht University Maastricht Netherlands; 3Institute of Psychiatry London United Kingdom Background: Subclinical psychotic experiences are prevalent in both adults and children. Very often they are not associated with a psychiatric disorder and mostly they will disappear over time. Experiencing traumatic events is considered to contribute to the development of auditory hallucinations. In a 5-year follow-up study of a case-control sample of voice-hearing children (aged 7 and 8 years), we studied the new incidence and (dis)continuity of voice-hearing, the association between voice-hearing and (problem) behaviour, and negative/traumatic life events. Methods: From the baseline (T1) case-control sample (n = 694), 337 children were interviewed (T2). Continuing voice-hearing children were compared with discontinuing children. New voice-hearing children were compared with control children. · Voice-hearing was again assessed with the Auditory Vocal Hallucination Rating Scale (AVHRS; Jenner & Van de Willige, 2002). · Behaviour problems were again assessed with the Child Behaviour Checklist (CBCL; Achenbach, 1991). · Measures of negative/traumatic events were: 1) 25 negative events and the experienced distress, in the past two years; 2) number of negative events and the experienced impact, in three periods of life: at 0-5, 6-11 and 12/13 years of age; 3) six traumatic events, lifetime. Results: In the T2 sample, voice-hearing at T1 was evenly divided: 170 voice-hearers and 167 controls. Twenty-four percent (n = 40) of the voice-hearers at baseline continued hearing voices. The 5-year new incidence was 9% (n = 15). Continuing voice-hearing children · had in 40% of the cases the highest scores on the T1 severity index of voice hearing · had more thought and attention problems at T1 · had more often a lower school level at T2 · showed more rule-braking behaviour at T2. Within the continuation group (18 boys/22 girls), girls compared with boys · were more anxious and suffered more because of the voices at T1 · more often had somatic complaints at T2 Both continuing voice-hearing children and new voice-hearers · were more often religiously-affiliated · had more somatic complaints, were more anxious/depressed and had more thought problems · reported more (distress of) negative life events, a higher impact of negative life events in the periods 0-5, 6-11 and 12/13 years of age, and had experienced more traumatic life events lifetime. Discussion: Thus far we can conclude that · the 5-year incidence rate of 12/13 years old voice-hearing children is 9% · the continuation rate after five years is 24% · there is an association between voice-hearing and somatic complaints, anxiety/depression and thought problems · experiencing negative and traumatic life events is associated with continuity and new incidence of voice-hearing. doi:10.1016/j.schres.2010.02.220