Not Signed In - Pictures
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baseline and were considered responders Risperidone treatment also significantly reduced HAM D17 scores by week 1 P < 001 and until the end of the 6 month treatment period P < 001 37 Study data were included in an analysis involving patients with different index episodes including manic hypomanic mixed or depressive episodes as well as those with schizoaffective
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PANSS and haloperidol showed a 76 decrease in PANSS When these first episode patients were followed over time there was less relapse with risperidone 42 compared to haloperidol 55 Medication Adherence McEvoy and colleagues7 9 conducted a 1 year trial of the comparative efficacy of olanzapine quetiapine and risperidone in treating first episode schizophrenia
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to develop psychosis but fewer than those in the treatment as usual group There is some indication that risperidone plus psychotherapy might prevent or at least delay onset of psychosis In a study by McGlashan and colleagues 7 >35 of placebo treated patients developed psychosis compared to ~15 of olanzapine treated patients Slide 10 This was significant at a trend
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to develop psychosis but fewer than those in the treatment as usual group There is some indication that risperidone plus psychotherapy might prevent or at least delay onset of psychosis In a study by McGlashan and colleagues 7 >35 of placebo treated patients developed psychosis compared to ~15 of olanzapine treated patients Slide 10 This was significant at a trend
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also have fewer dendritic spines than control subjects The prevailing hypothesis is that this results from the chemical neurotoxicity that occurs during fulminating and psychotic episodes Role of Apoptosis While it seems that the neuropathology of schizophrenia results in the loss of synapses and cell processes rather than a massive loss in cell numbers certain
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Discussion Published switch studies of risperidone to olanzapine in dementia patients are scant There are different switch strategies for antipsychotic agents recommended based primarily
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blind comparison of olanzapine versus placebo Morisson and colleagues8 ran an unblinded comparison of cognitive behavioral therapy CBT plus treatment as usual versus symptom monitoring The study by McGorry and colleagues6 offered 6 months of intervention with risperidone plus therapy to some subjects and treatment as usual to others and then followed subjects for 1
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a prodromal phase When symptoms coalesce into a syndromal level that is diagnosable a person is said to experience the onset of the illness this is usually a first psychotic episode The likelihood of a person experiencing only a single psychotic episode but no recurrence is extremely unusual The vast majority of people with schizophrenia even those who recover fully
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work to reduce relapses and morbidity The Hillside First Episode Study showed that medication nonadherence in first episode patients increases the likelihood of relapse 5 fold Slide 7 10
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this gray matter volume loss is associated with the process of degeneration observed in schizophrenia If this gray matter volume reduction could be prevented deterioration might not occur A coronal plane magnetic resonance imaging MRI series shows a patient at three different points of illness After the patient s first episode his brain looked completely normal It had
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this neurodevelopment process Functional decline occurs early in the course of the illness At first presentation most of the functional decline seen in schizophrenia has already occurred The onset of the prodromal symptoms the first stages of schizophrenia may portend the inevitable development of the disorder However the prodromal period may be an at risk state that
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The most recent iteration of the Texas Medication Algorithm Project considered which medications should be administered to someone suffering from a first episode of psychosis Slide 3 Most clinicians agree that although clozapine is a powerful antipsychotic it is not a first line medication and should be reserved for later stages of illness Several researchers have
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work to reduce relapses and morbidity The Hillside First Episode Study showed that medication nonadherence in first episode patients increases the likelihood of relapse 5 fold Slide 7 10
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the course of a decade 1 of those individuals will develop a psychotic disorder meaning the relative risk is quite high at ~235 times greater than the risk of the general population While the risk was relatively high for the NAPLS subjects 65 did not develop a psychotic disorder during the 2 5 year follow up period What will happen to these subjects long term is
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arbor the large tree of dendrites and dendritic spines that form synaptic connections The loss of these cell processes this neuropil is detected with MRI as a volume reduction A postmortem study by Black and colleagues4 reflects this process Slide 5 Postmortem cells taken from the brain tissue of control subjects have longer dendrites than tissue taken from
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from differences in research settings some of which are naturalistic first episode studies The variability very likely accurately reflects the population seen in clinical practices An obvious question is Why is there such a long duration of untreated psychosis Slide 2 Patients experiencing an evolving psychotic process are unlikely to realize immediately that
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yields better prognosis However it is often difficult to decide precisely when to institute pharmacologic treatment in a patient with declining function and worsening positive symptoms Nonpharmacologic interventions carry much lower risk and potentially may help These include educating patients and families about the potential causes of psychotic disorders the course
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dementia or dementia not otherwise specified 291 2 Concomitant medical diagnoses are also listed in Table 1 Cardiovascular disease was the most common concomitant medical diagnosis Concurrent psychotropic medications were used by eight patients Table 2 Fifty two out of 58 patients were taking concurrent non psychotropic medications 1 7 medications per patient
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in the patient s best interest Environmental issues include family support cost of treatment caregiver support and a whole host of practical barriers such as access to pharmacies Conclusion There are overarching themes in treating first episode psychosis Slide 9 It is important to provide prompt access to specialized care There is a range of effective treatment
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