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First-Episode Psychosis: A Window of Opportunity for Best Practices

Published online by Cambridge University Press:  07 November 2014

Peter F. Buckley ,
Christoph U. Correll  and
Alexander L. Miller
Peter F. Buckley
Affiliation:
Dr. Buckley is professor and chairman in the Department of Psychiatry and Health Behavior at, the Medical College of Georgia, in Augusta. Dr. Buckley is a consultant to Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Merck, Pfizer, Roche Diagnostics, Solvay, and Wyeth; is on the speaker's bureaus of Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Pfizer; and has received grant/research support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Solvay, and Wyeth.
Christoph U. Correll
Affiliation:
Dr. Correll is medical director of the Recognition and Prevention Program at, the Zucker Hillside Hospital in Queens, New York. He is also assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine in Bronx, New York. Dr. Correll is a consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Intra-Cellular Therapeuties, Otsuka America, Pfizer, Solvay, Supernus, and Wyeth; is on the advisory boards of Bristol-Myers Squibb, Eli Lilly, Otsuka America, and Vanda; and is on the speaker's bureaus of AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Otsuka America.
Alexander L. Miller
Affiliation:
Dr. Miller is Hugo Auler Professor of Psychiatry and chief of the Division of Schizophrenia and Related Disorders at, the University of Texas Health Science Center at San Antonio. Dr. Miller is a consultant to Centene; is on advisory boards of AstraZeneca, Bristol-Myers Squibb, and Solvay; is on the speaker's bureaus of AstraZeneca, Bristol-Myers Squibb, and Janssen; and has received grant/research support from Alexza, AstraZeneca, Bristol-Myers Squibb, Forest, Eli Lilly, GlaxoSmithKline, Janssen, Pfizer, and Organon.
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Abstract

Patients experiencing a first psychotic episode or early stages of psychosis present with key diagnostic issues for clinicians. At the time of first-episode psychosis presentation, it is crucial that clinicians select the most effective treatment option as immediate intervention offers the best chance for containing the illness. Functional impairment occurs most rapidly at the early stage of illness, and such impairment can influence the patient's future prognosis, alter the level of necessary treatment, and affect morbidity. Although research has shown a decrease in brain gray matter as well as signs of functional impairment in those who develop psychosis, many of these patients remain untreated for extended periods of time and do not visit a clinician due to fear of stigma, a failure to recognize the problem, or complexities of their care system. Prior studies have shown that untreated psychosis results in worse outcome for patients compared to psychosis that is treated earlier in the course of illness. There is a range of treatment options for psychosis, including use of first-generation or second-generation antipsychotic medication. Clinicians should note that both medication types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively. For all antipsychotics, doses should be lower for patients with a first psychotic episode than for patients with chronic psychosis. Finally, clinicians must consider that patients may present with various comorbidities, such as substance abuse, that also may affect treatment.

This expert roundtable supplement will address the diagnosis and treatment selection for first-episode psychosis as well as comorbidities related to the condition. The use of first- or second-generation antipsychotics for psychosis treatment, dosing guidelines, and the antipsychotic side-effect profile will also be addressed.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S15 , 2007 , pp. 1 - 16
Copyright
Copyright © Cambridge University Press 2007

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References

1.Pantelis, C, Velakoulis, D, McGorry, PD, et al.Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison. Lancet. 2003;361(9354):281–288.CrossRefGoogle ScholarPubMed
2.Menezes, NM, Arenovich, T, Zipursky, RB. A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med. 2006;36(10):1349–1362.CrossRefGoogle ScholarPubMed
3.Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry. 2005;62(9):975–983.Google Scholar
4.Lieberman, JA, Stroup, TS, McEvoy, JP, et al.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353(12):1209–1223.CrossRefGoogle ScholarPubMed
5.Jones, PB, Barnes, TR, Davies, L, et al.Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry. 2006;63(10):1079–1087.Google Scholar
6. Texas Implementation of Medication Algorithms. Available at: www.dshs.state.tx.us/mhprograms/TIMA.shtm. Accessed June 28, 2007.Google Scholar
7.Emsley, RA. Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group. Schizophr Bull. 1999;25(4):721–729.Google Scholar
8.Lieberman, JA, Toleffson, G, Tohen, M, et al.Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. Am J Psychiatry. 2003;160:1396–1404.Google Scholar
9.Lieberman, JA, Tollefson, GD, Charles, C, et al, and the HGDH Study Group. Antipsychotic drug effects on brain morphology in first-episode psychosis. Arch Gen Psychiatry. 2005;62(4):361–370.CrossRefGoogle ScholarPubMed
10.Schooler, N, Rabinowitz, J, Davidson, M, et, al, and the Early Psychosis Global Working Group. Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. Am J Psychiatry. 2005;162(5):947–953.Google Scholar
11.Leucht, S, Barnes, TR, Kissling, W, Engel, RR, Correll, C, Kane, JM. Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry. 2003;160(7):1209–1222.Google Scholar
12.Newcomer, JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 2007;68(Suppl 1):20–27.Google ScholarPubMed
13.Siris, SG. Depression in schizophrenia: perspective in the era of “Atypical” antipsychotic agents. Am J Psychiatry. 2000;157(9):1379–1389.Google Scholar
14.Correll, CU, Leucht, S, Kane, JM. Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. Am J Psychiatry. 2004;161(3):414–425.Google Scholar
15.Correll, C, Kane, JM. One-Year Tardive Dyskinesia Rates in Children and Adolescents Treated with Second-Generation Antipsychotics: A Systematic Review. J Child Adolesc Psychopharmacol. In press.Google Scholar
16.Kane, JM, Rifkin, A, Quitkin, F, Nayak, D, Ramos-Lorenzi, J. Fluphenazine vs placebo in patients with remitted, acute first-episode schizophrenia. Arch Gen Psychiatry. 1982;39(1):70–73.Google Scholar
17.Crow, TJ, MacMillan, JF, Johnson, AL, Johnstone, EC. A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry. 1986;148:120–127.CrossRefGoogle ScholarPubMed
18.McCreadie, RG, Wiles, D, Grant, S, et al.The Scottish first episode schizophrenia study. VII. Two-year follow-up. Scottish Schizophrenia Research Group. Acta Psychiatr Scand. 1989;80(6):597–602.Google ScholarPubMed
19.Hogarty, GE, Ulrich, RF. The limitations of antipsychotic medication on schizophrenia relapse and adjustment and the contributions of psychosocial treatment. J Psychiatr Res. 1998;32(3-4):243–250.CrossRefGoogle ScholarPubMed
20.Robinson, D, Woerner, MG, Alvir, JM, et al.Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999;56(3):241–247.Google Scholar
21.Robinson, DG, Woerner, MG, Alvir, JM, Bilder, RM, Hinrichsen, GA, Lieberman, JA. Predictors of medication discontinuation by patients with first-episode schizophrenia and schizoaffective disorder. Schizophr Res. 2002;57(2-3):209–219.CrossRefGoogle ScholarPubMed
22.Robinson, DG, Woerner, MG, Napolitano, B, et al.Randomized comparison of olanzapine versus risperidone for the treatment of first-episode schizophrenia: 4-month outcomes. Am J Psychiatry. 2006;163(12):2096–2102.CrossRefGoogle ScholarPubMed
23.McEvoy, JP, Lieberman, JA, Perkins, DO, et al.Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry. 2007;164(7):1050–1060.CrossRefGoogle ScholarPubMed
24.Newcomer, JW. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19(Suppl 1):1–93.Google Scholar
25.Newcomer, JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 2007;68(suppl 1):20–27.Google ScholarPubMed
26.Faulkner, G, Cohn, T, Remington, G. Interventions to reduce weight gain in schizophrenia. Cochrane Database Syst Rev. 2007;(1):CD005148.Google Scholar
27.Weiden, PJ, Newcomer, JW, Loebel, AD, Yang, R, Lebovitz, HE. Long-term changes in weight and plasma lipids during maintenance treatment with ziprasidone. Neuropsychopharmacology. 2007 Jul 18; [Epub ahead of print].Google Scholar
28.De Hert, M, Hanssens, L, van Winkel, R, Wampers, M, Van Eyck, D, Scheen, A, Peuskens, J. A case series: evaluation of the metabolic safety of aripiprazole. Schizophr Bull. 2007;33(3):823–830.Google Scholar
29. Zarate CA, Jr, Tohen, M. Double-blind comparison of the continued use of antipsychotic treatment versus its discontinuation in remitted manic patients. Am J Psychiatry. 2004;161(1):169–171.Google Scholar
30.Mauri, M, Volonteri, L, De Gaspari, I, Colasanti, A, Brambilla, M, Cerruti, L. Substance abuse in first-episode schizophrenic patients: a retrospective study. Clin Pract Epidemol Ment Health. 2006;2:4.Google Scholar
31.Sim, K, Mahendran, R, Chong, SA. Health-related quality of life and psychiatric comorbidity in first episode psychosis. Compr Psychiatry. 2005;46(4):278–283.Google Scholar
32.Buckley, PF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry. 2006;67(suppl 7):5–9.Google Scholar
33.Caspi, A, Moffitt, TE, Cannon, M, et al.Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry. 2005;57(10):1117–1127.Google Scholar
1.Citrome, L, Jaffe, A, Levine, J. Datapoints: The ups and downs of dosing second-generation antipsychotics. Psychiatr Serv. 2007;58(1):11.Google Scholar
2.Pae, CU, Kim, JJ, Lee, CU, et al.Rapid versus conventional initiation of quetiapine in the treatment of schizophrenia: a randomized, parallel-group trial. J Clin Psychiatry. 2007;68(3):399–405.Google Scholar
3.Manji, HK, Moore, GJ, Chen, G. Clinical and preclinical evidence for the neurotrophic effects of mood stabilizers: implications for the pathophysiology and treatment of manic-depressive illness. Biol Psychiatry. 2000;48(8):740–754.Google Scholar
4. Zarate CA, Jr, Singh, J, Manji, HK. Cellular plasticity cascades: targets for the development of novel therapeutics for bipolar disorder. Biol Psychiatry. 2006;59(11):1006–1020.Google Scholar