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The GET UP multi-element psychosocial intervention proved to be superior to treatment as usual in improving outcomes in patients with first-episode psychosis (FEP). However, to guide treatment decisions, information on which patients may benefit more from the intervention is warranted.
Aims
To identify patients' characteristics associated with (a) a better treatment response regardless of treatment type (non-specific predictors), and (b) a better response to the specific treatment provided (moderators).
Method
Some demographic and clinical variables were selected a priori as potential predictors/moderators of outcomes at 9 months. Outcomes were analysed in mixed-effects random regression models. (Trial registration: ClinicalTrials.gov, NCT01436331.)
Results
Analyses were performed on 444 patients. Education, duration of untreated psychosis, premorbid adjustment and insight predicted outcomes regardless of treatment. Only age at first contact with the services proved to be a moderator of treatment outcome (patients aged ≥35 years had greater improvement in psychopathology), thus suggesting that the intervention is beneficial to a broad array of patients with FEP.
Conclusions
Except for patients aged over 35 years, no specific subgroups benefit more from the multi-element psychosocial intervention, suggesting that this intervention should be recommended to all those with FEP seeking treatment in mental health services.
In her target article, Sue Llewellyn concludes that an unconstrained form of consciousness is necessary for the elaboration of meaningful associations. Unlike the author's view that dedifferentiation of memory encoding processes across wakefulness and sleep determines schizophrenia, our proposal suggests this mechanism could reflect a common neurobiological substrate for psychosis across several different diagnostic domains.
We used [18F]FDG and PET in patients with obsessive–compulsive disorder (OCD) to evaluate cerebral metabolic involvement before and after treatment with serotonin-specific reuptake inhibitors.
Method
In 11 untreated, drug-free adults, regional cerebral metabolic rate for glucose (rCMRglu) was compared with that of 15 age-matched normal controls.
Results
rCMRglu values were significantly increased in the cingulate cortex, thalamus and pallidum/putamen complex. After treatment a significant improvement in obsessive–compulsive symptoms on the Y-BOC scale (t = 3.59, P < 0.01) was associated with a significant bilateral decrease of metabolism in the whole cingulate cortex (P < 0.001). Clinical and metabolic data were significantly intercorrelated (Kendall's τ = 0.65; P < 0.01).
Conclusions
These findings indicate that OCD is associated with functional hyperactivity of a selected neuronal network and that treatment to reduce symptoms may have a selective neuromodulatory effect on cingulate cortex.
The Quality Extinction Test was used to detect lateralised abnormalities of hemispheric functions in schizophrenic patients. Course of illness significantly affected the distribution of tactile extinctions, chronic patients showing more left-side extinctions than sub-chronic ones. Age significantly affected the number of left extinctions, and sex the number of right extinctions. The importance of clinical and epidemiological characteristics of the patients in determining the quality and degree of hemispheric dysfunction in schizophrenia was confirmed.
This study evaluates the tactile extinction rate in acute and chronic schizophrenics by means of the Quality Extinction Test (QET) proposed by Schwartz in 1977. This procedure is successful in detecting ipsilateral abnormal extinction rates in neurological patients with dominant frontal lesions. Sixty schizophrenics and sixty controls were tested. The results suggest adominant temporo-parietal dysfunction in acute patients and a dominant frontal dysfunction in chronic patients.
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