Skip to main content Accessibility help
×
Home

Contents:

Information:

  • Access
  • Cited by 1

Actions:

      • Send article to Kindle

        To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Letter to the Editor: The need for drug-naive research in first-episode psychosis: a response to Moncrieff & Leo (2010)
        Available formats
        ×

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Letter to the Editor: The need for drug-naive research in first-episode psychosis: a response to Moncrieff & Leo (2010)
        Available formats
        ×

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Letter to the Editor: The need for drug-naive research in first-episode psychosis: a response to Moncrieff & Leo (2010)
        Available formats
        ×
Export citation

Moncrieff & Leo (Reference Moncrieff and Leo2010) provide a thorough overview of the literature on the association between use of antipsychotic medication and global brain volume changes. One of the central arguments of the piece is that some of the brain abnormalities observed in schizophrenia patients are not a consequence of the illness itself but in fact result from antipsychotic medication. The mechanisms by which the structure of the brain is influenced by antipsychotic medication is currently not well understood. The authors argue that there is an urgent need for studies that randomize first-episode psychosis patients to either treatment with antipsychotic medication or to withhold antipsychotic treatment for a few weeks while studying the effect of antipsychotics on brain structure. Such studies would inform the issue of the relative role of antipsychotic medication and the progression of psychosis in brain changes associated with psychotic disorders.

Our group at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia, is currently conducting a trial with such a design (Francey et al. Reference Francey, Nelson, Thompson, Parker, Kerr, Macneil, Fraser, Hughes, Crisp, Harrigan, Wood, Berk and McGorry2010). The study involves randomizing first-episode psychosis patients to two different treatments – intensive psychosocial intervention plus antipsychotic medication versus intensive psychosocial intervention plus placebo – with the primary outcome being social functioning at 6 months. The study was prompted by first-episode psychosis services' increased ability to identify people as early as possible after the onset of psychosis, reducing the duration of untreated psychosis. This has meant, as in other areas of health care, that different treatment approaches may be indicated. It is possible, in line with clinical staging and stepped care principles, that the immediate introduction of antipsychotic medication may not be necessary for all first-episode psychosis patients, but that comprehensive psychosocial intervention may constitute effective treatment at least for a subgroup of patients at this very early stage of disorder (McGorry et al. Reference McGorry, Hickie, Yung, Pantelis and Jackson2006, Reference McGorry, Nelson, Goldstone and Yung2010). Structural magnetic resonance imaging scans are being performed at baseline prior to randomization and after 12 weeks. If both intervention groups display similar structural brain changes over the course of intervention then we can infer that these changes are more likely to be associated with the progression of psychosis rather than due to antipsychotic medication, especially if the experimental groups are similar in other respects. However, if certain structural brain changes only occur in the group treated with medication then these changes are more likely to be related to antipsychotics. Of course, it is entirely possible that antipsychotic medications could be neuroprotective and retard or prevent brain changes which derive from underlying neuroprogressive changes (Lieberman et al. Reference Lieberman, Stroup, McEvoy, Swartz, Rosenheck, Perkins, Keefe, Davis, Davis, Lebowitz, Severe and Hsiao2005; DeLisi, Reference DeLisi2008).

The study described above is currently in the recruitment phase. We agree with Moncrieff and Leo that studies of this sort, that effectively provide an experimental manipulation of the duration of psychosis untreated with antipsychotic medication, are necessary to disentangle the effects of antipsychotic medications and the putative neurobiological processes associated with brain changes in psychotic disorders. Clearly, studies of this nature need to be conducted with strict ethical guidelines, including close monitoring of patients and a low threshold for withdrawal or discontinuation.

Declaration of Interest

None.

References

DeLisi, LE (2008). The concept of progressive brain change in schizophrenia: implications for understanding schizophrenia. Schizophrenia Bulletin 34, 312321.
Francey, SM, Nelson, B, Thompson, A, Parker, A, Kerr, M, Macneil, C, Fraser, R, Hughes, F, Crisp, K, Harrigan, S, Wood, SJ, Berk, M, McGorry, PD (2010). Who needs antipsychotic medication in the earliest stages of psychosis? A reconsideration of benefits, risks, neurobiology and ethics in the era of early intervention. Schizophrenia Research 119, 110.
Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Keefe, RS, Davis, SM, Davis, CE, Lebowitz, BD, Severe, J, Hsiao, JK (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 12091223.
McGorry, PD, Hickie, IB, Yung, AR, Pantelis, C, Jackson, HJ (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry 40, 616622.
McGorry, PD, Nelson, B, Goldstone, S, Yung, AR (2010). Clinical staging: a gateway to better health and social outcomes for psychotic and mood disorders. Canadian Journal of Psychiatry 55, 486497.
Moncrieff, J, Leo, J (2010). A systematic review of the effects of antipsychotic drugs on brain volume. Psychological Medicine 40, 14091422.