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Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders

  • Diana O. Perkins (a1), Jeffrey A. Lieberman (a1), Hongbin Gu (a1), Mauricio Tohen (a2), Joseph McEvoy (a3), Alan I. Green (a4), Robert B. Zipursky (a5), Stephen M. Strakowski (a6), Tonmoy Sharma (a7), René S. Kahn (a8), Raquel Gur (a9) and Gary Tollefson (a10)...

Abstract

Background

Duration of untreated psychosis (DUP) may contribute to the observed heterogeneity of the treatment response in first-episode schizophrenia.

Aims

To examine the relationship of DUP and premorbid function with clinical outcomes following up to 2 years of antipsychotic treatment.

Method

For a subsample (n = 191) of subjects participating in a clinical trial, DUP and premorbid function were prospectively compared with clinical response to olanzapine or haloperidol.

Results

Shorter DUP and good premorbid function each independently are associated with better clinical response, including improvement in overall psychopathology and negative symptoms. Premorbid function also is associated with positive symptom, social and vocational outcomes.

Conclusions

Earlier antipsychotic treatment is associated with better outcomes in first-episode schizophrenia. Poor premorbid function could indicate an illness subtype less likely to respond to antipsychotic treatment regardless of when it is instituted.

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Copyright

Corresponding author

Diana O. Perkins, Department of Psychiatry, C. B. #7160, University of North Carolina, Chapel Hill, NC 27599-7160, USA. Tel: 919 966 3813; fax: 919 966 5620; e-mail: Diana_Perkins@med.unc.edu

Footnotes

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This paper was based (in part) on results from the study of the Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis by the HGDH Study Group sponsored by Eli Lilly and Company.

Declaration of interest

This work was supported by Lilly Research Laboratories and USPHS grants MH01905-01 (D.O.P.) MH00537, MH33127 (J.A.L.) the UNC Mental Health and Neuroscience Clinical Research Centre, the North Carolina Foundation of Hope, MH52376 and MH62157 (A.I.G.).

Footnotes

References

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American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: APA.
Cahn, W., Pol, H. E., Lems, E. B., et al (2002) Brain volume changes in first-episode schizophrenia: a 1-year follow-up study. Archives of General Psychiatry, 59, 10021010.
Cannon-Spoor, H. E., Potkin, S. G. & Wyatt, R. J. (1982) Measurement of premorbid adjustment in schizophrenia. Schizophrenia Bulletin, 8, 470484.
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Publication ADM 76-338, pp. 218222. Washington, DC: US Department of Health, Education and Welfare.
Haas, G. L., Garratt, L. S. & Sweeney, J. A. (1998) Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. Journal of Psychiatric Research, 32, 151159.
Harrigan, S. M., McGorry, P. D. & Krstev, H. (2000) Does treatmentdelayin first-episode psychosisreally matter? Schizophrenia Research, 41, 97110.
Heinrichs, D. W., Hanlan, T. E. & Carpenter, W. T. Jr (1984) The Quality of Life Scale: an instrument for rating the schizophrenia deficit syndrome. Schizophrenia Bulletin, 10, 388398.
Ho, B. C., Andreasen, N. C., Nopoulos, P., et al (2003) Progressive structural brain abnormalities and their relationship to clinical outcome: alongitudinal magnetic resonance imaging study early in schizophrenia. Archives of General Psychiatry, 60, 585594.
Johnstone, E. C., Macmillan, J. F., Frith, C. D., et al (1990) Further investigation of the predictors of outcome following first schizophrenic episodes. British Journal of Psychiatry, 157, 182189.
Kay, S. R., Opler, L. A. & Lindenmayer, J. P. (1988) Reliabiility and validity of the positive and negatiive syndrome scale for schizophrenics. Psychiatry Research, 23, 99110.
Larsen, T. K., Moe, L. C., Vibe-Hansen, L., et al (2000) Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophrenia Research, 45, 19.
Lieberman, J., Chakos, M., Wu, H., et al (2001a) Longitudinal study of brain morphologyin first-episode schizophrenia. Biological Psychiatry, 49, 487499.
Lieberman, J. A., Perkins, D., Belger, A., et al (2001b) The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biological Psychiatry, 50, 884897.
Lieberman, J. A., Tollefson, G., Tohen, M., et al (2003) Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol. American Journal of Psychiatry, 160, 13961404.
Loebel, A. D., Lieberman, J. A., Alvir, J. M., et al (1992) Duration of psychosis and outcome in first-episode schizophrenia. American Journal of Psychiatry, 149, 11831188.
Malla, A. K., Norman, R. M. G., Manchanda, R., et al (2002) One year outcome in first-episode psychosis: influence of DUP and other predictors. Schizophrenia Research, 54, 231242.
McGlashan, T. H. (1986) The prediction of outcome in chronic schizophrenia. IV. The Chestnut Lodge follow-up study. Archives of General Psychiatry, 43, 167176.
McGlashan, T. H. (1999) Duration of untreated psychosis in first-episode schizophrenia: marker or determinant of course? Biological Psychiatry, 46, 899907.
Montgomery, S. A. & Asberg, M. (1979) Anew depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Ott, S. L., Spinelli, S., Rock, D., et al (1998) The New York High-Risk Project: social and general intelligence in children at risk for schizophrenia. Schizophrenia Research, 31, 111.
Perkins, D. O., Leserman, J., Jarskog, L. F., et al (2000) Characterizing and dating the on set of symptoms in psychotic illness: the Symptom Onset in Schizophrenia (SOS) inventory. Schizophrenia Research, 44, 110.
Robinson, D. G., Woerner, M. G., Alvir, J. M., et al (1999) Predictors of treatment response from a first-episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry, 156, 544549.
Weinberger, D. R. (1987) Implications of normal brain development for the pathogenesis of schizophrenia. Archives of General Psychiatry, 44, 660669.
Wiersma, D., Nienhuis, F. J., Slooff, C. J., et al (1998) Natural course of schizophrenic disorders: a 15-year follow up of a Dutch incidence cohort. Schizophrenia Bulletin, 24, 7585.

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Predictors of antipsychotic treatment response in patients with first-episode schizophrenia, schizoaffective and schizophreniform disorders

  • Diana O. Perkins (a1), Jeffrey A. Lieberman (a1), Hongbin Gu (a1), Mauricio Tohen (a2), Joseph McEvoy (a3), Alan I. Green (a4), Robert B. Zipursky (a5), Stephen M. Strakowski (a6), Tonmoy Sharma (a7), René S. Kahn (a8), Raquel Gur (a9) and Gary Tollefson (a10)...
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eLetters

Use of the PAS in first episode schizophrenia studies

Gerardo Florez, psychiatrist
28 July 2004

During the last decade, many first-episode schizophrenia studies have been published. Like in the study by Perkins et al., one, if not the most important aim, is to examine the relationship between DUP (Duration of Untreated Illness) and outcome. If DUP is independently associated withbetter outcome, then early intervention programmes on first episode psychosis are clearly justified; but if DUP is a merely statistically artefact, consequence of the type of onset (acute versus insidious), we can wonder if it is really worthy to invest so much money in these programmes. Many studies have evaluated if DUP is independently related to outcome, orif this influence dissapears when premorbid function is added in the ecuation. Premorbid function has been clearly associated with outcome and type of onset (good premorbid adjustment = acute onset; bad premorbid adjustment = insidious onset ) (1). To measure premorbid function many studies, including the Perkins et al. one, have used the Premorbid Adjustment Scale (PAS). This scale, that divides the premorbid period in four stages ( childhood, early and late adolescence and adulthood ) considers that the premorbid period lasts from birth until six months before the first contact with psychiatric service or before the first psychotic symptom appears. When the scale was developed, in the early eighties, there wasn´t much knowledge about the prodromes in schizophrenia, that´s why the PAS authors arbitrarly established the six month period in order to clearly distinguish the premorbid psychosocial deterioration from the deterioration that appears at the psychotic early stages. But nowadays we have robust data about the existence of a schizophrenic prodromal phase and its duration ( mean duration two years with a one year median (2)); so we can say that if we don´t measure the duration of the prodromal phase and adjust the PAS to it, we will be mixing up two different stages of the illness. As new studies about the relationship between the prodromal phase and the outcome appear, this confusion becomes more relevant(3).That´s why when using the PAS or any other premorbid scale we must firts assess the duration of the DUP and the prodromal phase (also called Duration of Untreated Illness, DUI), and then adjust the premorbid scale to the period of time that goes from birth to the onset of the prodomal phase, a method that has been pointed out by several authors(4).

REFERENCES

1.Harrison G. et al. Recovery from psychotic illness: a 15- and 25- year international follow-up study. Br J Psychiatry 2001 ;178: 506-517.2.Häfner H. Nowotny B. Epidemiology of early – onset schizophrenia. Eur Arch Psychiatry Clin Nuerosci 1995; 245: 80-92.3.Keshavan MS, Haas G, Miewald J, Montrose DM, Reddy R, Schooler NR, Sweeney JA. Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychoses. Schizophr Bull. 2003;29(4):757-69.4.Larsen TK, McGlashan TH, Moe LC. First- Episode Schizophrenia: I. EarlyCourse Parameters. Schizophrenia Bulletin 1996. 22(2): 241-256.
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