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Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years.
Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study.
There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of ‘expressivity’ and ‘motivation’. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46.
Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.
Current neuroscience literature has related treatment with aripiprazole to improved memory performance and subcellular changes in the hippocampus.
To explore the volumetric changes in hippocampal grey matter in people with a first episode of psychosis (FEP) treated with second-generation antipsychotics.
Baseline and 1-year follow-up magnetic resonance images were obtained. Hippocampal volumes were estimated by using FreeSurfer and MAGeT-Brain. Subgroups included: aripiprazole (n=13), olanzapine (n=12), risperidone/paliperidone (n=24), refused-antipsychotics (n=13) and controls (n=44).
Aripiprazole subgroup displayed significant increases in bilateral hippocampal volume compared with all other subgroups (FreeSurfer: all P's<0.012; MAGeT-Brain: all P's<0.040).
Aripiprazole is a first-line, second-generation treatment option that may provide an added benefit of pro-hippocampal growth. The biological underpinnings of these changes should be the focus of future investigations and may be key towards achieving a better clinical outcome for more individuals.
Previous studies in schizophrenia have shown a strong relationship between memory deficits and a poor clinical outcome. However, no previous study has identified the functional neural correlates of memory encoding in relation to remission.
To determine whether functional magnetic resonance imaging (fMRI) activation patterns differed between individuals that later achieved remission v. those who did not.
Forty-two participants with first-episode schizophrenia were divided into two groups after 1 year of treatment as per the 2005 remission in schizophrenia consensus definition. We then examined fMRI activation using three contrasts (associative v. item-oriented strategy, semantically unrelated v. related image pairs, and successful v. unsuccessful memory encoding) among 15 participants who had achieved remission (remitted group), 27 who had not (non-remitted group) and 31 healthy controls (control group).
Participants in the non-remitted group displayed a positive activation in the posterior cingulate compared with those in the remitted group when encoding related images; no significant differences between the two groups were identified for the other contrasts. From the behavioural data, compared with the remitted and control groups, the non-remitted group demonstrated an inability to encode related images and displayed worse recognition memory overall.
This is the first study to identify differential neural activation between individuals with first-episode schizophrenia that later achieved remission v. those who did not. The behavioural and functional results together add to the growing evidence relating a poor clinical outcome in schizophrenia to memory-related deficits.
Outcome from psychotic disorders is heterogeneous with poorer outcomes
frequently identified too late to be influenced. Symptomatic ratings at 1
or more years following initiation of treatment have been related to
cognition in firstepisode psychosis. However, the relationship between
cognition and early outcome remains unclear.
To determine whether specific cognitive domains could identify poor
short-term outcome among individuals with first-episode psychosis.
One hundred and fifty-one individuals with first-episode psychosis were
divided into two groups based on 6-month clinical data after the
initiation of treatment. Six cognitive domains were compared among 78
participants with poor outcomes, 73 with good outcomes and 31 healthy
Lower performance on verbal memory (z-scores: poor
outcome=–1.3 (s.d.=1.1); good outcome=–0.8 (s.d.=0.9);
P=0.001) and working memory (poor outcome=–1.0
(s.d.=1.2); good outcome=–0.4 (s.d.=0.9); P=0.003)
identified individuals with first-episode psychosis with a poor outcome
after 6 months of treatment.
The early identification of those individuals with first-episode
psychosis with a poor clinical outcome may encourage clinicians to pay
special attention to them in the form of alternative pharmacological and
psychological treatments for a more favourable outcome in the long
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