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April 16, 2019 by Fran Lowry | Medscape

Exercise Cuts Brain Inflammation in First-Episode Psychosis

ORLANDO, Florida — Aerobic exercise reduces brain inflammation in patients with first-episode psychosis (FEP), early research suggests.

In a study involving 25 outpatients newly diagnosed with schizophrenia, aerobic exercise performed once a week led to a significant reduction in interleukin-6 (IL-6), suggesting physical activity may reduce the deleterious effects of brain inflammation.

“IL-6 has been found to be a marker for brain inflammation in schizophrenia, and schizophrenia patients have higher levels than controls,” lead author Joseph Ventura, PhD, University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior, told Medscape Medical News.

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March 27, 2019 by Sarah Reeve; Bryony Sheaves; Daniel Freeman | Schizophrenia Bulletin

Sleep Disorders in Early Psychosis: Incidence, Severity, and Association With Clinical Symptoms

Sarah Reeve; Bryony Sheaves; Daniel Freeman. Schizophr Bull. 2019;45(2):287-295

 

Abstract

Sleep disturbance is known to be associated with psychosis, but sleep disorders (eg, insomnia, nightmare disorder, sleep apnea) have rarely been investigated. We aimed to provide the first detailed assessment of sleep disorders and their correlates in patients with early psychosis. Sixty outpatients aged between 18 and 30 with nonaffective psychosis were assessed for sleep disorder presence, severity, and treatment using a structured diagnostic interview, sleep diaries, and actigraphy. Psychotic experiences, mood, and psychological wellbeing were also measured. Forty-eight patients (80%) had at least one sleep disorder, with insomnia and nightmare disorder being the most common. Comorbidity of sleep disorders within this group was high, with an average of 3.3 sleep disorders per patient. Over half of the sleep disorders had been discussed with a clinician but almost three-quarters had received no treatment. Treatment according to clinical guidelines was rare, occurring in only 8% of cases (n = 13). Sleep disorders were significantly associated with increased psychotic experiences, depression, anxiety, fatigue, and lower quality of life. Sleep disorders are very common in patients with psychosis, may have wide-ranging negative effects, and merit routine assessment and treatment in psychiatric practice.

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March 21, 2019 by Marta Di Forti, PhD et al | The Lancet

The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study

Summary

Background
Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder.
 
Methods
We included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ9-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites.

 
Findings
Between May 1, 2010, and April 1, 2015, we obtained data from 901 patients with first-episode psychosis across 11 sites and 1237 population controls from those same sites. Daily cannabis use was associated with increased odds of psychotic disorder compared with never users (adjusted odds ratio [OR] 3·2, 95% CI 2·2–4·1), increasing to nearly five-times increased odds for daily use of high-potency types of cannabis (4·8, 2·5–6·3). The PAFs calculated indicated that if high-potency cannabis were no longer available, 12·2% (95% CI 3·0–16·1) of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% (15·2–40·0) in London and 50·3% (27·4–66·0) in Amsterdam. The adjusted incident rates for psychotic disorder were positively correlated with the prevalence in controls across the 11 sites of use of high-potency cannabis (r = 0·7; p=0·0286) and daily use (r = 0·8; p=0·0109).

Interpretation
Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health.
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January 21, 2019 by Peter Simons | MadInAmerica.com

Better Outcomes Off Medication for Those Recovered from First-Episode Schizophrenia

(MadInAmerica.com) – A new study has found that of 10 people who were fully recovered from their first episode of schizophrenia (FES), those not taking antipsychotics did better in terms of cognitive, social, and role functioning—and reached full recovery more quickly. The research was led by Susie Fu at the University of Oslo, Norway. It was published in Psychiatry: Interpersonal and Biological Processes.

According to Fu, “The findings challenge some of the views about medication treatment of FES patients. For a subgroup of FES patients, continuous medication treatment is not necessary for maintaining low levels of symptoms. These patients show sustained good functioning once fully recovered.”

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October 17, 2018 by Pauline Anderson | Medscape

Schizophrenia in Youth Not a Neurodegenerative Illness

(Medscape) – Young patients with recent-onset schizophrenia do not show signs of cognitive deterioration or disruption of ongoing brain development in the first years following illness onset, new research shows.

Results of a large longitudinal study show that young patients with schizophrenia experience cognitive impairment prior to the onset of psychotic symptoms, but the trajectory of their neurobehavioral development and performance is comparable to that of healthy control persons.

“The study results suggest that whatever effect cognition has in schizophrenia seems to happen before people develop clinical symptoms, the psychotic symptoms,” study investigator Cameron S. Carter, MD, professor of psychiatry and psychology, and director of the Schizophrenia Research and Education Program, Department of Psychiatry and Behavioural Sciences, University of California, Davis, told Medscape Medical News.

“So cognitive dysfunction is already there when people come in for treatment,” he said.

The findings are in line with the neurodevelopmental model of schizophrenia. This model hypothesizes that prenatal central nervous system insultsand/or genetic alterations during early brain developmentinteract with environmental risk factors and lead to the onset of psychosis in late adolescence or early adulthood.

“The study confirms our sense that schizophrenia is not a neurodegenerative disorder; the brain does not necessarily deteriorate after people become ill and develop these symptoms,” said Carter.

“In fact, these young people have the capacity to continue to improve and develop to the same degree as typical individuals,” he said.

The study was published online October 3 in JAMA Psychiatry.

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September 25, 2018 by Tomi Bergström et al | Psychiatry Research

The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen–year outcomes

Tomi Bergström, Jaakko Seikkula, Birgitta Alakare, Pirjo MäkiPäivi Köngäs-Saviaro, Jyri J.Taskila, Asko Tolvanen,  Jukka Aaltonen

Highlights

• The long-term outcomes of a network-based treatment of psychosis were studied.
• The approach was associated with a decreased need for treatment, and with better work capability.
• Over decades, the outcomes were more sustained than with other FEP treatments.
• The approach showed no significant difference in its ability to prevent suicides.

Abstract

Open Dialogue (OD) is a family-oriented early intervention approach which has demonstrated good outcomes in the treatment of first-episode psychosis (FEP). Nevertheless, more evidence is needed. In this register-based cohort study the long-term outcomes of OD were evaluated through a comparison with a control group over a period of approximately 19 years. We examined the mortality, the need for psychiatric treatment, and the granting of disability allowances. Data were obtained from Finnish national registers regarding all OD patients whose treatment for FEP commenced within the time of the original interventions (total N = 108). The control group consisted of all Finnish FEP patients who had a follow-up of 19–20 years and who were guided to other Finnish specialized mental healthcare facilities (N = 1763). No difference between the samples was found regarding the annual incidence of FEP, the diagnosis, and suicide rates. Over the entire follow-up, the figures for durations of hospital treatment, disability allowances, and the need for neuroleptics remained significantly lower with OD group. Findings indicated that many positive outcomes of OD are sustained over a long time period. Due to the observational nature of the study, randomized trials are still needed to provide more information on effectiveness of approach.

Source: ScienceDirect.com/science/article/pii/S0165178117323338

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August 17, 2018 by Bernalyn Ruiz | MadInAmerica.com

Call to Monitor Adverse Effects of Antipsychotics in Youth

Researchers point to the risks of using antipsychotics with youth and caution against the practice.

(MadInAmerica.com) – A recent editorial published in JAMA Psychiatry responds to a randomized controlled trial (RCT) examining the metabolic effects of second-generation antipsychotics (SGA) in young people. In the RCT, the researchers monitored the metabolic effects of antipsychotics (aripiprazole, olanzapine, and risperidone) in a group of nonpsychotic youth diagnosed with behavioral disorders. The results showed adverse metabolic effects across the 12 weeks with the most significant effects found for the antipsychotic olanzapine. The researchers associated these adverse effects on premature cardiometabolic morbidity and mortality.

“The potential psychiatric benefits of antipsychotic use in this population, evident in this trial and others, should be carefully weighed against the potential for childhood onset of abdominal obesity and insulin resistance that—compared with adult onset—further increases long-term risk for T2D, cardiovascular disease, and related conditions,” the researchers write.

In response to these results, De Hert, MD, PhD and Detraux, MPsy advocate for use of psychosocial interventions prior to prescribing SGAs for off-label use and monitoring adverse effects, particularly the metabolic effects, in children and adolescents taking these medications.

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June 17, 2018 by Ginger E. Nicol, MD et al | JAMA Psychiatry

Metabolic Effects of Antipsychotics on Adiposity and Insulin Sensitivity in Youths

(JAMA Psychiatry) – A Randomized Clinical Trial

Key Points

Question  What is the effect of first exposure to antipsychotics on adiposity and insulin sensitivity in youths?

Findings  In this randomized clinical trial, 144 youths aged 6 to 18 years with disruptive behavior disorders who were randomized to receive aripiprazole, olanzapine, or risperidone experienced clinically significant increases in total and abdominal adiposity during 12 weeks of treatment. Increases were greater for olanzapine vs risperidone or aripiprazole; decreases in insulin sensitivity and improvements in behavior were also noted.

Meaning  Antipsychotic medications are commonly used in children for the treatment of disruptive behavior disorders, but potential benefits should be carefully weighed against the risk for adverse changes in total and abdominal adiposity and insulin sensitivity, known contributors to the development of early-onset type 2 diabetes, cardiovascular disease, and other illnesses associated with premature morbidity and mortality.

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June 15, 2018 by Pauline Anderson | Medscape

All Young Cannabis Users Face Psychosis Risk

(Medscape) – Cannabis use directly increases the risk for psychosis in teens, new research suggests.

A large prospective study of teens shows that “in adolescents, cannabis use is harmful” with respect to psychosis risk, study author Patricia J. Conrod, PhD, professor of psychiatry, University of Montreal, Canada, told Medscape Medical News.

The effect was observed for the entire cohort. This finding, said Conrod, means that all young cannabis users face psychosis risk, not just those with a family history of schizophrenia or a biological factor that increases their susceptibility to the effects of cannabis.

“The whole population is prone to have this risk,” she said.

The study was published online June 6 in JAMA Psychiatry.

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June 8, 2018 by James Melley | BBC

The children who hear ‘terrifying’ voices

One in 12 children is thought to persistently hear voices that are not there. Sometimes they tell them they are worthless. Now new research suggests the reaction of adults can affect the voices they hear in future.

“It’s like being in a crowded room. All you can hear is all these multiple different voices having a go at you,” Laura Moulding tells the BBC’s Victoria Derbyshire programme.

The 21-year-old hears voices around her almost constantly, and has done since childhood.

“The voices are a combination of male and female voices, adults and children. One of them sounds like a Doctor Who monster.

“They just tell me I’m useless pretty much all the time.”

Laura’s experiences began when she was around three years old.

She was sitting on the stairs at her grandparents’ home and heard a lion and bear from a children’s television programme saying, “I’m coming to get you, I’m coming to get you”, over and over again.

It was a terrifying experience, she says.

But when she first approached her parents, they assumed she was talking about imaginary friends.

She does not blame them for this, but did not try and talk to an adult about her voices for several more years.

It is estimated that one in 12 children has persistent auditory hallucinations.

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