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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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May 4, 2018 by Sherry Kit Wa Chan, MRCPsych et al. | JAMA

Early Intervention Service Lowers Suicide Rate of Patients with First-Episode Schizophrenia-Spectrum Disorders

(JAMA Network)

Key Points

Questions  Is an early intervention service associated with a reduction in the long-term suicide rate in patients with schizophrenia-spectrum disorders?

Findings  In this historical control study of 1234 patients with first-episode schizophrenia-spectrum disorders (617 each in the early intervention and standard care groups), patients receiving a 2-year early intervention service had a significantly lower suicide rate during 12 years, with the main difference observed during the first 3 years.

Meaning  An early intervention service may be associated with reductions in the suicide rate among patients with schizophrenia-spectrum disorders during their most vulnerable period, and the benefits may persist in the long term.

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February 13, 2018 by Batya Swift Yasgur, MA, LSW | Medscape

Exercise May Help Prevent Psychosis in High-Risk Youth

Exercise may improve positive and negative symptoms, as well as social and cognitive function, in youth at ultra-high risk (UHR) for psychosis, new research shows.

Results from a pilot study in 12 UHR adolescents and young adults who participated in a supervised aerobic exercise regimen showed improvements in clinical, social, and cognitive domains as well as changes in brain function in regions affected by psychosis.

“The results of this study suggest that exercise interventions are feasible within UHR samples and may help to improve important domains that are affected during the development of psychosis,” the researchers, with first author Derek J. Dean, University of Colorado at Boulder, write.

“Unique to this study from others in psychosis is the examination of brain structure and functional connectivity, suggesting that exercise may lead to change in the functional organization of the cortical-hippocampal networks,” they add.

The study was published in the November/December issue of the Journal of Clinical Psychiatry.

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December 31, 2017 by Bernalyn Ruiz | MadInAmerica.com

New Review Suggests Higher Recovery and Remission Rates for Psychosis

(MadInAmerica) – Meta-analysis gives updated recovery and remission rates for persons identified as having a first-episode psychosis and those diagnosed with schizophrenia

Researchers from King’s College London conducted a systematic review and meta-analysis to provide improved rates of recovery and remission for persons identified as having a first-episode psychosis (FEP) and those diagnosed with schizophrenia. The overall rates of both remission and recovery found in this meta-analysis are significantly higher than those reported in previous studies.

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December 22, 2017 by Batya Swift Yasgur, MA, LSW | Medscape

Low Folate, Vitamin D Implicated in First-Episode Psychosis

(Medscape) – Nutritional deficiencies, especially deficiencies in folate and vitamin D, are associated with first-episode psychosis (FEP), new research suggests.

Australian researchers found significantly lower levels of folate and vitamin D in patients with FEP, compared to healthy control persons. Limited evidence also suggested that serum levels of vitamin C were reduced in people with FEP.

“The extent of nutritional deficiencies was present right from illness onset,” said lead author Joseph Firth, PhD, NICM, School of Science and Health, University of Western Sydney, Australia.

“Seeing it in young people, even prior to antipsychotic treatment, is surprising,” he told Medscape Medical News.

The study was published online November 30 in Schizophrenia Bulletin.

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