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Intervención farmacológica en la fase prodrómica inicial de la psicosis

Published online by Cambridge University Press:  12 May 2020

Stephan Ruhrmann ,
Frauke Schultze-Lutter ,
Wolfgang Maier  and
Joachim Klosterkötter
Stephan Ruhrmann
Affiliation:
Departamento de Psiquiatría y Psicoterapia, Universidad de Colonia, Colonia, Alemania
Frauke Schultze-Lutter
Affiliation:
Departamento de Psiquiatría y Psicoterapia, Universidad de Colonia, Colonia, Alemania
Wolfgang Maier
Affiliation:
Departamento de Psiquiatría y Psicoterapia, Universidad de Bonn, Bonn, Alemania
Joachim Klosterkötter
Affiliation:
Departamento de Psiquiatría y Psicoterapia, Universidad de Colonia, Colonia, Alemania
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Resumen

La identificación y el tratamiento tempranos de la esquizofrenia pueden aliviar los síntomas, retrasar el comienzo y mejorar la evolución de la psicosis. Así, la detección de individuos en situación de riesgo durante la fase prodrómica es una tarea importante. Los enfoques universales para la detección selectiva de la población general o los sujetos sanos en situación de riesgo no han resultado posibles hasta la fecha. Sin embargo, se han desarrollado criterios clínicos para detectar individuos en situación de riesgo ultra-elevado para entornos especializados, llevándose a la práctica en estudios de intervención. Este artículo examina la justificación racional para la detección e intervención tempranas de la psicosis, junto con una revisión de algunos estudios actuales. Éstos llevan a cabo la prevención utilizando estrategias de intervención psicológica, farmacológica o de ambos tipos y han demostrado resultados prometedores en individuos con riesgo alto. La Red Alemana de Investigación sobre Esquizofrenia (GRNS) está realizando dos estudios multicéntricos de intervención temprana; uno con intervención psicológica temprana en sujetos que manifiestan síntomas prodrómicos tempranos, aplicando el segundo ensayo tratamiento clínico e intervención farmacológica temprana en sujetos que experimentan síntomas prodrómicos tardíos (sujetos de riesgo alto). A pesar de los resultados prometedores, el tamaño de muestra de muchos de los estudios actuales es pequeño, con un periodo breve de duración del estudio. Los beneficios completos de la detección e intervención tempranas se deberían revelar después que se hayan realizado estudios más grandes y largos.

Keywords

Intervención tempranaPsicosisFase prodrómicaEsquizofreniaRed Alemana de Investigación sobre Esquizofrenia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 12 , Issue 4 , May 2005 , pp. 217 - 222
Copyright
Copyright © European Psychiatric Association 2005

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Footnotes

Ruhrmann S, Schultze-Lutter F, Maier W, Klosterkötter J. Pharmacological intervention in the initial prodromal phase of psychosis. Eur Psychiatry 2005;20:1-6.

References

Bibliografía

[1]Addington, DAddington, JPatten, S. Depression in people with first-episode schizophrenia. Br J Psychiatry 1998; 172:S90-2.CrossRefGoogle ScholarPubMed
[2]Andreasson, SAllebeck, PEngstrom, ARydberg, U. Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet 1987; 2: 1483-6.Google Scholar
[3]Bebbington, PWilkins, SJones, PFoerster, AMurray, RToone, B, et al. Life events and psychosis. Initial results from the Carnberwell Collaborative Psychosis Study. Br J Psychiatry 1993; 162: 72-9.Google ScholarPubMed
[4]Berger, GEWood, SMcGorry, PD. Incipient neurovulnerability and neuroprotection in early psychosis. Psychopharmacol Bull 2003; 37: 79–101.Google ScholarPubMed
[5]Birchwood, MMcMillan, JF. Early intervention in schizophrenia. Aust N Z J Psychiatry 1993; 27: 374-8.CrossRefGoogle Scholar
[6]Boydell, JVan Os, JMcKenzie, KAllardyce, JGoel, RMcCreadie, RG, et al. Incidente of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. Br Med J 2001; 323: 1336-8.CrossRefGoogle Scholar
[7]Brown, SBirtwistle, J. People with schizophrenia and their families. Fifteen-year outcome. Br J Psychiatry 1998; 173: 139-44.CrossRefGoogle ScholarPubMed
[8]Bruce, MLTakeuchi, DTLeaf, PJ. Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area study. Arch Gen Psychiatry 1991; 48: 470-4.Google ScholarPubMed
[9]Comblatt, BA. The New York high risk project to the Hill side recognition and prevention (RAP) program. Am J Med Genet 2002; 114: 956–956.CrossRefGoogle Scholar
[10]Cornblatt, BALencz, TSmith, CWCorrell, CUAuther, AMNakayama, E. The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr Bull 2003; 29: 633-51.CrossRefGoogle ScholarPubMed
[11]DeGrazia, D. Ethical issues in early-intervention clinical trials involving minors at risk for schizophrenia. Schizophr Res 2001; 51: 77–86.CrossRefGoogle ScholarPubMed
[12]Gottesman, II. Schizophrenia epigenesis: post, present, and future. Acta Psychiatr Scand 1994; 384: S26-33.CrossRefGoogle Scholar
[13]Haas, GLGarratt, LSSweeney, JA. Delay to first antipsychotic medication in schizophrenia: impact on symptomatology and clinical course of illness. J Psychiatr Res 1998; 32: 151-9.CrossRefGoogle ScholarPubMed
[14]Hambrecht, MHafner, H. Cannabis, vulnerability, and the onset of schizophrenia: an epidemiological perspective. Aust New Zealand J Psychiatry 2000; 34: 468-75.CrossRefGoogle Scholar
[15]Hambrecht, MLammertink, MKlosterkötter, JMatuschek, EPukrop, R. Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic. Br J Psychiatry Suppl 2002; 43: S30-7.CrossRefGoogle Scholar
[16]Heinssen, RKPerkins, DOAppelbaum, PSFenton, WS. Informed consent in early psychosis research: National Institute of Mental Health Workshop, November 15, 2000. Schizophr Bull 2001; 27: 563-70.CrossRefGoogle ScholarPubMed
[17]Helgason, L. Twenty years’ follow-up of first psychiatric presentation for schizophrenia: what could have been prevented? Acta Psychiatr Scand 1990; 81: 231-5.CrossRefGoogle ScholarPubMed
[18]Huber, G. Reine Defektsyndrome und Basisstadien endogener Psychosen. Fortschr Neurol Psychiatr 1966; 34: 409-26.Google Scholar
[19]Humphreys, MSJohnstone, ECMacMillan, JFTaylor, PJ. Dangerous behaviour preceding first admissions for schizophrenia. Br J Psychiatry 1992; 161: 501-5.CrossRefGoogle Scholar
[20]Häfner, HNowotny, B. Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 1995; 245: 80 92.CrossRefGoogle ScholarPubMed
[21]Hafner, HLöffler, WMaurer, KHambrecht, MDer Heiden, W.Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand 1999; 100: 105-8.CrossRefGoogle ScholarPubMed
[22]Häfner, HMaurer, KRuhrmann, SBechdolf, AKlosterkötter, JWagner, M, et al. Early detection and secondary prevention of psychosis: facts and visions. Eur Arch Psychiatry Clin Neurosci 2004; 254: 117-28.CrossRefGoogle ScholarPubMed
[23]Jablensky, A. The 100-year epidemiology of schizophrenia. Schizophr Res 1997; 28: 111-25.CrossRefGoogle ScholarPubMed
[24]Johannessen, JOMcGlashan, THLarsen, TKHorneland, MJoa, IMardal, S, et al. Early detection strategies for untreated first-episode psychosis. Schizophr Res 2001; 51: 39–46.CrossRefGoogle ScholarPubMed
[25]Johnstone, ECCrow, TJJohnson, ALMcMillan, JE The Northwick Park study of first episodes of schizophrenia: I. Presentation of the illness and problems relating to admission. Br J Psychiatry 1986; 148: 115-20.CrossRefGoogle Scholar
[26]Kane, JMKrystal, JCorell, CU. Treatment models and designs for intervention research during the psychotic prodrome. Schizophr Bull 2003; 29: 747-56.CrossRefGoogle ScholarPubMed
[27]Klosterkötter, J, Schultze-Lutter E Is there a primary prevention of schizophrenic psychiosis? Fortschr Neurol Psychiatr 2001; 69: S104- 12 [Article in German].CrossRefGoogle Scholar
[28]Kolakowska, TWilliams, AOArdern, MReveley, MAJambor, KGelder, MG, et al. Schizophrenia with good and peor outcome. I: Early clinical features, response to neuroleptics and signs of organic dysfunction. Br J Psychiatry 1985; 146: 229-39.Google Scholar
[29]Koreen, ARSiris, SGChakos, MAlvir, JMayerhoff, DLieberman, J. Depression in first-episode schizophrenia. Am J Psychiatry 1993; 150: 1643-8.Google ScholarPubMed
[30]Larsen, TKJohannessen, JOOpjordsmoen, S. First-episode schizophrenia with long duration of untreated psychosis. Pathways to care. Br J Psychiatry 1998; 172: S45-52.CrossRefGoogle ScholarPubMed
[31]Lieberman, JASheitman, BBKinon, BJ. Endogenous neurochemical sensitization in the pathophysiology of schizophrenia: deficits and dysfunction in neural regulation and plasticity. Neuropsychopharmacology 1997; 17: 205-9.CrossRefGoogle Scholar
[32]Lieberman, JAPerkins, DBelger, AChakos, MJarskog, FBoteva, K, et al. The early stages of schizophrenia: speculations on pathogenesis, pathophysiology, and therapeutic approaches. Biol Psychiatry 2001; 50: 884 97.CrossRefGoogle ScholarPubMed
[33]Loebel, ADLieberman, JAAlvir, JMMayerhoff, DIGeisler, SHSzymansh, SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 1992; 149: 1183-8.Google ScholarPubMed
[34]McGlashan, TH. Psychosis treatment prior to psychosis onset: ethical issues. Schizophr Res 2001; 51: 47–54.CrossRefGoogle ScholarPubMed
[35]McGlashan, TH. Abstract presented at the Twelfth Biennial Winter Workshop on Schizophrenia. pavos, Switzerland, 7-13 February 2004.Google Scholar
[36]McGorry, PDEdwards, JMihalopoulos, CHarrigan, SMJackson, HJ. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22: 305-26.CrossRefGoogle ScholarPubMed
[37]McGorry, PDYung, ARPhillips, LJYuen, HPFrancey, SCosgrave, EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002; 59: 921-8.CrossRefGoogle Scholar
[38]McGorry, PDYung, ARPhillips, LJ. The “close-in” or ultra highrisk model: A safe and effective strategy for research and clinical intervention inprepsychotic mental disorder. Schizophr Bull 2003; 29: 771-90.CrossRefGoogle ScholarPubMed
[39]McGrath, JSaha, SWelham, JEl Saadi, OMacCauley, CChant, D, et al. A systematic review of the incidence of schizophrenia: the distribution of rates and the Influence of sex, urbanicity, migrant status and methodology. BMC Med 2004; 2: 13.CrossRefGoogle ScholarPubMed
[40]McGue, MGottesman, II. The genetic epidemiology of schizophrenia and the design of linkage studies. Eur Arch Psychiatry Clin Neurosci 1991; 240: 174-81.CrossRefGoogle ScholarPubMed
[41]Miller, PLawrie, SMHodges, AClafferty, RCosway, RJohnstone, EC. Genetic liability, illicit drug use, life stress and psychotic symptoms: preliminary findings from the Edinburgh study of people at high risk for schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 338-42.CrossRefGoogle ScholarPubMed
[42]Miller, TJZipursky, RBPerkins, DAddington, JWoods, SWHawkins, KA, et al. The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the “prodromal'’ sample. Schizophr Res 2003; 61: 19–30.Google Scholar
[43]O'Callaghan, EGibson, TColohan, HABuckley, PWalshe, DGLarkin, C, et al. Risk of schizophrenia in adults born after obstetric complications complications and their association with early onset of illness: a controlled study. BMJ 1992; 305: 1256-9.CrossRefGoogle ScholarPubMed
[44]Phillips, LJYung, ARMcGorry, PD. Identification of young people at risk of psychosis: validation of personal assessment and crisis evaluation clinic intake criteria. Aust New Zealand J Psychiatry 2000; 34: S164 9.CrossRefGoogle ScholarPubMed
[45]Pollack, MWoerner, MGGoodman, WGreenberg, IM. Childhood development patterns of hospitalized adult schizophrenic and nonschizophrenic patients and their siblings. Am J Orthopsychiatry 1966; 36: 510-7.CrossRefGoogle ScholarPubMed
[46]Ruhrmann, SSchultze-Lutter, FKlosterkotter, J. Early detection and intervention in the initial prodromal phase of schizophrenia. Pharmacopsychiatry 2003; 36: S162-7.Google ScholarPubMed
[47]Ruhrmann, SSchultze-Lutter, FVon Reventlow, HPicker, HTschinkel, SBühler, B, et al. Functional disability in the prodromal phase of psychosis. Eur Psychiatry 2004; 19: S11.Google Scholar
[48]Schultze-Lutter, F. Prediction of psychosis is necessary and possible. In: McDonald, CSchulze, KMurray, RWright, P, editors. Schizophrenia: challenging the orthodox. London, New York: Taylor & Francis; 2004. p. 81–90.Google Scholar
[49]Selten, JPSlaets, JPKahn, RS. Schizophrenia in Surinamese and Dutch Antillean immigrants to The Netherlands: evidence of an increased incidence. Psychol Med 1997; 27: 807-11.CrossRefGoogle ScholarPubMed
[50]Sham, PCO'Callaghan, ETakei, NMurray, GKHare, EHMurray, RM. Schizophrenia following pro-natal exposure to influenza epidemics between 1939 and 1960. Br J Psychiatry 1992; 160: 461-6.CrossRefGoogle Scholar
[51]Stirling, JTantam, DThomas, PNewby, DMontague, LRing, N, et al. Expressed emotion and early onset schizophrenia: a 1 year follow-up. Psychol Med 1991; 21: 675-85.CrossRefGoogle Scholar
[52]Strakowski, SMKeck, PE Jr.McElroy, SLLonczak, HSWest, SA. Chronology of comorbid and principal syndromes in first-episode psychosis. Compr Psychiatry 1995; 36: 106-12.CrossRefGoogle ScholarPubMed
[53]Strous, RDAlvir, JMRobinson, DGal, GSheitman, BChakos, M, et al. Premorbid functioning in schizophrenia: relation to baseline symptoms, treatment response, and medication side effects. Schizophr Bull 2004; 30: 265-78.CrossRefGoogle ScholarPubMed
[54]Susser, ENeugebauer, RHoek, HWBrown, ASLin, SLabovitz, D, et al. Schizophrenia after prenatal famine. Further evidence. Arch Gen Psychiatry 1996; 53: 25–31.CrossRefGoogle ScholarPubMed
[55]Woods, SWMiller, TJMcGlashan, TH. The ‘prodromal’ patient: Both, symptomatic and at risk. CNS Spectr 2001; 6: 223-32.CrossRefGoogle ScholarPubMed
[56]Woods, SWBreier, AZipursky, RBPerkins, DOAddington, JMiller, TJ, et al. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biol Psychiatry 2003; 54: 453-64.CrossRefGoogle ScholarPubMed
[57]Wölwer, WBuchkremer, GHäfner, HKlosterkotter, JMaier, WMoller, HJ, et al. German research network on schizophrenia-bridging the gap between research and care. Eur Arch Psychiatry Clin Neurosci 2003; 253: 321-9.CrossRefGoogle ScholarPubMed
[58]Yung, ARPhillips, LJMcGorry, PDMcFarlane, CAFrancey, SHarrigan, S, et al. Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl 1998; 172: S1420.CrossRefGoogle ScholarPubMed