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Trajectories of symptom dimensions in short-term response to antipsychotic treatment in patients with a first episode of non-affective psychosis

Published online by Cambridge University Press:  06 March 2013

J. M. Pelayo-Terán ,
F. J. Diaz ,
R. Pérez-Iglesias ,
P. Suárez-Pinilla ,
R. Tabarés-Seisdedos ,
J. de León  and
B. Crespo-Facorro
J. M. Pelayo-Terán*
Affiliation:
University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
F. J. Diaz
Affiliation:
Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
R. Pérez-Iglesias
Affiliation:
University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
P. Suárez-Pinilla
Affiliation:
University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
R. Tabarés-Seisdedos
Affiliation:
CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain Department of Psychiatry, University of Valencia, CIBERSAM, Valencia, Spain
J. de León
Affiliation:
Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA
B. Crespo-Facorro
Affiliation:
University Hospital Marqués de Valdecilla, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
*
* Address for correspondence: J. M. Pelayo-Terán, M.D., Ph.D., University Hospital Marqués de Valdecilla-IFIMAV, CIBERSAM, Department of Psychiatry, School of Medicine, University of Cantabria, Planta 2a, Edificio 2 de Noviembre, Avda Valdecilla s/n, 39008 Santander, Spain.(Email: [email protected])
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Abstract

Background

Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data.

Method

This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and negative) in order to identify the different response trajectories. Diagnosis, cannabis use, duration of untreated psychosis (DUP), smoking and antipsychotic class were examined as possible predictive variables.

Results

Patients were classified in five groups according to the positive dimension, three groups according to the disorganized dimension and five groups according to the negative dimension. Longer DUPs and cannabis use were associated with higher scores and poorer responses in the positive dimension. Cannabis use was associated with higher scores and poorer responses in the disorganized dimension. Only schizophrenia diagnosis was associated with higher scores and poorer responses in the negative dimension.

Conclusions

Our results illustrate the heterogeneity of short-term response to antipsychotics in patients with a first episode of psychosis and highlight markedly different patterns of response in the positive, disorganized and negative dimensions. DUP, cannabis use and diagnosis appeared to have a prognostic value in predicting treatment response with different implications for each dimension.

Keywords

Antipsychoticfirst-episode psychosisschizophreniatreatment outcometreatment trajectories
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 37 - 50
Copyright
Copyright © Cambridge University Press 2013 

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References

Agid, O, Kapur, S, Arenovich, T, Zipursky, RB (2003). Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Archives of General Psychiatry 60, 1228–1235.CrossRefGoogle Scholar
Andreasen, NC (1983 a). Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.Google Scholar
Andreasen, NC (1983 b). Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City.Google Scholar
Arndt, S, Andreasen, NC, Flaum, M, Miller, D, Nopoulos, P (1995). A longitudinal study of symptom dimensions in schizophrenia: prediction and patterns of change. Archives of General Psychiatry 52, 352–360.Google Scholar
Bobes, J, Arango, C, Garcia-Garcia, M, Rejas, J (2010). Prevalence of negative symptoms in outpatients with schizophrenia spectrum disorders treated with antipsychotics in routine clinical practice: findings from the CLAMORS study. Journal of Clinical Psychiatry 71, 280–286.CrossRefGoogle ScholarPubMed
Buhler, B, Hambrecht, M, Loffler, W, an der Heiden, W, Hafner, H (2002). Precipitation and determination of the onset and course of schizophrenia by substance abuse – a retrospective and prospective study of 232 population-based first illness episodes. Schizophrenia Research 54, 243–251.CrossRefGoogle ScholarPubMed
Case, M, Stauffer, VL, Ascher-Svanum, H, Conley, R, Kapur, S, Kane, JM, Kollack-Walker, S, Jacob, J, Kinon, BJ (2011). The heterogeneity of antipsychotic response in the treatment of schizophrenia. Psychological Medicine 41, 1291–1300.CrossRefGoogle ScholarPubMed
Caseiro, O, Perez-Iglesias, R, Mata, I, Martinez-Garcia, O, Pelayo-Teran, JM, Tabares-Seisdedos, R, Ortiz-Garcia de la Foz, V, Vazquez-Barquero, JL, Crespo-Facorro, B (2012). Predicting relapse after a first episode of non-affective psychosis: a three-year follow-up study. Journal of Psychiatric Research 46, 1099–1105.Google Scholar
Correll, CU, Malhotra, AK, Kaushik, S, McMeniman, M, Kane, JM (2003). Early prediction of antipsychotic response in schizophrenia. American Journal of Psychiatry 160, 2063–2065.CrossRefGoogle ScholarPubMed
Crespo-Facorro, B, Pelayo-Teran, JM, Perez-Iglesias, R, Ramirez-Bonilla, M, Martinez-Garcia, O, Pardo-Garcia, G, Vazquez-Barquero, JL (2007). Predictors of acute treatment response in patients with a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables. Journal of Psychiatric Research 41, 659–666.Google Scholar
Crespo-Facorro, B, Perez-Iglesias, R, Ramirez-Bonilla, M, Martinez-Garcia, O, Llorca, J, Luis Vazquez-Barquero, J (2006). A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis. Journal of Clinical Psychiatry 67, 1511–1521.Google Scholar
Cuesta, MJ, Peralta, V (1995). Are positive and negative symptoms relevant to cross-sectional diagnosis of schizophrenic and schizoaffective patients? Comprehensive Psychiatry 36, 353–361.Google Scholar
Czobor, P, Bitter, I, Volavka, J (1991). Relationship between the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms: a study of their correlation and redundancy. Psychiatry Research 36, 129–139.CrossRefGoogle ScholarPubMed
Diaz, I, Pelayo-Teran, JM, Perez-Iglesias, R, Mata, I, Tabares-Seisdedos, R, Suarez-Pinilla, P, Vazquez-Barquero, JL, Crespo-Facorro, B (2012). Predictors of clinical remission following a first episode of non-affective psychosis: sociodemographics, premorbid and clinical variables. Psychiatry Research. Published online 14 11 2012 . doi:10.1016/j.psychres.2012.10.011.Google Scholar
Emsley, R, Rabinowitz, J, Medori, R (2006). Time course for antipsychotic treatment response in first-episode schizophrenia. American Journal of Psychiatry 163, 743–745.CrossRefGoogle ScholarPubMed
Geddes, J, Freemantle, N, Harrison, P, Bebbington, P (2000). Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 321, 1371–1376.Google Scholar
Grube, BS, Bilder, RM, Goldman, RS (1998). Meta-analysis of symptom factors in schizophrenia. Schizophrenia Research 31, 113–120.CrossRefGoogle ScholarPubMed
Harvey, PD, Koren, D, Reichenberg, A, Bowie, CR (2006). Negative symptoms and cognitive deficits: what is the nature of their relationship? Schizophrenia Bulletin 32, 250–258.CrossRefGoogle ScholarPubMed
Jones, BL, Nagin, DS, Roeder, K (2001). A SAS procedure based on mixture models for estimating developmental trajectories. Sociological Methods and Research 29, 374–393.CrossRefGoogle Scholar
Kerfoot, KE, Rosenheck, RA, Petrakis, IL, Swartz, MS, Keefe, RS, McEvoy, JP, Stroup, TS; CATIE Investigators (2011). Substance use and schizophrenia: adverse correlates in the CATIE study sample. Schizophrenia Research 132, 177–182.CrossRefGoogle ScholarPubMed
Leucht, S, Busch, R, Hamann, J, Kissling, W, Kane, JM (2005). Early-onset hypothesis of antipsychotic drug action: a hypothesis tested, confirmed and extended. Biological Psychiatry 57, 1543–1549.Google Scholar
Levine, SZ, Leucht, S (2010). Elaboration on the early-onset hypothesis of antipsychotic drug action: treatment response trajectories. Biological Psychiatry 68, 86–92.CrossRefGoogle ScholarPubMed
Levine, SZ, Leucht, S (2012). Delayed- and early-onset hypotheses of antipsychotic drug action in the negative symptoms of schizophrenia. European Neuropsychopharmacology. Published online 14 04 2012 . doi:10.1016/j.euroneuro.2012.03.001.Google Scholar
Levine, SZ, Lurie, I, Kohn, R. Levav, I (2011). Trajectories of the course of schizophrenia: from progressive deterioration to amelioration over three decades. Schizophrenia Research 126, 184–191.Google Scholar
Levine, SZ, Rabinowitz, J (2010). Trajectories and antecedents of treatment response over time in early-episode psychosis. Schizophrenia Bulletin 36, 624–632.Google Scholar
Levine, SZ, Rabinowitz, J, Case, M, Ascher-Svanum, H (2010). Treatment response trajectories and their antecedents in recent-onset psychosis: a 2-year prospective study. Journal of Clinical Psychopharmacology 30, 446–449.Google Scholar
Levine, SZ, Rabinowitz, J, Faries, D, Lawson, AH, Ascher-Svanum, H (2012). Treatment response trajectories and antipsychotic medications: examination of up to18 months of treatment in the CATIE chronic schizophrenia trial. Schizophrenia Research 137, 141–146.Google Scholar
Lieberman, JA, Tollefson, G, Tohen, M, Green, AI, Gur, RE, Kahn, R, McEvoy, J, Perkins, D, Sharma, T, Zipursky, R, Wei, H, Hamer, RM; HGDH Study Group (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, 1396–1404.Google Scholar
Marques, TR, Arenovich, T, Agid, O, Sajeev, G, Muthéen, B, Chen, L, Kinon, BJ, Kapur, S (2011). The different trajectories of antipsychotic response: antipsychotics versus placebo. Psychological Medicine 41, 1481–1488.Google Scholar
Muthén, B, Brown, CH, Masyn, K, Jo, B, Khoo, ST, Yang, CC, Wang, CP, Kellam, SG, Carlin, JB, Liao, J (2002). General growth mixture modeling for randomized preventive interventions. Biostatistics 3, 459–475.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (2007). Mplus: Statistical Analysis with Latent Variables: User's Guide, 5th edn. Muthén & Muthén: Los Angeles.Google Scholar
Overall, JE, Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports 10, 799–812.Google Scholar
Pelayo-Terán, JM, Perez-Iglesias, R, Ramírez-Bonilla, M, González-Blanch, C, Martínez-García, O, Pardo-García, G, Rodríguez-Sánchez, JM, Roiz-Santiáñez, R, Tordesillas-Gutiérrez, D, Mata, I, Vázquez-Barquero, JL, Crespo-Facorro, B (2008). Epidemiological factors associated with treated incidence of first-episode non-affective psychosis in Cantabria: insights from the Clinical Programme on Early Phases of Psychosis. Early Intervention in Psychiatry 2, 178–187.Google Scholar
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 1785–1804.CrossRefGoogle ScholarPubMed
Pini, S, de Queiroz, V, Dell'Osso, L, Abelli, M, Mastrocinque, C, Saettoni, M, Catena, M, Cassano, GB (2004). Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features. European Psychiatry 19, 8–14.Google Scholar
Rabany, L, Weiser, M, Werbeloff, N, Levkovitz, Y (2011). Assessment of negative symptoms and depression in schizophrenia: revision of the SANS and how it relates to the PANSS and CDSS. Schizophrenia Research 126, 226–230.Google Scholar
Schennach, R, Meyer, S, Seemüller, F, Jäger, M, Schmauss, M, Laux, G, Pfeiffer, H, Naber, D, Schmidt, LG, Gaebel, W, Klosterkötter, J, Heuser, I, Maier, W, Lemke, MR, Rüther, E, Klingberg, S, Gastpar, M, Musil, R, Möller, HJ, Riedel, M (2012). Response trajectories in “real-world” naturalistically treated schizophrenia patients. Schizophrenia Research 139, 218–224.Google Scholar
Stauffer, V, Case, M, Kollack-Walker, S, Ascher-Svanum, H, Ball, T, Kapur, S, Kinon, BJ (2011). Trajectories of response to treatment with atypical antipsychotic medication in patients with schizophrenia pooled from 6 double-blind, randomized clinical trials. Schizophrenia Research 130, 11–19.CrossRefGoogle ScholarPubMed