DOCSLIB.ORG

Aripiprazole in the Treatment of the Psychosis Prodrome an Open-Label Pilot Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Aripiprazole in the Treatment of the Psychosis Prodrome an Open-Label Pilot Study BRITISH JOURNAL OF PSYCHIATRY (2007), 191 (suppl. 51), s96^s96^s101. s101. doi: 10.1192/bjp.191.51.s96 Aripiprazole in the treatment of the psychosis past 3 months; (e) use of antipsychotic medication in the previous 3 months; (f) prodromeprodrome change in dosage of any antidepressant within 6 weeks, stimulant medication with- in 4 weeks, or mood stabiliser within 4 An open-label pilot study weeks.weeks. The Criteria of Prodromal Syndromes SCOTT W.WOODS, ELIZABETH M. TULLY, BARBARA C. WALSH, (COPS; Woods et aletal, 2001) were used to KEITH A. HAWKINS, JENNIFER L. CALLAHAN, SHUKI J. COHEN, identify those possibly prodromal. The DANIEL H. MATHALON, TANDY J. MILLERand THOMAS H. McMcGLASHANGLASHAN COPS are based on sub-threshold levels of positive symptoms and operationally de- fine three prodromal syndromes (Yung etet Background Research studies for the The prodromal phase of schizophrenic dis- alal, 1998): attenuated positive symptom treatmentofthe putative prodromal orders has been recognised since the 19th syndrome, brief intermittent psychotic century (Bleuler, 1911) and the possibility syndrome, and genetic risk and recent phase of psychotic disorders have begunto of treatment during the prodromal phase functional decline syndrome. The COPS appear.appear. has a history almost as long (Sullivan, and the three syndromes are described in 1927). Although some studies have begun detail elsewhere (Woods et aletal, 2001; Miller Aims To obtain preliminary evidence of to investigate methods to prevent progres- et aletal, 2003,2003aa). Individuals were assessed to the short-term efficacy and safetyof sion from the putatively identified pro- determine whether the COPS were met by aripiprazole treatment in people with the dromal phase to frank psychosis (Falloon, using the Structured Interview for Prodro- psychosis prodrome. 1992; McGorry et aletal, 2002; Morrison etet mal Syndromes (SIPS; Miller et aletal, 1999).,1999). alal, 2004; McGlashan et aletal, 2006), fewer Reliability of the COPS diagnosis of pos- MethodMethod Fifteen participants meeting have focused on the acute treatment effects sible prodrome has been excellent when prodrome criteria (mean age17.1years, on current symptoms (Woods et aletal, 2003).,2003). using the SIPS (Miller et aletal, 2002, 2003aa),), Aripiprazole is a relatively new anti- and patients thus diagnosed are symptom- s.d.s.d.¼5.5) enrolledin an open-label, single- psychotic medication with limited liability atic (Milleratic(Miller et aletal, 2003,2003bb), functionally im- site trialwith fixed-flexible dosing of for weight gain (Marder et aletal, 2003), whose paired (Miller et aletal, 2003,2003bb), cognitively aripiprazole (5^30 mg/day) for 8 weeks. mechanism of action differs from other impaired (Hawkins et aletal, 2004,2004aa) and)and antipsychotics in that it is a partial agonist treatment-seeking (Preda et aletal, 2002).,2002). ResultsResults Inthe mixed-effects repeated- rather than a full antagonist at dopamine measures analysis, improvementfromimprovement from DD22 receptors (Burris et aletal, 2002). The Study design overall goal of the present pilot study was baseline on the Scale of Prodromal Participants were enrolled between October to obtain preliminary information about Symptoms total score was statistically 2004 and February 2006. The Yale Human the efficacy and safety of aripiprazole in significant by the first week.No Investigation Committee Institutional relieving symptoms that may be prodromal Review Board approved the protocol. The participantconvertedparticipantconvertedto to psychosis and for schizophrenia. trial is registered with ClinicalTrials.gov 13 completed treatment.Neuro- (NCT00237874). This was an open-label psychologicalmeasures showed no study at one site for 8 weeks, followed by consistent improvement; mean weight METHOD an open-label extension phase with gain waswas1.2 1.2 kg. Akathisia emerged in 8 SampleSample monthly follow-up visits to 52 weeks. Findings from the extension phase will be participants, butthe mean Barnes Adult participants gave written informed reported subsequently. Akathisia Scale score fell to baseline levels consent and minors gave written informed by the finalfinalvisit. visit. Adverse events were assent with consent from a parent or guar- dian. Participants were included if they Procedure otherwise minimal. were treatment-seeking out-patients of 13– During the 1–2 weeks prior to beginning Conclusions Aripiprazole shows a 40 years of age who met diagnostic criteria study medication, participants underwent for a possible prodromal syndrome. People eligibility and neuropsychological examina- promising efficacy and safety profile for were excluded for any of the following tions. After beginning study medication, the psychosis prodrome.Placebo- reasons: (a) past or current DSM–IV criter- participants were scheduled for eight controlled studies are indicated. ia (American Psychiatric Association, 1994) weekly visits. for any lifetime psychotic disorder; (b) they Dosing followed a fixed-flexible sched- Declaration of interest S.S.W.W.W.has W. h a s were judged clinically to have a psychiatric ule. Initial doses were 5 mg/day aripipra- received grants from Bristol-Myers disorder (e.g. mania, depression, attention- zole; after 1 week, the dose was scheduled Squibb,Janssen, and Eli Lilly. deficit hyperactivity disorder) which could for increase to 10 mg/day and after 2 weeks account for the symptoms; (c) they pre- to 15 mg/day, unless adverse effects dic- sented with symptoms occurring primarily tated a slower titration schedule. After the as sequelae to drug or alcohol use; (d) alco- third week, the dose could be increased hol or drug misuse or dependence in the further to 20 mg/day and if needed to s96 Downloaded from https://www.cambridge.org/core. 29 Sep 2021 at 17:08:56, subject to the Cambridge Core terms of use. ARIPIPRAZOLE FOR THE PSYCHOSIS PRODROME 30 mg/day should the person not be re- forms for verbal memory; and the Wiscon- there are a dearth of age-specific normative sponding. Aripiprazole was prescribed as sin Card Sort Test (WCST; Heaton et aletal,, data (our sample with test–retest data has a a single daily dose unless there was a reason 1993), semantic (category) fluency, and mean age of 15.5 years, s.d.¼1.3), baseline to divide the dose. The number of milli- Controlled Oral Word Association (FAS; data (Table 3) suggest mild neuropsycho- grams prescribed and the number taken Spreen & Benton, 1969) test of phonemic logical impairment similar to that observed were recorded each day; these data were fluency for executive functioning. in our previous prodromal sample (Hawkins used to calculate the percentage adherence Abnormal involuntary movements and et aletal, 2004,2004aa). A higher mean AVLT total since the previous visit. Drowsiness was EPS were assessed by observation and ad- score was reported for a younger sample managed initially by switching the timing ministration of the Simpson–Angus Scale by Spreen & Strauss (1998) and substan- of the daily dose to bedtime or by dividing (SAS; Simpson & Angus, 1970), the Barnes tially better Trail-Making Part A and Part the dose. Insomnia was managed initially Akathisia Scale (BAS; Barnes, 1989), and B performances were reported for a healthy by switching the timing of the daily dose the Abnormal Involuntary Movement Scale sample aged 15–17 years by Fromm-Auch to early morning. Lorazepam was used to (AIMS; Branch, 1975). Safety was also & Yeudall (1983). treat insomnia or agitation. Lorazepam or assessed by analysing treatment-emergent Thirteen participants completed the 8- the anticholinergic benztropine was per- adverse events (Systematic Assessment For week study (87%). Of the two drop-outs, mitted for extrapyramidal symptoms Treatment-Emergent Events, SAFTEE, spe- one completed 48 days on aripiprazole (EPS). Participants continued doses of anti- cific inquiry method; Levine & Schooler, and dropped out because of improvement, depressant, mood stabiliser, or stimulant 1986), vital signs and weight. Treatment- feeling medication was no longer needed. medication prescribed before consent but emergent adverse events were defined as The other completed only 8 days on medi- were not permitted to begin or increase do- those first occurring or worsening after cation and left the study primarily because sage of these medications after consent. baseline. All of the above measures were of sedation after the first 10 mg dose, after Individual and family psychosocial inter- assessed at baseline and weekly thereafter. having concluded that 5 mg was ineffective ventions with supportive and psychoeduca- after the first week. tional components were available to each Statistical analyses participant. Medication For the present report, the time frame was the first 8 weeks after beginning study Prescribed mean (s.d.) aripiprazole doses at Assessments medication, and the principal outcome weeks 1, 2, 3, 4, 5, 6, 7 and 8 were 5 (0), 9 (2), 11 (5), 11 (7), 11 (6), 13 (6), 14 (8), and The primary efficacy measure for the analy- measure was the SOPS total score. Analyses 15 (7) mg/day, respectively. Final pre- sis of acute treatment was change over time were based on the intent-to-treat (ITT) scribed doses were 5 mg/day (nn¼1 parti-1parti- in the total score of the Scale of Prodromal principle. All participants were included in cipant), 10 mg/day (nn¼3), 15 mg/day Symptoms (SOPS; Miller et aletal, 1999), a 19- the analysis. The principal outcome mea- (s.d.(s.d.¼7) (7)(nn¼6), 20 mg/day (nn¼4) and4)and item scale with items scored 0–6. The inter- sure was addressed using a mixed-effects 30 mg/day (nn¼1). Reported mean (s.d.) per- rater reliability has been excellent (Miller etet likelihood-based repeated measures linear centage adherence with prescribed aripipra- alal, 2003,2003aa). Factor analysis supports the val- model (MMRM, as implemented in SAS zole doses was 94 (13), 92 (22), 98 (4), 96 idity of the SOPS sub-scales (Hawkins etet PROC MIXED) on post-baseline change (8), 97 (7), 95 (10), 98 (5), and 94 (9) at alal, 2004,2004bb). Treatment response was defined scores, using baseline scores as a covariate.
Load more

Recommended publications
  • World Journal of Psychiatry
    World Journal of W J P Psychiatry Submit a Manuscript: http://www.wjgnet.com/esps/ World J Psychiatr 2014 December 22; 4(4): 112-119 Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx ISSN 2220-3206 (online) DOI: 10.5498/wjp.v4.i4.112 © 2014 Baishideng Publishing Group Inc. All rights reserved. REVIEW Eating disorders and psychosis: Seven hypotheses Mary V Seeman Mary V Seeman, Department of Psychiatry, University of To- to the different individual ways in which these two ronto, Toronto, Ontario M5S 1A8, Canada disparate conditions often overlap. Author contributions: The author is solely responsible for this work. © 2014 Baishideng Publishing Group Inc. All rights reserved. Correspondence to: Mary V Seeman, MD, Professor, De- partment of Psychiatry, University of Toronto, Medical Sciences Key words: Psychosis; Anorexia; Bulimia; Eating disorder; Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Comorbidity Canada. [email protected] Telephone: +1-416-9468286 Fax: +1-416-9712253 Core tip: Eating disorder symptoms and psychotic Received: July 16, 2014 symptoms may co-exist and may serve individual Peer-review started: July 16, 2014 psychological purposes. When planning treatment, the First decision: August 28, 2014 whole person needs to be kept in mind, lest curing one Revised: September 16, 2014 symptom exacerbates another. Effective treatment Accepted: September 18, 2014 requires attention to overlapping dimensions of illness. Article in press: September 19, 2014 Published online: December 22, 2014 Seeman MV. Eating disorders and psychosis: Seven hypotheses. World J Psychiatr 2014; 4(4): 112-119 Available from: URL: http://www.wjgnet.com/2220-3206/full/v4/i4/112.htm DOI: Abstract http://dx.doi.org/10.5498/wjp.v4.i4.112 Psychotic disorders and eating disorders sometimes occur in the same person, and sometimes, but not always, at the same time.
    [Show full text]
  • The Bipolar Prodrome Symptom Interview and Scale-Prospective
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Hofstra Northwell Academic Works (Hofstra Northwell School of Medicine) Donald and Barbara Zucker School of Medicine Journal Articles Academic Works 2014 The iB polar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls C. U. Correll Hofstra Northwell School of Medicine D. M. Olvet Northwell Health A. M. Auther Hofstra Northwell School of Medicine M. Hauser Hofstra Northwell School of Medicine T. Kishimoto Hofstra Northwell School of Medicine See next page for additional authors Follow this and additional works at: https://academicworks.medicine.hofstra.edu/articles Part of the Psychiatry Commons Recommended Citation Correll CU, Olvet D, Auther AM, Hauser M, Kishimoto T, Carrion R, Snyder S, Cornblatt BA. The ipoB lar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. 2014 Jan 01; 16(5):Article 996 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/articles/996. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. Authors C. U. Correll, D. M. Olvet, A. M. Auther, M. Hauser, T. Kishimoto, R. Carrion, S. Snyder, and B. A. Cornblatt This article is available at Donald and Barbara Zucker School of Medicine Academic Works: https://academicworks.medicine.hofstra.edu/articles/996 NIH Public Access Author Manuscript Bipolar Disord.
    [Show full text]
  • Herpes: a Patient's Guide
    Herpes: A Patient’s Guide Herpes: A Patient’s Guide Introduction Herpes is a very common infection that is passed through HSV-1 and HSV-2: what’s in a name? ....................................................................3 skin-to-skin contact. Canadian studies have estimated that up to 89% of Canadians have been exposed to herpes simplex Herpes symptoms .........................................................................................................4 type 1 (HSV-1), which usually shows up as cold sores on the Herpes transmission: how do you get herpes? ................................................6 mouth. In a British Columbia study, about 15% of people tested positive for herpes simplex type 2 (HSV-2), which Herpes testing: when is it useful? ..........................................................................8 is the type of herpes most commonly thought of as genital herpes. Recently, HSV-1 has been showing up more and Herpes treatment: managing your symptoms ...................................................10 more on the genitals. Some people can have both types of What does herpes mean to you: receiving a new diagnosis ......................12 herpes. Most people have such minor symptoms that they don’t even know they have herpes. What does herpes mean to you: accepting your diagnosis ........................14 While herpes is very common, it also carries a lot of stigma. What does herpes mean to you: dating with herpes ....................................16 This stigma can lead to anxiety, fear and misinformation
    [Show full text]
  • Disparities in Eating Disorder Diagnosis and Treatment According to Weight Status, Race/Ethnicity, Socioeconomic Background, and Sex Among College Students
    Received: 19 September 2017 | Revised: 5 February 2018 | Accepted: 6 February 2018 DOI: 10.1002/eat.22846 ORIGINAL ARTICLE Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students K. R. Sonneville ScD, RD1 | S. K. Lipson PhD2 1Department of Nutritional Sciences, University of Michigan School of Public Abstract Health, Ann Arbor, Michigan Objective: Eating disorders (EDs) present a significant threat to the health of adolescents and 2 Department of Health Management and young adults, yet remain under-diagnosed and under-treated at a population-level. EDs have Policy, University of Michigan School of “ ” Public Health, Ann Arbor, Michigan historically been thought to afflict skinny, white, affluent girls (the SWAG stereotype). As such, higher-weight individuals, racial/ethnic minorities, those from socioeconomically disadvantaged Correspondence backgrounds, and males may not recognize their need for treatment, may not be properly screened Kendrin Sonneville, Assistant Professor, for EDs, and/or may not be referred to treatment. University of Michigan, School of Public Health, Ann Arbor, MI. Method: Using large-scale survey data from the healthy bodies study, we examined variations Email: [email protected] in prevalence of perceived need for ED treatment, ED diagnosis, past-year ED treatment, and treatment barriers according to weight status, race, socioeconomic background, and sex among undergraduate and graduate students with symptoms of an ED (N 5 1,747). Results: Among students with symptoms of an ED, 30.7% perceived a need for treatment, 10.5% had received a diagnosis, and 13.6% had received treatment in the past year.
    [Show full text]
  • PRODROMAL SYMPTOMS of RECURRENT MAJOR DEPRESSIVE EPISODES: a Qualitative Analysis
    Arriericun Jouniul o/Orthop.vychiutty,6-(2). April IYY7 PRODROMAL SYMPTOMS OF RECURRENT MAJOR DEPRESSIVE EPISODES: A Qualitative Analysis Bonnie M. Hagerty, Ph.D., R.N., Reg A Williams, Ph.D., R.N., Michelle Liken, M.S., R.N. In four focus groups, I6 people with major depressive or bipolar disorder were asked to describe the onset of an acute depressive episode. Findings indicate that those entering a major depressive episode often have diflculty identihing pro- dromal symptoms, although they experience early warning phases. These phases and described, and implications for clinical intervention are outlined. pisodes of major depression, whether terns can be identified early as prodromes E as a component of major depressive of reemerging depression, it may be possi- disorder or a bipolar disorder, are now rec- ble to intervene so as to prevent or mini- ognized as a public-health problem causing mize the episode. Thus, the purpose of this untold personal suffering and socioeco- qualitative study was to explore the experi- nomic costs. These episodes are recurrent ence of individuals in the prodromal phase for most individuals with bipolar disorder of recurrent MDE. and for 50%85% of those with major de- The prodromal stage of an illness is usu- pressive disorder (MDD) (Consensus De- ally considered a time period during which velopment Panel, 198.5)).Clinicians treat signs and symptoms of a particular disorder more patients for recurrent than first-time begin to be manifested. These early indica- episodes (Thase, 1992). Recurrence is asso- tions may be quantitatively or qualitatively ciated with increased severity of episodes, different than symptoms evident during the increased duration of episodes, and shorter acute stage of the illness.
    [Show full text]
  • Early Identification of Psychosis a Primer
    Early Identification of Psychosis A Primer Mental Health Evaluation & Community Consultation Unit TABLE OF CONTENTS Introduction...............................................................................................................3 Psychosis and Early Intervention........................................................................4 Why is Early Intervention Needed?...................................................................5 Risk and Onset..........................................................................................................6 Course of First-Episode Psychosis 1. Prodrome........................................................................................................7 2. Acute Phase....................................................................................................8 3. Recovery Phase..............................................................................................9 Summary of First-Episode Psychosis...............................................................11 Tips for Helpers......................................................................................................12 More Resources......................................................................................................15 Acknowledgements...............................................................................................16 2 INTRODUCTION Psychosis is a condition characterized by loss of contact with reality and may involve severe disturbances in perception, cognition, behavior,
    [Show full text]
  • Clinical Characteristic of Prodromal Symptoms Between Bipolar I and II Disorder Among Chinese Patients
    Zhao et al. BMC Psychiatry (2021) 21:275 https://doi.org/10.1186/s12888-021-03295-y RESEARCH Open Access Clinical characteristic of prodromal symptoms between bipolar I and II disorder among Chinese patients: a retrospective study Qian Zhao1,2†, Tong Guo1†, Yang Li1†, Lei Zhang1, Nan Lyu1, Amanda Wilson3, Xuequan Zhu1,2 and Xiaohong Li1* Abstract Background: This study aimed to identify the clinical characteristic of prodromal symptoms in Chinese patients with bipolar disorder (BD), prior to the first affective episode. It further aimed to characterize the prodromal traits between bipolar disorder type I (BD-I) and type II (BD-II). Methods: 120 individuals with BD-I (n = 92) and BD- II (n = 28) were recruited to the study. Semi-structured interviews were then administered to evaluate prodromal symptoms in patients, within 3 years of BD onset, by using the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R). Results: In the prodromal phase of the first depressive episode, patients with BD-II experienced more prodromal symptoms (p = 0.0028) compared to BD-I. Additionally, more frequent predictors were reported in patients with BD- II than BD-I including educational and occupational dysfunction (p = 0.0023), social isolation (p < 0.001), difficulty making decisions (p = 0.0012), oppositionality (p = 0.012), and suspiciousness/persecutory ideas (p = 0.017). There were also differences in the duration of the precursors. The duration of “weight loss or decrease in appetite” (p = 0.016) lasted longer in patients with BD-I, while “obsessions and compulsions” (p = 0.023) started earlier in patients with BD-II and occurred during the pre-depressive period.
    [Show full text]
  • Identifying and Treating the Prodromal Phases of Bipolar Disorder and Schizophrenia
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Curr Treat Manuscript Author Options Psychiatry Manuscript Author . Author manuscript; available in PMC 2019 March 01. Published in final edited form as: Curr Treat Options Psychiatry. 2018 March ; 5(1): 113–128. doi:10.1007/s40501-018-0138-0. Identifying and treating the prodromal phases of bipolar disorder and schizophrenia Susan Conroy, MD PhD1, Michael Francis, MD1, and Leslie A. Hulvershorn, MD, MSc1 1Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA Abstract Purpose of review—The goal of this paper is to review recent research on the identification and treatment of prodromal periods that precede bipolar and psychotic disorders. We also sought to provide information about current best clinical practices for prodromal youth. Recent findings—Research in the areas of identifying prodromal periods has rapidly advanced. Calculators that can predict risk are now available for use during both bipolar and psychotic disorder prodromes. Cognitive behavior therapies have emerged as the gold standard psychosocial interventions for the psychosis prodrome, while several other types of therapies hold promise for treatment during the bipolar prodrome. Due to safety and efficacy concerns, pharmacologic treatments are not currently recommended during either prodromal period. Summary—While additional research is needed to develop useful clinical tools to screen and diagnose during prodromal phases, existing literature has identified constellations of symptoms that can be reliably identified in research settings. Specialized psychotherapies are currently recommended to treat prodromal symptoms in clinical settings. They may also be useful to curtail future episodes, although further research is needed. Keywords bipolar disorder; schizophrenia; psychosis prodrome Introduction Diagnoses of schizophrenia and bipolar disorder are both preceded by a prodromal period, typically lasting months or years, in which sub-syndromal symptoms begin to manifest [1, 2].
    [Show full text]
  • Exploring the Prodrome to Psychosis Through Cognitive and Dialogic Theoretical Lenses : a Project Based Upon an Independent Investigation
    Smith ScholarWorks Theses, Dissertations, and Projects 2010 "Ultra-high risk" : exploring the prodrome to psychosis through cognitive and dialogic theoretical lenses : a project based upon an independent investigation Clare Bullock Boyd Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Boyd, Clare Bullock, ""Ultra-high risk" : exploring the prodrome to psychosis through cognitive and dialogic theoretical lenses : a project based upon an independent investigation" (2010). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1116 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Clare Bullock Boyd “Ultra-High Risk”: Exploring the Prodrome to Psychosis through Cognitive and Dialogic Theoretical Lenses ABSTRACT This study is a theoretical exploration of the clinical phenomenon known as the prodrome to schizophrenia. The prodrome refers to a constellation of clinical symptoms that signal considerably high risk for the development of psychosis and/or schizophrenia. The prodrome is an area of high research interest, as the potential for early intervention with prodromal individuals to prevent or delay the onset of psychosis appears to be possible. The clinical phenomena of the prodrome were explored, including a comprehensive review of the relevant literature and research. Case material is also presented. The prodrome is then conceptualized with a cognitive theoretical framework, including a discussion of research interventions using a cognitive or cognitive-behavioral approach and application to the case material with a cognitive theoretical perspective.
    [Show full text]
  • Prodrome Or Risk Syndrome: What’S in a Name? Pierre Alexis Geoffroy1,2 and Jan Scott3*
    Geoffroy and Scott Int J Bipolar Disord (2017) 5:7 DOI 10.1186/s40345-017-0077-5 SHORT COMMUNICATION Open Access Prodrome or risk syndrome: what’s in a name? Pierre Alexis Geoffroy1,2 and Jan Scott3* Abstract Background: In the last decade, an increasing number of publications have examined the precursors of bipolar disorders (BD) and attempted to clarify the early origins and illness trajectory. This is a complex task as the evolu- tion of BD often shows greater heterogeneity than psychosis, and the first onset episode of BD may be dominated by depressive or manic features or both. To date, most of the published reviews have not clarified whether they are focused on prodromes, risk syndromes or addressing both phenomena. To assist in the interpretation of the findings from previous reviews and independent studies, this paper examines two concepts deemed critical to understanding the pre-onset phase of any mental disorder: prodromes and risk syndromes. The utility of these concepts to studies of the evolution of bipolar disorder (BD) is explored. Findings: The term “prodrome” is commonly used to describe the symptoms and signs that precede episode onset. If strictly defined, the term should only be applied retrospectively as it refers to cohorts of cases that all progress to meet diagnostic criteria for a specific disorder and gives insights into equifinality. Whilst prodromes may reliably predict individual relapses, the findings cannot necessarily be extrapolated to identify prospectively who will develop a first episode of a specific disorder from within a given population. In contrast, ‘risk syndrome’ is a term that encom- passes sub-threshold symptom clusters, but has often been extended to include other putative risk factors such as family history, or other variables expressed continuously in the population, such as personality traits.
    [Show full text]
  • Psychotic Prodrome: Are Antipsychotics Effective? Ethical? Evidence Is Mixed but Risk Is High When Abnormal Cognition Falls Short of Schizophrenia
    Psychotic prodrome: Are antipsychotics effective? Ethical? Evidence is mixed but risk is high when abnormal cognition falls short of schizophrenia Meera Narasimhan, MD Director, psychopharmacology division Associate professor of clinical psychiatry Department of neuropsychiatry and behavioral sciences University of South Carolina School of Medicine Columbia Peter F. Buckley, MD Chairman and professor Department of psychiatry and behavioral health Medical College of Georgia, Augusta ecause 40% of individuals with a psy- B chotic prodrome develop schizophrenia, detecting and preventing this transition could improve many patients’ lives. Unfortunately: • psychotic prodrome lacks clear-cut symp- toms and is difficult to identify • little evidence exists to help clinicians select psychotropics and decide how long to use them • treating all prodromal patients would expose those who never develop psychosis to the risk of psychotropics’ side effects. How, then, can psychiatrists help patients who present with possible prodromal symptoms? Based on research and our experience, this article describes the psychotic prodrome and offers a © Marc Bruce / Images.com 32 Current VOL. 4, NO. 3 / MARCH 2005 p SYCHIATRY Current p SYCHIATRY pragmatic, evidence-based approach to Box 1 diagnosis and treatment. Neuroimaging detects brain changes during psychotic prodrome WHAT CAUSES PSYCHOTIC CONVERSION? Reduced gray matter volumes in certain educed gray matter volumes in certain brain brain regions may be associated with con- Rregions may be associated with conversion to version to psychosis (Box 1). Stress also may psychosis. Imaging studies have found medial play a role; elevated stress-reactive cortisol temporal lobe changes—specifically, hippocampal volume alterations—in persons with schizophrenia, levels are associated with positive symptom genetic high-risk groups, and those thought to be at 1 severity in the prodrome.
    [Show full text]
  • Detecting the Psychosis Prodrome Across High-Risk Populations Using Neuroanatomical Biomarkers
    Schizophrenia Bulletin vol. 41 no. 2 pp. 471–482, 2015 doi:10.1093/schbul/sbu078 Advance Access publication June 9, 2014 Detecting the Psychosis Prodrome Across High-Risk Populations Using Neuroanatomical Biomarkers Nikolaos Koutsouleris*,1, Anita Riecher-Rössler2,4, Eva M. Meisenzahl1, Renata Smieskova2, Erich Studerus2, Lana Kambeitz-Ilankovic1, Sebastian von Saldern1, Carlos Cabral1, Maximilian Reiser3, Peter Falkai1, and Stefan Borgwardt2 1Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; 2Department of Psychiatry, University of Basel, Basel, Switzerland; 3Department of Radiology, Ludwig-Maximilian-University, Munich, Germany 4This author contributed equally to this article. *To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstr. 7, 80336 Munich, Germany; tel: +49-89-4400-55885, fax: +49-89-4400-55776, e-mail: [email protected] To date, the MRI-based individualized prediction of psy- Key words: neuroanatomical biomarker/individualized chosis has only been demonstrated in single-site studies. It risk stratification/cross-center/machine learning remains unclear if MRI biomarkers generalize across dif- ferent centers and MR scanners and represent accurate sur- Introduction rogates of the risk for developing this devastating illness. Therefore, we assessed whether a MRI-based prediction Two decades of early recognition research revealed system identified patients with a later disease transition that patterns of subtle prodromal symptoms allow per- among 73 clinically defined high-risk persons recruited at sons with at-risk mental states (ARMS) for psychoses two different early recognition centers. Prognostic per- to be reliably identified using clinical high-risk criteria. formance was measured using cross-validation, indepen- Compared to the general population, these persons have dent test validation, and Kaplan-Meier survival analysis.
    [Show full text]