Early medication discontinuation on long-term recovery outcome in first-episode psychosis- to the editor

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Rate and predictors of disengagement from a 2-year early intervention program for psychosis in Hong Kong

Objectives: This study aims to examine the prevalence and predictors of disengagement in a longitudinal cohort of first-episode psychosis (FEP) patients. Methods: Seven hundred FEP patients aged 15 to 25 enrolled into the Early Assessment Service for Young People with Psychosis (EASY) from 2001 to 2003 were recruited into the study. Data on sociodemographics, clinical characteristics, baseline symptoms and functioning and medication adherence were collected. Rate and predictors of service disengagement were the outcomes of interest. Predictors were examined using Cox proportional hazards model. Results: Ninety four patients (13%) were disengaged from the EASY program. Fewer negative symptoms at initial presentation, a diagnosis other than schizophrenia-spectrum disorder and poorer medication compliance in the first month of treatment were significant predictors of disengagement from service. Conclusions: Early intervention teams should pay attention to factors associated with disengagement, and monitor at risk patients closely to detect signs of non-adherence. © 2014 Elsevier B.V.link_to_subscribed_fulltex

Coupling physical exercise with dietary glucose supplement for treating cognitive impairment in schizophrenia: A theoretical model and future directions

Aims: Metabolic dysregulation may disrupt the complex neuroprotective mechanisms essential for brain health. Recent studies have pointed out the possible aetiological role of metabolic dysregulation in the onset of schizophrenia and the associated cognitive impairment. In this paper, we aimed to generate a theoretical model of how a combination of physical exercise and dietary glucose supplement may help to alleviate cognitive impairment in schizophrenia. Methods: Literature on metabolic dysregulation, especially insulin resistance, in relation to the onset of schizophrenia and the associated cognitive impairment is reviewed. The cognitive enhancement effects of physical exercise and dietary glucose supplement are then summarised. Finally, we propose a theoretical model based on the concerted effects of physical exercise and glucose supplement. Results: In general, the joint action of physical exercise and dietary glucose supplement could up-regulate glucose and insulin transport into the brain, as well as augmenting the release of insulin growth factor-1 and brain-derived neurotrophic factor. Physical exercise and glucose supplement could enhance energy supply and neuroplasticity in brain, subsequently leading to potential cognitive enhancement in schizophrenia. However, glucose supplement is not suitable for patients with abnormal metabolic profile. Conclusions: The combination of physical exercise and glucose supplement has potential therapeutic values in treating cognitive impairment in schizophrenia. Further research is necessary to investigate the optimal patterns of exercise and doses of glucose for treating cognitive impairment in schizophrenia. © 2013 Wiley Publishing Asia Pty Ltd.link_to_subscribed_fulltex

Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: A prospective three-year follow-up study

Background: Diminished expression (DE) is a core sub-domain of negative symptoms construct in schizophrenia. There is limited, yet inconsistent data regarding DE and its associations with cognition, particularly in the early illness course. This study aimed to examine cross-sectional and longitudinal relationships of DE with cognitive functions in first-episode schizophrenia utilizing a prospective design. Method: Ninety-three Hong Kong Chinese aged 18 to 55. years presenting with first-episode schizophrenia-spectrum disorder were studied. Severity of DE was measured as sum of individual item scores indicative of affect flattening and alogia. Symptom evaluation was conducted at intake, after clinical stabilization of first psychotic episode, at 12, 24 and 36. months. Cognitive functions were evaluated at clinical stabilization, 12, 24 and 36. months. Results: DE was significantly correlated with various cognitive functions in successive follow-up assessments. Regression analyses adjusting confounding effects of sex, pre-morbid adjustment, duration of untreated psychosis and chlorpromazine equivalents showed that DE was associated with performance on verbal fluency at 12 (p. <. 0.01) and 24. months (p. <. 0.05), visual reproduction at 24 (p. <. 0.05) and 36. months (p. <. 0.01), logical memory at 36. months (p. <. 0.05) and Modified Wisconsin Card Sorting test at 24 (p. <. 0.05) and 36. months (p. <. 0.05). Neither cross-lagged associations between DE and cognition nor significant correlations between changes in these two domains over three years were observed. Conclusions: DE and cognitive functions were correlated concurrently but no longitudinal associations between these two domains could be demonstrated. Our findings indicated that DE and cognitive impairment represented relatively independent domains of the illness with potentially distinctive therapeutic implications. © 2013 Elsevier B.V.link_to_subscribed_fulltex

Sexual dysfunction in Chinese patients with first-episode psychosis: Prevalence, clinical correlates and functioning

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The relationships of suicidal ideation with symptoms, neurocognitive function, and psychological factors in patients with first-episode psychosis

Background: Individuals with first-episode psychosis (FEP) have markedly elevated risk for suicide. Previous research on suicidality in early psychosis mainly focused on attempted and completed suicide. Data regarding risk factors for suicidal ideation, which is a common antecedent and predictor of suicide attempt, were limited. This study aimed to examine the prevalence of suicidal ideation and its relationships with clinical, neurocognitive and psychological factors in FEP patients. Method: Eighty-nine Chinese patients aged 15 to 25. years presenting with FEP to specialized early intervention service were recruited. A comprehensive set of assessments examining pre-treatment illness characteristics, symptom severity, neurocognitive function, and psychological factors were administered. Current suicidal ideation and history of suicide attempt were systematically evaluated. Results: Approximately 42% of patients expressed suicidal ideation after service entry. Univariate regression analyses found that suicidal ideation was significantly associated with past suicide attempt, depressive symptoms, emotion expressivity, hopelessness, future expectation, attentional impulsiveness, internal and external locus of control, and the likelihood of endorsing fear of social approval and survival and coping beliefs as reasons for living. Final multivariate model showed that previous suicide attempt, depression, less severe diminished expression, greater degree of hopelessness and lower level of internal locus of control independently predicted suicidal ideation. Conclusions: Suicidal ideation was prevalent in FEP patients. Our findings implied that close monitoring and prompt intervention of those potentially modifiable risk factors for suicidal ideation including depression, hopelessness and perceived inadequate personal control may reduce suicide risk in the early course of psychotic illness. © 2014 Elsevier B.V.link_to_subscribed_fulltex

Perceived risk of relapse and role of medication: comparison between patients with psychosis and their caregivers

Purpose Studies have suggested that appraisal of relapse risk and knowledge of medications in relapse prevention may shape one's reactions towards an illness and treatment, and influence the illness outcome. The aim of this study is to explore patients' and caregivers' knowledge of medications, perceived chances of relapse and its predictors, as well as their relations with medication adherence. Methods Eighty patient-caregiver dyads participated in the study. Their knowledge about psychosis, specific knowledge about medications and course of illness of their own and their relatives, medication adherence and symptomatology of patients were assessed. Differences in knowledge between patients and caregivers were compared. The link between adherence with perceived relapse risk and consequences of stopping medication were explored. Multinomial regression analyses were performed to examine predictors of perceived relapse risk. Results More patients underestimated their chance of relapse and were unaware that stopping medication may lead to relapse. The lack of understanding about the effect of stopping medication of both caregivers and patients was related to poor medication adherence of patients. Patients perceived of having higher chance of relapse had more severe positive symptoms. Positive symptoms of patients and greater knowledge about psychosis of caregivers were related to higher caregivers' perceived relapse risk of their relative. Conclusions This study explored the views of patients and their caregivers on the perceived risk of relapse and role of medication in preventing relapse, and the potential significance. Specific interventions addressing these areas should be considered in developing relapse prevention programs. © 2014 Springer-Verlag Berlin Heidelberg.link_to_subscribed_fulltex

Impact of physical activity on functioning of patients with first-episode psychosis - A 6months prospective longitudinal study

There has been increasing interest in studying the impact of physical activity on the psychological and physical well-being and functioning in patients with first-episode psychosis. The exploration of factors which contribute to physical activity in psychosis may open up opportunities for improvement of functional outcome. The purpose of this study was to examine the association between physical activity level and functioning in psychosis. A total of 283 patients with first-episode psychosis were recruited from a specialized early intervention service for adult-onset psychosis (Jockey Club Early Psychosis Project) in Hong Kong. The level of physical activity, sociodemographics and clinical characteristics was assessed at study entry. Functioning was assessed at 6-months period. Ninety-six (33.9%) patients were categorized as physically inactive, and 187 (66.1%) of them were physically active. Being physically inactive (β = 0.163, P= 0.003), having more positive and negative symptoms [SAPS total score (β = -0.161, P= 0.005), and SANS total score (β = -0.202, P = 0.001)], and having lower household income (β = 0.207, P= 0.001) at baseline predicted poorer functioning at 6. months. Early intervention for psychosis should target to improve patients' physical activity level which may help subsequent functioning. © 2013 Elsevier B.V.link_to_subscribed_fulltex

The concurrent and predictive validity of symptomatic remission criteria in first-episode schizophrenia

Background: Since the introduction of consensus criteria for symptomatic remission in 2005, most first-episode studies focused on cross-sectional relationship between remission status and functional outcome. Predictive validity of the proposed remission definition was under-studied. Relationship of remission with subjective quality of life (QoL) was inadequately addressed with inconsistent findings being observed. Method: One hundred and four Hong Kong Chinese aged 18 to 55. years presenting with first-episode schizophrenia-spectrum disorder were studied. Socio-demographics, baseline clinical and functioning profiles were obtained. Psychopathological and functional reassessments were conducted at 6, 12 and 24. months. Subjective QoL was measured at 12 and 24. months. Symptomatic remission was operationally defined according to the consensus criteria developed by the Remission in Schizophrenia Working Group (RSWG), comprising both symptom-severity and 6-month duration components. Results: At 12. months, 59.6% of patients achieved symptomatic remission. Remitted patients had significantly lower symptom severity, more favorable psychosocial functioning and better subjective QoL at 12. months than non-remitted counterparts. Attainment of remission at 12. months was significantly associated with fewer positive, negative, depressive and disorganization symptoms, higher levels of functioning and subjective QoL at 24. months. Linear regression analysis indicated that remission status independently predicted functional outcome even when the effects of educational level, baseline functioning and negative symptom scores were controlled for. Conclusion: The operationally defined symptomatic remission formulated by the RSWG represented a clinically valid construct that was found to be closely related to both concurrent and longitudinal outcomes on psychopathology, functioning and subjective QoL in the early stage of schizophrenia. © 2012 Elsevier B.V.link_to_subscribed_fulltex