The HELPER programme: HEalthy Living and Prevention of Early Relapse – three exploratory randomised controlled trials of phase-specific interventions in first-episode psychosis.

Marshall M, Barrowclough C, Drake R, Husain N, Lobban F, Lovell K, Wearden A, Bradshaw T, Day C, Fitzsimmons M, Pedley R, Piccuci R, Picken A, Larkin W, Tomenson B, Warburton J, Gregg L.

Programme Grants for Applied Research; Vol. 3, No. 2.

Schizophrenia represents a substantial cost to the NHS and society because it is common (lifetime prevalence around 0.5–1%); it begins in adolescence or early adulthood and often causes lifelong impairment. The first 3 years are a ‘critical period’ in which the course of the illness is determined. Hence under the NHS Plan, specialist early intervention in psychosis services were established to care for people who develop psychosis between the ages of 14 and 35 years for the first 3 years of their illness. However, there has been a lack of evidence-based treatments specifically designed for the early years. This is important because emerging evidence has shown that in the critical period it is vital to avoid relapse and prevent deterioration in physical health, as both can drastically reduce the chances of a full recovery….

Congratulations to Prof Max Marshall, Mike Fitzsimmons and Warren Larkin of LCFT on the publication of this new research.

Click here to access the full text paper.

Advertisements

Psychosis and schizophrenia in adults

NICE, February 2015

 NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

This quality standard covers the treatment and management of psychosis and schizophrenia (including related psychotic disorders such as schizoaffective disorder, schizophreniform disorder and delusional disorder) in adults (18 years and older) with onset before the age of 60 years in primary, secondary and community care. It will not cover adults with transient psychotic symptoms.

Click here to view the guidance.

Association between serum lipids and membrane fatty acids and clinical characteristics in patients with schizophrenia

Acta Psychiatrica Scandinavica, 16 January 2015

Objective:
Earlier reports indicate that patients with schizophrenia have altered lipid levels in serum and cell membranes. The purpose of this study was to determine the relationship between clinical characteristics and serum and membrane lipids.
Method:
Fifty-five patients with schizophrenia and 51 healthy controls were included. The patients were characterized with Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF). Serum lipids [high- and low-density lipoprotein cholesterol (HDL, LDL) and triglyceride (TG)] and erythrocyte polyunsaturated fatty acids (PUFA) were measured.
Results:
Among the participants with schizophrenia, there was a significant correlation between serum triglyceride levels and PANSS-positive symptoms (r = 0.28, P = 0.04), GAF-S (r = −0.48, P = 0.001) and GAF-F (r = −0.32, P = 0.01), and between HDL level and GAF-S (r = 0.37, P = 0.008) and GAF-F (r = 0.28, P = 0.04). Long-chain PUFA were significantly associated with PANSS-negative symptoms (r = 0.52, P < 0.001), GAF-S (r = −0.32, P = 0.02), and GAF-F (r = −0.29, P = 0.04). The patients with schizophrenia had significantly higher TG (P < 0.001) and lower HDL (P < 0.001) levels than healthy controls. HDL was also lower in the subgroup (n = 11) not receiving antipsychotic medication (P = 0.02).
Conclusion:
The results suggest associations between lipid profile and clinical characteristics. This may indicate a role for lipid biology in schizophrenia pathophysiology.

Please contact the Library if you would like a copy of this article.

Second-generation antipsychotic effect on cognition in patients with schizophrenia—a meta-analysis of randomized clinical trials

Acta Psychiatrica Scandinavica, 16 January 2015

Objective:
To investigate the effect of second-generation antipsychotics on cognitive function in patients diagnosed with schizophrenia or schizoaffective disorder.

Method:
Multiple-treatments meta-analysis model.

Results:
On cognitive composite score, sertindole was superior to clozapine, effect size (ES) 0.87; 95% CI: 0.12–1.63, quetiapine, ES 0.75; 95% CI: 0.00–1.49, and first-generation antipsychotics (FGAs), ES 0.89; 95% CI: 0.14–1.64. Analyses on each cognitive domain showed clozapine, ES 0.37; 95% CI: 0.00–0.74, olanzapine, ES 0.31; 95%CI: 0.02–0.59, quetiapine, ES 0.34; 95% CI: 0.03–0.64, and FGAs, ES 0.51; 95% CI: 0.18–0.83 performing poorer on verbal working memory than ziprasidone, as well as FGAs performing poorer than risperidone, ES 0.31; 95% CI: 0.04–0.58. On executive function, sertindole performed better than clozapine, ES 0.82; 95% CI: 0.06–1.58, olanzapine, ES 0.81; 95% CI: 0.07–1.55, quetiapine, ES 0.76; 95% CI: 0.02–1.51, ziprasidone, ES 0.90; 95% CI: 0.14–1.67, and FGAs, ES 0.83; 95% CI: 0.08–1.58. On processing speed, FGAs performed poorer than sertindole, ES 0.97; 95% CI: 0.02–1.91, and quetiapine, ES 0.36; 95% CI: 0.01–0.72. On long-term verbal working memory, clozapine performed poorer than olanzapine, ES 0.41; 95% CI: 0.06–0.76. On verbal fluency, FGAs performed poorer than olanzapine, ES 0.26; 95% CI: 0.01–0.50, and clozapine, ES 0.44; 95% CI: 0.06–0.81. Lastly, FGAs, ES 0.41; 95% CI: 0.04–0.78, and clozapine, ES 0.44; 95% CI: 0.05–0.83, performed poorer on visuospatial skill compared to olanzapine.

Conclusion:
The meta-analysis was able to detect some trends in the data analyzed, but did not show any drug having a uniform positive cognitive profile.

Please contact the Library if you would like a copy of this paper.

Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help

The British Psychological Society, 27 November 2014

The British Psychological Society’s Division of Clinical Psychology have published a report challenging received wisdom about the nature of mental illness. 

‘Understanding Psychosis and Schizophrenia: Why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’ has been written by a group of eminent clinical psychologists drawn from eight universities and six NHS trusts, together with people who have themselves experienced psychosis. 

It provides an accessible overview of the current state of knowledge, and its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services. 

Click here to download the full report.

Click here to read the press release and for further information.